Wednesday, December 29, 2010

Hepatitis - Def., Types, Causes, Symptoms, Treatment & Prevention

Hepatitis is derived from latin word meaning inflamed liver. Hepatitis means inflammation (itis) of the liver (hepar), an irritation or swelling of the liver cells.

What is hepatitis?
Def:- An inflammation of the liver caused by certain viruses and other factors such as alcohol abuse, some medications and trauma. Although many cases of hepatitis are not a serious threat to health, the disease can become chronic and can sometimes lead to liver failure and death
What Are the Different Types of Hepatitis?

Types of Hepatitis
There are 5 types of hepatitis -
1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D
5. Hepatitis E

1) Hepatitis A
It is caused by eating food and drinking water infected with a virus called HAV. It can also be caused by anal-oral contact during sex. While it can cause swelling and inflammation in the liver, it doesn't lead to chronic, or life long, disease. Almost everyone who gets hepatitis A has a full recovery.

Symptoms of hepatitis A
• A short, mild, flu-like illness;
• nausea, vomiting and diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin;
• abdominal pain.

Treatment for hepatitis A
There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.

2) Hepatitis B
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus.It is spread by contact with an infected person's blood, semen, or other body fluid. And, it is a sexually transmitted disease (STD).

Key factors of Hepatitis B
• Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
• The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
• About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
• About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
• The hepatitis B virus is 50 to 100 times more infectious than HIV.
• Hepatitis B virus is an important occupational hazard for health workers.
• Hepatitis B is preventable with a safe and effective vaccine.

Hepatitis B Transmission and Causes
• Having unprotected sex (not using a condom) with an infected person.
• Sharing drug needles (for illegal drugs like heroin and cocaine or legal drugs like vitamins and steroids).
• Getting a tattoo or body piercing with dirty (unsterile) needles and tools that were used on someone else.
• Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way).
• Sharing a toothbrush, razor, or other personal items with an infected person.
• An infected woman can give hepatitis B to her baby at birth or through her breast milk.
• Through a bite from another person.

You cannot get hepatitis B from the following activities:
• Having someone sneeze or cough on you
• Hugging someone
• Handshaking a persons hand
• Breastfeeding your child
• Eating food or drinking water
• Casual contact

Symptoms of hepatitis B
• A short, mild, flu-like illness;
• nausea, vomiting and diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin.

If a person lives with hepatitis B infection for a number of years then they may develop the following complications:

• chronic hepatitis
• liver cirrhosis
• liver cancer

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea are present, the affected person may require treatment to restore fluids and electrolytes.

Self-Care at Home
The goals of self-care are to relieve symptoms and prevent worsening of the disease.
• Drink plenty of fluids and water to prevent dehydration. Although, broth, sports drinks, gelatin, frozen ice treats (such as Popsicles), and fruit juices may be better because they also provide calories.
• Ask your physician before taking any medications, even those that are over-the-counter. Some medications depend on the liver, and liver damage may impair the body's ability to metabolize these drugs
• Avoid drinking alcohol until your health care practitioner allows it. Individuals with chronic HBV should avoid alcohol for the rest of their lives.
• Try to eat a diet that provides adequate nutrition
• Avoid prolonged, vigorous exercise until symptoms start to improve.
• Call your health care practitioner for advice if your condition worsens or new symptoms appear.
• Avoid any activity that may spread the infection to other people (sexual intercourse, sharing needles, etc).

Hepatitis B Vaccine
There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB). It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months.

The following groups should be vaccinated for hepatitis B:

• All children younger than 19 years, including all newborns - especially those born to mothers who are infected with HBV
• All health care and public safety workers who may be exposed to blood
• People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors
• People who have end-stage renal disease including those who require hem dialysis for kidney disease
• Travelers to countries where HBV infection is common. This includes most areas of Africa, Southeast Asia, China and Central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon River basin of South America.
• People who are in prison
• People who live or work in residential facilities for developmentally disabled persons
• People who inject illegal drugs
• People with chronic liver disease such as hepatitis C
• People who have multiple sex partners or have ever had a sexually transmitted disease
• Men who have sex with men
• Persons with HIV
• People who have a sexual partner who is an HBV carrier.
• Household contacts of persons who are carriers of HBV.
• Anyone who wants to be vaccinated, regardless of risk factors.

