The ABCs of Hepatitis

Everyone has heard of hepatitis but do we really know what it is. If you break down the word into two parts hepat- and –it is you get inflammation of the liver. After doing a little bit of research, I found that there are 3 classes of hepatitis and several other causes, such as alcohol and drug abuse. Two classes of hepatitis, B&C, can be spread through sexual intercourse which is why it is important to understand the symptoms, signs, and prevention of hepatitis. Hepatitis can lead to liver failure or cancer. Liver transplantation is a potential treatment plan but not always a definite treatment.

The earlier hepatitis is diagnosed and treated, the better your prognosis. General symptoms include abdominal pain/ distention, dark urine, fatigue, fever, jaundice, nausea, loss of appetite and weight loss. Symptoms are a good way to detect hepatitis early but sometimes people do not develop them and people at risk should be tested regularly to avoid liver failure. Diagnostic testing can be performed to indicate whether or not an infection exists. A simple physical examination can detect an enlarged liver, fluid in the abdomen, and yellow hued skin. If hepatitis is suspected, further testing will be ordered by the physician. There are a range of tests that can be done that can check for any abnormalities that indicate hepatitis. The most common is a simple blood test, or liver function test which can pinpoint that the abdominal inflammation is being caused by one’s liver. The next step would be for the patient to get an ultrasound, paracentesis of fluid if present, and/or a liver biopsy. All of these can help further investigate the infection and determine its pathology.

Hepatitis A

Like I mentioned before, there are several ways to develop hepatitis and several different kinds. I want to discuss the most common that can be spread from person to person where prevention can be key to not contracting the potentially fatal disease. Let’s start with the beginning of the alphabet and tackle Hepatitis A. The Hep A virus is found mostly in the stool or blood of infected persons. The infected person is contagious 15-45 days prior to symptoms occurring and the first week of illness. Sources of infection include drinking or eating items that have been contaminated by stool containing the Hep A virus. Common food and liquid sources of the hepatitis A virus are fruits, vegetables, shellfish, ice, and water. Another source is coming into contact with the stool or blood of an infected person. It is possible for an infected person to not properly wash their hands and touch items. These items are now contaminated and can potentially infect the next person who comes across them. I mentioned before that Hep B and C are the most common among the sexually active but according to PubMed, persons who engage in oral-anal contact are at risk of contracting Hep A if the person is infected. All sexually active persons should be aware of potential exposure to all three types of hepatitis. Risk factors for contracting Hep A are international travel, IV drug use, and healthcare providers. Symptoms include all the ones mentioned previously and detection is by LFT or elevated IgM and IgG Hep A antibodies. Hep A is the more mild form of hepatitis. The virus will not remain in the body once the infection is gone, however the infection can last up to 6 months. During the recovery period, rest is suggested, along with avoiding alcohol and drugs that are toxic to the liver.

Hepatitis B

In following with the alphabet, the next viral infection to be discussed would be none other than Hepatitis B. The Hep B virus is found in blood, semen, and vaginal fluids of an infected person. The infection’s most common sources are blood transfusions, sexual intercourse, contaminated tattoo or drug needles, and sharing of personal items (toothbrush, razor, etc.). A mother can pass the virus to her infant during childbirth if infected, as well. People who are at increased risk of contracting the virus are those born in regions with high infection rates, HIV positive persons, hemodialysis patients, and having multiple sex partners, especially men with men. Staying protected during intercourse is the best way to prevent infection. Hemodialysis patients have the constant risk due to continuous blood transfusions. Once a person is infected with the Hep B virus, the body produces and sends special cells to fight the infection which are harmful to the liver and cause the inflammation. Symptoms range from mild to severe and the infection can last for a few weeks to a few months. If the body is not able to overcome the infection, the person is then said to have chronic hepatitis. Generally those that have chronic hepatitis have little to no symptoms and appear healthy. Symptoms are congruent with those of Hep A and detection can be done by LFT and other blood tests (PT and albumin level). Hep B antigens can also be detected if there is an active infection and can also help define the source of infection. Hep B has the potential to clear up but for those unfortunate to develop chronic hepatitis, live failure may ensue and a transplant may be necessary for survival. Anti-viral medications are also available to help reduce the risk of liver cancer and cirrhosis.

Hepatitis C

Last but not least, Hepatitis C.  Unlike the others, the Hep C virus is found primarily in the blood.  Those at risk for exposure are people who receive regular transfusions, in contact with blood regularly, transplant recipient, and exposure to contaminated needles through tattoos and/or recreational drug use. A person can also be exposed to the virus through unprotected sexual contact with an infected partner.  Once exposure has occurred, it is very unlikely for the newly infected person to show symptoms.  This indicates that most persons infected with Hep C develop a chronic infection which then turns into cirrhosis, and the liver is permanently damaged from the infection.  Since symptoms are poor indicators of the infection, diagnosis is primarily based on blood tests, EIA and Hepatitis C RNA assays.  Some alternative testing options are a liver function panel and liver biopsy.  Once the Hep C virus is diagnosed, the goal is to eradicate the virus from the blood before permanent liver damage (cirrhosis) occurs.  Treatment usually involves anti-viral medications for up to 48 weeks.  Liver transplantation may result if cirrhosis is too far along and prevention is no longer achievable.

Now that we know a little about the most common forms of Hepatitis, we can use prevention to keep ourselves protected. When engaging in sexual intercourse, always use protection.  Also, if a tattoo is in your near future, research the sterile techniques the facility uses and watch their sterile practice through the procedure.  People receiving blood transfusions unfortunately cannot screen the blood before they receive, but keeping a healthy lifestyle can in the long run prevent you from having to receive transfusions in the future.  All in all, prevention and awareness is key to avoiding any type of hepatitis infection.