[KMI TDMC] Hepatitis | ABCs of Preventing Hepatitis Infection
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4 March 2024
Hepatitis is an inflammation of the liver. It may be caused by viral infection, alcohol consumption, several health conditions, or even some medications. Treatment varies based on the type and underlying cause.
Hepatitis refers to an inflammatory condition of the liver. It is commonly the result of 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.
The five main viral classifications of hepatitis are hepatitis A, B, C, D, and E. A different virus is responsible for each type of viral hepatitis.
The World Health Organization (WHO) estimates that 354 millionTrusted Source people currently live with chronic hepatitis B and C globally.
Hepatitis A is the result of an infection with the hepatitis A virus (HAV). This type of hepatitis is an acute, short-term disease.
The hepatitis B virus (HBV) causes hepatitis B. This is often an ongoing, chronic condition. The Centers for Disease Control and Prevention (CDC) estimates that around 826,000Trusted Source people are living with chronic hepatitis B in the United States and around 257 million people worldwide.
Hepatitis C comes from the hepatitis C virus (HCV). HCV is among the most common bloodborne viral infections in the United States and typically presents as a long-term condition.
This is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus (HDV) causes liver inflammation like other strains, but a person cannot contract HDV without an existing hepatitis B infection.
Globally, HDV affects almost 5 percentTrusted Source of people with chronic hepatitis B.
Hepatitis E is a waterborne disease that results from exposure to 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.
This disease is uncommon in the United States, according to the CDC.
Hepatitis E is usually acute but can be particularly dangerous in pregnant women.
| Type of hepatitis | Common route of transmission |
| hepatitis A | exposure to HAV in food or water |
| hepatitis B | contact with HBV in body fluids, such as blood, vaginal secretions, or semen |
| hepatitis C | contact with HCV in body fluids, such as blood, vaginal secretions, or semen |
| hepatitis D | contact with blood containing HDV |
| hepatitis E | exposure to HEV in food or water |
Causes of noninfectious hepatitis
Although hepatitis is most commonly the result of an infection, other factors can cause the condition.
Alcohol and other toxins
Excess alcohol consumption can cause liver damage and inflammation. This may also be referred to as alcoholic hepatitis.
The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to thickening or scarring of liver tissue (cirrhosis) and liver failure.
Other toxic causes of hepatitis include misuse of medications and exposure to toxins.
Autoimmune system response
Sometimes, the immune system mistakes the liver as harmful and attacks it. This causes ongoing inflammation ranging from mild to severe, often hindering liver function. It’s three times more common in women than in men.
If you are living with a chronic form of hepatitis, like hepatitis B and C, you may not show symptoms until the damage affects liver function. By contrast, people with acute hepatitis may present with symptoms shortly after contracting a hepatitis virus.
Common symptoms of infectious hepatitis include:
- fatigue
- flu-like symptoms
- dark urine
- pale stool
- abdominal pain
- loss of appetite
- unexplained weight loss
- yellow skin and eyes, which may be signs of jaundice
How hepatitis is diagnosed
It is crucial to understand what is causing hepatitis to treat it correctly. Doctors will progress through a series of tests to accurately diagnose your condition.
History and physical exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
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 check for any swelling of the liver and any yellow discoloration in your eyes or skin.
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 correctly.
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 determine the Source if you have infectious hepatitis by checking for the presence of hepatitis viruses or antibodies your body produces to combat them.
Doctors may also use blood tests to check for any signs of autoimmune hepatitis.
Liver biopsy
When diagnosing hepatitis, doctors will also assess your liver for potential damageTrusted Source. A liver biopsy is a procedure that involves taking a sample of tissue from your liver.
A medical professional may take this sample through your skin with a needle, meaning there is no need for surgery. They will typically use an ultrasound scan for guidance during this procedure.
This test allows your doctor to determine how infection or inflammation has affected your liver.
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 look 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.
Treatment options will vary by the type of hepatitis you have and whether the infection is acute or chronic.
Hepatitis A
Hepatitis A is a short-term illness and may not require treatment. However, if symptoms cause a great deal of discomfort, bed rest may be necessary. In addition, if you experience vomiting or diarrhea, your doctor may recommend a dietary program to maintain your hydration and nutrition.
Hepatitis B
There is no specific treatment program for acute hepatitis B.
However, if you have chronic hepatitis B, you will require trusted Source antiviral medications. This form of treatment can be costly, as you may have to continue it 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 can treat both acute and chronic forms of hepatitis C.
Typically, people who develop chronic hepatitis C will use a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.
People who develop cirrhosis or liver disease due to chronic hepatitis C may be candidates for a liver transplant.
Hepatitis D
The WHOTrusted Source lists pegylated interferon alpha as a treatment for hepatitis D. However, this medication can have severe side effects. As a result, it’s not recommended for people with cirrhosis liver damage, those with psychiatric conditions, and people with autoimmune diseases.
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.
Doctors will typically advise people with this infection 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, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.
Azathioprine (Imuran), a drug that suppresses the immune system, may also be a part of treatment programs. People may use this with or without steroids.
Other immune-suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf), and cyclosporine (Neoral) can also replace azathioprine in treatment.
Some vaccines can help protect against many hepatitis viruses. Minimizing your risk of exposure to substances containing these viruses can also be an important preventive measure.
Vaccines
A vaccine for hepatitis A is available and can help prevent the contraction of HAV. The hepatitis A vaccine is a series of two doses and most children begin vaccination at age 12 to 23 months Source. This is also available for adults and can also include the hepatitis B vaccine.
The CDCTrusted Source recommends hepatitis B vaccinations for all newborns. Doctors typically administer the series of three vaccines over the first 6 months of childhood.
The CDC also recommends the vaccine for all healthcare and medical personnel. Vaccination against hepatitis B can also prevent hepatitis D.
There are currently no vaccines for hepatitis C or E.
Reducing exposure
Hepatitis viruses can transmit from person to person through contact with bodily fluids, water, and foods containing infectious agents. Minimizing your risk of contact with these substances can help to prevent contracting hepatitis viruses.
Practicing effective hygiene is one way to avoid contracting hepatitis A and E. The viruses that cause these conditions can be present in water. If you’re traveling to a country where there is a high prevalence of hepatitis, you should avoid:
- local water
- ice
- raw or undercooked shellfish and oysters
- raw fruit and vegetables
The hepatitis B, C, and D viruses can be transmitted through contact with bodily fluids containing these infectious agents.
You can reduce your riskTrusted Source of coming into contact with fluids containing these viruses by:
- not sharing needles
- not sharing razors
- not using someone else’s toothbrush
- not touching spilled blood
Hepatitis B and C can carry through sexual intercourse and sexual contact. Using barrier methods, such as condoms and dental dams, during sexual activity can help decrease the risk of infection.
Chronic hepatitis B or C can lead to more severe health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk of:
- chronic liver disease
- cirrhosis
- liver cancer
When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:
- bleeding disorders
- a buildup 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
- hepatocellular carcinoma, which is a form of liver cancer
- death
People with chronic hepatitis B and C should avoid alcohol as 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.
Proofead and edited by:
Dr. Christopher Fatinathan
Consultant Internal Medicine Physician
M.D. (USM) Master in Internal Medicine (UKM)