Prevention of hepatitis B
There are components to preventing hepatitis B:
1. Prevention of transmission of the virus
2. Immunisation
3. Know the HBV status of any sexual partner
4. Use a new latex or polyurethane condom every time you have sex.
5. Stop using illicit drugs.
6. Be cautious about body piercing and tattooing.
7. Ask about the hepatitis B vaccine before you travel.

3) Hepatitis C
It is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV).[1] The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer[1] or life threatening esophageal varices and gastric varices.

Cause:- hepatitis C virus (HCV)
• The hepatitis C virus is transmitted mainly by contact with blood or blood products
• Sex with an HCV- infected person (an inefficient means of transmission)
• Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission)
• Other healthcare procedures that involve invasive procedures, such as injections
• Sharing drug products via insufflations

Less common causes of HCV transmission:-
• From mother to infant at the time of childbirth
• Through sexual intercourse with an infected person: Having multiple sex partners is a risk factor.
• Needle sticks with HCV-contaminated blood: This is mostly seen in health care workers. The risk of developing HCV infection after a needle stick is about 5-10%

Symptoms of hepatitis C
Although hepatitis C damages the liver, 80% of people with the disease do not have symptoms. In those who do,symptoms may not appear for10-20 years, or even longer. Unfortunately, by the time symptoms appear, the damage may be very serious.

1. Acute
Acute hepatitis C refers to the first 6 months after infection with HCV. Between 60% and 70% of people infected develop no symptoms during the acute phase. A minority of people have symptoms during the early acute phase of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV.

The symptoms may last a few weeks or months.
• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Fatigue
• Pain over the liver (on the right side of the abdomen, just under the rib cage)
• Jaundice - A condition in which the skin and the whites of the eyes turn yellow
• Dark-colored urine (may look like cola or tea)
• Stoolsbecome pale in color (grayish or clay colored)

2. Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice the following symptoms:
• Fatigue or weakness
• Confusion or difficulty concentrating
• Headache
• Not urinating
• Irritability

3. Chronic
Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months. Once chronic hepatitis C has progressed to cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension. Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy. Hepatic encephalopathy is due to the accumulation of ammonia and other substances normally cleared by a healthy liver.
Factors that have been reported to influence the rate of HCV disease progression include age (increasing age associated with more rapid progression), gender (males have more rapid disease progression than females), alcohol consumption (associated with an increased rate of disease progression), HIV coinfection (associated with a markedly increased rate of disease progression), and fatty liver (the presence of fat in liver cells has been associated with an increased rate of disease progression)

Symptoms of cirrhosisinclude the following:
* Fluid retention causing swelling of the belly (ascites), legs, or whole body
* Persistent jaundice
* Fatigue
* Disturbances in sleeping
* Itchy skin
* Loss of appetite, weight loss, wasting
* Vomiting with blood in the vomit
* Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy)

Hepatitis C - Treatment

1. Self-Care at Home

If you have symptoms, these measures will help you feel better faster.
• Take it easy; get plenty of rest.
• Drink plenty of fluids to prevent dehydration.
• Do not drink alcohol of any kind, including beer, wine, and hard liquor.
• Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and other preparations that contain acetaminophen.
• Avoid prolonged, vigorous exercise until symptoms start to improve.

2. Medical Treatment

• Decisions to start medications for treatment of hepatitis C are usually made in consultation with a gastroenterologist or liver specialist (hepatologist).
• The decision is based on the results of lab tests of liver function, on results of tests for HCV and liver biopsy, and on the person's age and general medical condition.

3. Surgery

4. Medications (interferon and ribavirin)

Current treatment is a combination of pegylated interferon-alpha-2a or pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype

Special factors affecting patients
1.Host factors
2 Viral factors
3 Depression during therapy
4 Additional recommendations and alternative therapies

• Injection drug use (currently the most common means of HCV transmission in the United States)
• Receipt of donated blood, blood products, and organs (once a common means of transmission, but now rare in the United States since blood screening became available in 1992)
• Needle stick injuries in healthcare settings
• Birth to an HCV-infected mother

4. Hepatitis D
It is caused by the virus HDV. You can only get hepatitis D if you are already infected with hepatitis B. It is spread through contact with infected blood, dirty needles that have HDV on them, and unprotected sex (not using a condom) with a person infected with HDV. Hepatitis D causes swelling of the liver.

5. Hepatitis E
It is caused by the virus HEV. You get hepatitis E by drinking water infected with the virus. This type of hepatitis doesn't often occur in the U.S. It causes swelling of the liver, but no long-term damage. It can also be spread through oral-anal contact.

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