26/06/2020
HEPATITIS OVERVIEW
Definition
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.
Timeline
8th Century: Infectious Nature of HBV suggested
17th-19th Centuries: Outbreaks of epidemics of jaundice in military and civilian populations during wars
1883: Lurman reports outbreaks of serum hepatitis follwing vaccination of dockers
1908: McDonald postulates that the infectious jaundice is caused by a virus
1939-1945: WWII-A series of outbreaks after vaccination for measles and yellow fever
1947: MacCallum classifies viral hepatitis into two types-
Viral hepatitis A—> Infectious hepatitis
Viral hepatitis B—> Serum hepatitis
1965: Blumberg discovers Australia antigen (HBsAg) in aborigines and shows presence of antigen
at high frequency in patients with leukemia and children with Down’s syndrome
1970: Dane discovers the Dane particle (complete HBV particle)
1972: Discovers HBeAg
1973: Feinstone and Purcell identifies HAV
1977: Rizzetto describes delta antigen HDV
1983: Recovery of HEV
1988: Chiron group (Choo, Kuo, Houghton) closes and identifies HCV.
1995: Abbot group reports GB Virus-C (GBV-C) and Genelabs group reports in 1996 hepatitis
G virus (HGV)—GBV-C=HGV
1996: Chang’s group at NTUH reports in JAMA the successful prevention of HBV infection by
nation-wide vaccination on newborn babies launched in 1984 in Taiwan.
1997: Chang’s group at NTUH reports in NEJM a decrease in annual incidence rate of
hepatocellular carcinoma in children ascribed to nation-wide vaccination against HBV on
newborn babies launched in 1984 in Taiwan.
Epidemiology
Globally, viral It was the seventh leading cause of death in 2013, up from the 10th leading cause in 1990. Worldwide, HAV is responsible for an estimated 1.4 million infections annually. About 2 billion people in the world have evidence of past or current HBV infection, with 240 million chronic carriers of HBsAg. HBV, along with the associated infection by the hepatitis D virus, is one of the most common pathogens afflicting humans. HBV leads to 650,000 deaths annually as a result of viral hepatitis–induced liver disease.
The worldwide annual incidence of acute HCV infection is not easily estimated, because patients are often asymptomatic. An estimated 71 million people are chronically infected with HCV worldwide. About 55-85% of these people infected progress to chronic HCV infection, with a 15-30% risk of developing liver cirrhosis within two decades. China, the United States, and Russia have the largest populations of anti-HCV positive injection drug users (IDUs). It is estimated that 6.4 million IDUs worldwide are positive for antibody to hepatitis B core antigen (HBcAg) (anti-HBc), and 1.2 million are HBsAg-positive.
TYPES AND CAUSES
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 f***s 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 s*x with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.
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 s*xual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection.
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. It’s very uncommon in the United States.
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 f***l matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC.
AUTOIMMUNE HEPATITIS
Autoimmune hepatitis is a rare form of chronic hepatitis. Like other autoimmune disorders, its exact cause is unknown. Autoimmune hepatitis may develop on its own or it may be associated with other autoimmune disorders, such as systemic lupus erythematosus. In autoimmune disorders, a misdirected immune system attacks the body’s own cells and organs (in this case the liver).
SYMPTOMS
When symptoms occur, they can include:
Jaundice (a yellowing of the skin and eyes)
Abdominal pain
Loss of appetite
Nausea and vomiting
Diarrhea
Fever
Clay-colored bowel movements
Painful joints
Yellowishing of skin and eye
COMPLICATIONS OF HEPATITIS
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 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 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.
DIAGNOSIS AND TEST
History and physical exam
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 exam.
LIVER FUNCTION TESTS(L.F.T)
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 tumours
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 AND MEDICATIONS
Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic.
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Foods to eat
While most people with hepatitis C do not require a special diet, there are certain foods people can eat to maintain good liver health.
Fruit and vegetables
Dark green leafy vegetables in the marketplace, including kale, cabbage, and spinach.
Green leafy vegetables, including kale, cabbage, and spinach, may be particularly beneficial for people with hepatitis C.
A healthful and balanced diet should include plenty of fruit and vegetables. These food groups are full of necessary vitamins and minerals that enable the liver to function properly.
Fresh fruit and vegetables are ideal, but they can also be frozen or canned. People should aim to consume at least 5 portions of fruit and vegetables a day.
Leafy green vegetables can lessen fatty acid composition in the liver, so they are particularly beneficial to people with hepatitis C. Good examples include kale, spinach, and cabbage.
Leafy green vegetables are sources of iron, which may be harmful to those with hepatitis C when consumed in excess. While it is unlikely a person would eat enough leafy greens to cause iron overload, people with liver damage may wish to monitor their intake. A doctor or dietitian can help a person determine the right amount for them.
Protein
Getting adequate amounts of protein is important, as it provides energy and can keep a person feeling full. Replacing a portion of simple carbohydrates with protein is a good way to reduce the risk of conditions such as diabetes.
Good sources of protein include:
Turkey
Fish
Tofu
Eggs
Cheese
Beans
Nuts and seeds
Dairy products also provide protein, calcium, and vitamin D. Low-fat or fat-free versions of dairy are the best choices for people with hepatitis C. People should limit dairy products with added sugar.
Complex carbohydrates
Cereals, bread, and grains are all examples of complex carbohydrates and are packed with B vitamins and minerals, as well as zinc and fiber.
Complex carbohydrates include:
Brown rice
Oatmeal
Whole oats
Whole Rye
Whole Wheat
Wild rice
PREVENTION
There are many steps you can take to reduce the risk of viral hepatitis:
Consider getting vaccinated against hepatitis A and B if you weren’t vaccinated as a child. This is the number one way to prevent these illnesses.
Wash your hands with soap and water after using the bathroom or changing a baby’s diaper and before handling food.
When traveling in developing countries, avoid unpeeled or raw foods. Drink only bottled, boiled or chemically treated water.
Practice safe s*x. Hepatitis B is about 50–100 times more transmissible during s*x than HIV. Condoms and other barrier methods greatly reduce the risk.
Never share syringes, shaving razors, toothbrushes or tattooing or piercing supplies.
Wear gloves when performing first aid.
Disinfect blood spills (including dried ones) with diluted bleach and wear gloves during clean-up.
Follow all occupational safety precautions in your workplace.
If you are pregnant, seek early and regular prenatal care.
To reduce the risk of non-viral hepatitis, avoid excessive ALCOHOL consumption and consult with a healthcare professional about medications and supplements.
