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Hepatitis B is a viral infection characterised by inflammation, i.e., swelling and redness, of the liver. It can sometimes lead to permanent liver damage.

The liver is a major organ located on the right side of the abdomen. Under normal conditions, the liver performs the following functions:

• Produces a fluid (bile) that helps in the digestion of food
• Eliminates waste products present in the blood
• Store sugar that is utilised by the body for energy production

In people with hepatitis B, the liver is unable to perform its normal functions. As a result, waste products begin building up in the blood and the body, resulting in various problems.

The infection develops either into an acute or a chronic condition:

• Acute hepatitis B: The infection is termed acute if it lasts for less than six months. In this case, the body is effectively able to eliminate the virus from the body.
• Chronic hepatitis B: The infection is termed chronic if it lasts more than six months. In this case, the body is unable to get rid of the virus. The risk of infection turning chronic is higher in infants and young children than in adults. Chronic hepatitis B tends to cause long-term liver damage. Approximately one in 20 people infected with the hepatitis B virus develop chronic hepatitis B.

Symptoms

The symptoms of hepatitis B range from mild to life-threatening. The severity of the symptoms depends on the age of the infected person. The infection usually does not show any symptoms in a majority of children aged below five years and in adults with a weakened immune system. However, the symptoms are often seen in 30-50% of infected people above five years of age. Some of the common symptoms of hepatitis B are given below:

• Confusion


• Fever


• Nausea


• Vomiting


• Loss of appetite


• Fatigue


• Joint pain


• Dark urine


• Abdominal pain


• Clay-coloured stool


• Yellowing of eyes and skin


• Abdominal swelling

The symptoms in infected people usually begin after about 90 days of exposure to the virus. It persists for several weeks, and in some cases, even up to six months.

Causes And Risk Factors

Causes

Hepatitis B primarily spreads from one person to another when the hepatitis B virus present in the blood or body fluids (saliva, vaginal secretions or semen) of an infected person enters the bloodstream of a healthy person. Some of the common routes of transmission of hepatitis B virus are as follows:

• Sharp instruments


• Shared toothbrush and razors


• Needles


• Unprotected sex with an infected person

Casual contact does not spread the virus. Hence, people do not contract hepatitis B from shaking hands, hugging or holding an infected person.

Risk Factors

The following people are at a higher risk of contracting hepatitis B:

• Those who come in contact with an infected person


• Family members or friends who live with an infected person


• Children born to infected mothers


• Those who practice unprotected sex, especially with multiple partners


• Those who take immunosuppressant medicines (medicines that weaken the immune system)


• Those who require dialysis


• Those with a blood clotting disorder (e.g., haemophilia), hepatitis C infection, human immunodeficiency virus (HIV)


• Those who had undergone organ transplants or blood transfusion, especially before the 1990s


• Those in the profession that require contact with human body fluids and needles


• Those who use intravenous (IV) drugs

Prevention

Vaccination is the best method to prevent hepatitis B. People should make sure that they and their children are immunised. According to studies, vaccination protects from the virus for about 20 years. Other preventive measures that can help people reduce the risk of contracting hepatitis B include:

1. Wear single-use gloves while handling blood or body fluids and while giving first aid.


2. People who need to take injectables should always use sterile syringes and needles available from pharmacists. They should wash the hands before and after using the injection equipment and never share it with others.


3. Before getting a piercing or tattoo, one should ensure that the tattoo practitioner is experienced and follows good hygiene and sterilisation practices.


4. Couples should undergo check-up before practising unprotected sex. Until then, one should practise safe sex using condoms.


5. Avoid oral sex with partners who have bleeding gums, ulcers or herpes.

Diagnosis

The following tests may be performed to diagnose Hepatitis B:

1. Physical examination: The doctor will perform a physical examination to look for signs of liver damage such as skin colour changes and swelling in the abdomen, ankles, feet or lower legs.

2. Blood test: Hepatitis is mainly diagnosed by a blood test that detects the presence of antibodies in the body. Antibodies are substances produced by the body’s immune system to fight off foreign objects like bacteria, viruses, etc. However, it takes about six months from the date of exposure for the body to produce enough antibodies against the hepatitis B virus that can be detected in the blood test. During this infection, a person who suspects being infected should take essential measures to prevent the spread of the disease.

3. Ultrasound: This test is performed to see whether the liver looks infected or damaged.

4. Biopsy: In people suspected of having chronic hepatitis B, the doctor may take a liver tissue sample by using a needle. This tissue sample is then studied under a microscope to diagnose the type and severity of liver disease.

