Hepatitis

Hepatitis is inflammation in the liver, which can have a range of causes including drugs, viruses, bacteria, heredity, and fatty tissue.

What Are the Types of Viral Hepatitis?

• Type A - Previously known as infectious hepatitis, it can be contracted through contaminated water or food. During the acute infection, the patient's blood and body fluids are also infectious. Although some patients become acutely and desperately sick from this infection, most people tolerate it well and fully recover. No chronic infection occurs with this virus.
• Type B - Previously known as serum hepatitis. Patients are sicker initially with this very unpleasant virus and take longer to recover, sometimes several months. Furthermore, about 10 percent of patients progress into a state of chronic smoldering infection in the liver. A person can be infected by a contaminated needle or through sexual contact. Homosexual men, intravenous drug users, or persons who have sexual contact with these people are at an especially high risk for contracting this disease.
• Type C – This viral infection was previously known as non A non B hepatitis. In the past, it was transmitted mostly by blood transfusion. There are now good blood tests to check for this virus before blood is given. Most cases now occur in people who use contaminated needles for drug use. However, many cases are community acquired, meaning the physicians really don’t know how they occur. It is difficult, but not impossible, to transmit this virus by unprotected sexual intercourse. Many people who acquire this infection go on to a chronic phase.
• Other Viruses – There are now types recognized D, E, and G viruses that can cause hepatitis. Infectious mono virus, CMV virus, and several other viruses are also capable of infecting the liver.

Are There Other Causes?

• Alcohol – Binge drinking of alcohol can inflict an acute hepatitis injury on the liver.
• Drugs – Certain drugs also can acutely injure the liver in a few people who are hypersensitive or allergic to a particular medicine.
• Autoimmune – Certain conditions similar to the disease, such as lupus erythematosus, can injure the liver. With autoimmune disorders, the body’s own antibody defenses seem to damage the liver.
• Hereditary Conditions – Certain hereditary disorders, such as Wilson’s disease, can acutely damage the liver.

Symptoms

Mild Viral Hepatitis

• Slight fatigue

Severe Hepatitis

• Loss of the taste
• Diarrhea and arthritis (especially with acute B hepatitis)
• Heaviness in the right upper abdomen
• Liver and spleen enlargement
• Jaundice

Diagnosis

The physician often suspects hepatitis based on:

• Medical history and physical exam
• Blood tests
• Ultrasound (sonography) may be needed to study the bile ducts, gallbladder, and liver
• Liver biopsy  - may be needed to provide information to the physician.

Treatment

No specific treatments are available for acute viral hepatitis. Fortunately, in most cases the body develops antibodies that fight and eventually kill the virus, allowing the liver to recover. For alcohol and drug induced hepatitis, the patient has to avoid the offending agent. The physician must make an accurate diagnosis, support the patient during the acute phase, and provide advice during recovery.

Recovery from viral hepatitis A and B results in protective antibodies so that the patient will not get these infections again and cannot transmit them to anyone else.

Chronic Phase

Some people progress to chronic hepatitis. Here, the liver smolders with persistent inflammation. Specialists must follow These patients closely  to address the various problems that can arise from this condition. Effective treatment is available for many types of chronic hepatitis. Because some of these patients are infectious and can transmit the disease, they and their families must be educated about how to protect themselves.

Contagion and Spread

In the past, viral hepatitis had a well, deserved reputation for being contagious. Contaminated water and poor sanitation provided easy transmission for these viruses. Today, we know a lot about how the viruses are transmitted so that prevention is usually possible.

However, infection still can occur through contaminated water or poor sanitation. In addition, during the acute phase, all body secretions saliva, tears, semen, urine, and especially blood are infectious. Sexual contact with someone who is infected can spread the virus. Also, if a patient is a carrier in the chronic phase, the infection may be spread through sexual contact.

Intravenous drug users who share needles are at an extremely high risk of contracting hepatitis, as are people who have multiple sexual partners. Because each hepatitis virus is different, it is always best to discuss this with a physician.

Vaccination

Passive (short acting) and active (permanent and long lasting) vaccines now are available against hepatitis A and B. People who travel to underdeveloped countries are encouraged to receive these vaccinations. The following high-risk groups should also receive active immunization:

• Health care workers, especially those who handle body fluids such as blood
• People who have multiple sex partners
• Intravenous drug users
• Infants and children

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This content was last medically reviewed in May 2022 by Sharlotte Manley, MSN, FNP, Erlanger Gastroenterology.