Hepatitis is derived from the Greek word “hepat” meaning liver and the Greek suffix “-itis” meaning inflammation. It is characterized by the destruction of liver cells and the presence of inflammatory cells in the liver tissues. It can either be acute or self-limiting where it heals on its own or it can be chronic which is longer or more persistent. There are many causes including:
- Toxins such as alcohol.
- Autoimmune processes which is an immune response against your own cells or tissues.
Often people do not have any symptoms or only develop them further on in the disease so it can be difficult to detect and can be quite advanced before it is actually picked up.
Hepatitis B is inflammation of the liver caused by a DNA virus causing viral hepatitis. At the moment in Western countries only 2% of the population are infected with chronic hepatitis. It is a blood-borne infection which can be transmitted by:
- Re-use of contaminated needles.
- Unprotected sexual contact.
- Blood transfusions
- During childbirth from the mother to the child if the mother is infected.
There are several vaccinations for Hepatitis B: it can either be made from recombinant DNA technology or obtained from the plasma of patients with long-standing Hepatitis B virus infections. Recombinant DNA technology involves adding the relevant bits of DNA into a bacterium plasmid which is put back into the bacteria which then replicates itself including the new piece of DNA. This can then be used as a vaccine so that people develop their own antibodies against the virus. The vaccine is targeted at people who are most at risk including:
- Family members of people with Chronic Hepatitis B
- Sexual partners of people with Hepatitis B
- Newborn babies of mother with Hepatitis B
- Drug Users
- Homosexual men
- Hospital staff who frequently come into contact with blood.
Symptoms of Acute Hepatitis B:
- General ill-health
- Loss of appetite
- Body aches
- Mild fever
- Dark urine
- Development of jaundice.
This is a yellowing of the sclera (white parts of the eye) the skin and the mucous membrane. It is caused when bilirubin (a yellow break down product of haem which is an iron containing group) levels in the blood increase. This is an insoluble substance which travels to the liver bound to serum albumin. It is joined with glucuronic acid forming bilirubin diglucuroonide which is more soluble and is excreted from the liver as bile. Unnatural cell death (necrosis) reduces the liver’s ability to make and excrete bilirubin leading to a build up of blood in the liver.
Acute Hepatitis B lasts a few weeks and in most people it gradually improves and doesn’t usually require treatment. The incubation period for Hepatitis B is usually 2-6months and 1 in 20 patients develops chronic Hepatitis B while 1 in 5 develops cirrhosis.
Symptoms of Chronic Hepatitis B:
· It can be asymptomatic.
· Chronic inflammation of the liver
· Develop fibrosis which is liver scarring
· Develop cirrhosis which is advanced liver scarring. The symptoms of cirrhosis are:
· Bone pain
· Enlarged veins (varicose veins) around the abdomen
· Fatty stools
· Increases the risk of hepatocellular carcinoma or liver cancer.
Chronic Hepatitis B can be diagnosed by using blood or serum tests that detect the presence of the viral antigens which are proteins produced by the virus, or they detect the presence of antibodies which are produced by the host as an immune response. The hepatitis surface antigen is most frequently tested for as it is the first detectable viral antigen.
There are 7 medications that can be used to treat Hepatitis B;
5 antiviral drugs:
2 immune system modulators:
- Interferon alpha-2a
- Pegylated interferon alpha-2a.
95% of infected adults and older children will stage a full recovery and develop protective immunity to the virus.
Hepatitis C is a blood-borne infection caused by the Hepatitis C virus which affects the liver. It is spread by blood to blood contact and at the moment there is no vaccination to protect against it. Acute Hepatitis C is the first six months of the infection. 60-70% of infected people are asymptomatic during this phase but they can suffer:
- General ill health including:
- Marked weight loss
- Flu-like symptoms
- Muscle and joint pain
- Sleep disturbances
- Head aches
- Loss of appetite
- Abdominal pain
- Development of Jaundice.
- Flu-like symptoms
Since the acute phase is often asymptomatic it is difficult to pick up early and treat so many people have developed more serious problems before they are aware they are infected making it more difficult to treat.
It can be tested for as the virus is detectable in the blood 1-3weeks after being infected and the antibodies which are produced as an immune response can be detected 3-12weeks after being infected but as mentioned above many people do not seek medical help because they don’t have any symptoms. 15-40% of people are able to clear the infection in the acute phase but 60-85% of people develop chronic hepatitis C which is where the infection has lasted more than 6 months. The incubation period is usually 1-6months and 8 in 10 patients develop chronic Hepatitis C while 1 in 3 develops cirrhosis.
Symptoms of Chronic Hepatitis C:
- Often asymptomatic.
- Inflammation of the liver
- Leads to fibrosis which is liver scarring
- Two thirds progress to cirrhosis (which is advanced liver scarring) within 20-30 years.
The rate of progression is increased by:
- Increasing age
- Gender: In males the progression is usually faster
- Alcohol consumption
- HIV co-infection
- Fatty liver
Liver biopsy tests are used as they are best for detecting the amount of scarring and inflammation of the liver. Hepatitis C can also be diagnosed using blood serum tests or serology, which detects the presence of antibodies against the Hepatitis C virus. In 80% of people the antibodies can be detected after 15weeks and in 90% they are detected after 20 weeks. You can also test for the presence of the virus using molecular nucleic acid testing methods which measure the amount of virus present.
In Western countries 90% of the people infected with Hepatitis C were infected through transmission of unscreened blood to blood contact for example:
· Body piercing and tattoos
· Injection drug use
· Nasal inhalation
· Blood products from blood transfusions or organ transplants
· From un-sterilized equipment
· Unprotected sexual contact
· Sharing personal items such as razors, tooth brushes and scissors
Hepatitis C can also be transmitted from an infected mother to her child during childbirth.
At the moment a combination of pegylated interferon alpha and an anti-viral drug called ribavirin are used for 24-48weeks to treat the disease. However, this is physically demanding and in some cases can cause temporary disability.
Smoking and alcohol consumption increases the progress of Hepatitis C virus associated fibrosis, cirrhosis and increases the risk of developing liver cancer. Insulin resistance and metabolic syndrome can worsen the prognosis of hepatitis.
It can be prevented by:
- Not sharing needles (or other drug paraphernalia)
- Avoiding unsanitary tattoo methods
- Avoiding unsanitary body piercing methods
- Avoiding unsanitary acupuncture methods
- Not sharing personal items
- Not having unprotected sex.