Hepatitis involves inflammation of the liver cells and damage to the liver. There are different types and causes of hepatitis, but the symptoms can be similar.
Viruses that primarily attack the liver are called hepatitis viruses. There are several types of hepatitis viruses including types A, B, C, D, and E.
Hepatitis infections can be prevented by avoiding exposure to viruses, and through injectable immunoglobulins, or by vaccines; however, vaccines are available for only hepatitis A and B.
This article covers the different types of hepatitis, including their causes, symptoms, diagnosis, treatments, and more.
What is Hepatitis?
Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.
Your liver is located in the right upper area of your abdomen. It performs many critical functions that affect metabolism throughout your body, including:
• Bile production, which is essential to digestion
• Filtering of toxins from your body
• Excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
• Breakdown of carbohydrates, fats, and proteins
• Activation of enzymes, which are specialized proteins essential to body functions
• Storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
• Synthesis of blood proteins, such as albumin
• Synthesis of clotting factors
When the liver is inflamed, it does not perform these functions well, which brings about many of the symptoms, signs, and problems associated with any type of hepatitis.
The 5 Types of Viral Hepatitis
Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.
Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.
Hepatitis A
Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.
Hepatitis B
Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
Hepatitis C
Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact.
Hepatitis D
Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B.
Hepatitis E
Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply.
Causes of Non - Infectious Hepatitis
Alcohol and Other Toxins
Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver.
Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.
Autoimmune System Response
In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.
Hepatitis A and E are acute (short-term) viral infections typically transmitted through food or water contaminated by fecal matter. The primary sources of the hepatitis A and E viruses are raw or undercooked food, food handled by people who have not properly washed their hands and water contaminated by animal or human waste.
Hepatitis B is spread through exposure to infected blood, through sexual contact with an infected person, or during childbirth, when the virus can be transmitted from mother to child.
Hepatitis C is mainly spread through contact with the blood of an infected person. Such contact can occur when people share needles to inject drugs. Less commonly, hepatitis C can spread through sex or childbirth.
Hepatitis D is also spread through contact with blood, but infections with this virus only occur when someone is also infected with hepatitis B. Injection drug users are at greatest risk for this type of hepatitis.
Risks for Viral Hepatitis
People who are most at risk for developing viral hepatitis are:
• Workers in the health care professions
• Asians and Pacific Islanders
• Sewage and water treatment workers
• People with multiple sexual partners
• Intravenous drug users
• HIV patients
• People with hemophilia who receive blood clotting factors
Symptoms
The period of time between exposure to hepatitis and the onset of the illness is called the incubation period. The incubation period varies depending on the specific hepatitis virus. Hepatitis A virus has an incubation period of about 15 to 45 days; Hepatitis B virus from 45 to 160 days, and Hepatitis C virus from about 2 weeks to 6 months.
Many people with hepatitis experience either mild or no symptoms. If symptoms do appear, they can do so 2 weeks to 6 months after infection. This applies to all types of hepatitis.
Acute Hepatitis
During the acute, or initial, phase of a hepatitis infection, a person might experience symptoms similar to those of mild flu, including:
• Fatigue
• Pale stools
• A loss of appetite and weight
• A fever
• Muscle or joint aches
• Nausea and vomiting
• Abdominal pain
• Jaundice, or a yellowing of the eyes
• Itchy skin
• Malaise, or a general feeling of being unwell
The acute phase is not usually dangerous, but chronic infection and severe liver complications can develop over time. These can take decades to appear.
Chronic Hepatitis
A person with chronic hepatitis may experience progressive liver failure, which can include the following symptoms:
• Jaundice
• Swelling of the lower extremities
• Confusion
• Blood in the feces or vomit
• Some symptoms of jaundice include:
• Dark urine
• Hives
• Itchy skin
• Light colored feces
• Yellow skin, whites of the eyes, and tongue
Diagnosis
History and Physical Examination
To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.
During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the examination.
Liver Function Tests
Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.
Other Blood Tests
If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis.
Ultrasound
An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal:
• Fluid in your abdomen
• Liver damage or enlargement
• Liver tumors
• Abnormalities of your gallbladder
Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.
Liver Biopsy
A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.
This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal.
Treatment
Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic.
Hepatitis A
Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.
The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine.
Hepatitis B
Acute hepatitis B doesn’t require specific treatment.
Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.
Hepatitis C
Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.
People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.
Currently, there is no vaccination for hepatitis C.
Hepatitis D
No antiviral medications exist for the treatment of hepatitis D at this time.
Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop.
Hepatitis E
Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.
Autoimmune Hepatitis
Corticosteroids are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.
Please contact your doctor for the potent corticosteroids to treat hepatitis.
Complications
Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for:
• Chronic liver disease
• Cirrhosis
• Liver cancer
When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:
• Bleeding disorders
• A build up of fluid in your abdomen, known as ascites
• Increased blood pressure in portal veins that enter your liver, known as portal hypertension
• Kidney failure
• Hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function
• Hepatocellular carcinoma, which is a form of liver cancer
• Death
People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications.
Prevention
1. Hygiene
Practicing good hygiene is one key way to avoid contracting hepatitis A and E. If you’re traveling to a developing country, you should avoid:
• local water
• ice
• raw or undercooked shellfish and oysters
• raw fruit and vegetables
Hepatitis B, C, and D contracted through contaminated blood can be prevented by:
• not sharing drug needles
• not sharing razors
• not using someone else’s toothbrush
• not touching spilled blood
Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection.
2. Vaccines
The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. Experts are currently developing vaccines against hepatitis C.
Conclusion
• Many illnesses and conditions can cause inflammation of the liver (hepatitis), but certain viruses cause about half of all hepatitis in people.
• Viruses that primarily attack the liver are called hepatitis viruses. There are several types of hepatitis viruses including types A, B, C, D, and E.
• Symptoms of acute viral hepatitis include fatigue, flu-like symptoms, dark urine, light-colored stools, fever, and jaundice; however, acute viral hepatitis may occur with minimal symptoms that go unrecognized. Rarely, acute viral hepatitis causes fulminant hepatic failure.
• Hepatitis infections can be prevented by avoiding exposure to viruses, and through injectable immunoglobulins, or by vaccines; however, vaccines are available for only hepatitis A and B.
• Those at risk for viral hepatitis B and C include workers in the health care profession, people with multiple sexual partners, intravenous drug abusers, and people with hemophilia. Blood transfusion is a rare cause of viral hepatitis.
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