Treatment

The treatment available currently does not cure hepatitis B but aims to control its severity. The type of treatment decided by the doctor may vary depending on the person’s time of exposure to the virus.

1. People recently exposed to the virus: Emergency treatment may be provided to people exposed to the virus in the last few days to prevent infection.


2.  People with acute hepatitis B: The doctor may suggest measures that aim to provide relief from the symptoms and support the body while the body naturally fights off the virus. Some of the measures suggested by the doctor may include:

• Maintain a healthy diet


• Drink lots of fluids


• Get plenty of rest

3. People with chronic hepatitis B: The doctor may prescribe medicinal treatment to control the virus’s growth and minimise the risk of liver damage and other complications. The medicines that may be prescribed include antiviral tablets and interferon injectables. People with chronic hepatitis may need regular health check-ups, approximately once or twice every year, to help the doctor look for early signs of liver cancer and liver damage.

Lifestyle/management

People with hepatitis B should maintain a healthy lifestyle to prevent further damage to the liver and support the body to fight off the infection. Few measures that one should incorporate in their life to lead a healthy lifestyle include:

1. Exercise regularly.


2. Eat nutritious foods, including a variety of fruits and vegetables such as cauliflower, broccoli, cabbage that helps to protect the liver.


3. Avoid smoking and drinking as they can damage the liver.


4. Take measures to cope with stress, such as meditating, journaling, etc.

Prognosis And Complications

Prognosis

People are nowadays better able to manage the infection and live a healthy life. People should make sure that they are immunised against hepatitis and undergo periodic check-ups from qualified healthcare providers. People with infection should discuss with the doctor before taking any new medicines as certain medicines such as acetaminophen can interfere with liver function and cause liver damage. Chronic hepatitis B is a chronic medical condition like high blood pressure, diabetes, etc., that can be effectively managed by undergoing regular check-ups and living a healthy lifestyle.

In people with a history of hepatitis B, certain conditions can reactivate the virus that may damage the liver and cause acute liver failure. Conditions that can reactivate the virus in the body include:

• Human immunodeficiency virus (HIV) infection


• Medicines used to treat hepatitis C


• Medicines taken to weaken the immune system, such as medicines used in chemotherapy, rheumatoid arthritis, inflammatory bowel disease. Such medicines are also given to people who have undergone organ or bone marrow transplant surgery. 

Complications

The complication associated with acute and chronic cases of hepatitis B are as follows:

1. Acute hepatitis B: The liver of people affected with acute hepatitis B can stop working suddenly, resulting in a condition known as acute liver failure. The condition can turn severe in a few cases resulting in the need for a liver transplant.


2. Chronic hepatitis B: The complications that could occur in people with chronic hepatitis B are as follows:


3. Cirrhosis: It is a condition wherein the liver’s healthy tissue is replaced by scar tissue, which affects the blood supply and normal working of the liver. 


4. Liver cancer


5. Liver failure: It is also known as end-stage liver disease. This is a condition wherein the liver completely stops working. Some people with liver failure require a liver transplant. 

References

1. Johns Hopkins Medicine. Hepatitis B [Internet]. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis/hepatitis-b#:~:text=Hepatitis%20B%20is%20a%20redness,%2C%20vaginal%20secretions%2C%20and%20saliva. Accessed on Feb 25, 2021.

2. familydoctor.org. Hepatitis B [Internet] [Updated Sep 22, 2020]. Available at: https://familydoctor.org/condition/hepatitis-b/. Accessed on Feb 25, 2021.

3. Health direct. Hepatitis B [Internet] [Updated May, 2020]. Available at: https://www.healthdirect.gov.au/hepatitis-b. Accessed on Feb 25, 2021.

4. Centers for Disease Control and Prevention. Hepatitis B questions and answers for health professionals [Internet] [Updated Jul 28, 2020]. Available at: https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#treatment. Accessed on Feb 25, 2021.

5. National Institute of Diabetes and Digestive and Kidney Diseases. Hepatitis B [Internet] [Updated Jun, 2020]. Available at: https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-b. Accessed on Feb 25, 2021.

6. BetterHealth Channel. Hepatitis B [Internet] [Updated Sep, 2018]. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-b#:~:text=It%20is%20transmitted%20through%20contaminated,people%20in%20high%2Drisk%20groups. Accessed on Feb 25, 2021.

7. Cleveland Clinic. Hepatitis B [Internet] . Available at: https://my.clevelandclinic.org/health/diseases/4246-hepatitis-b. Accessed on Feb 25, 2021.

8. NHS. Hepatitis B [Internet] [Updated Jan 30, 2019]. Available at: https://www.nhs.uk/conditions/hepatitis-b/. Accessed on Feb 25, 2021.