Hepatitis -- types, causes, symptoms, diagnosis, treatment and prevention

According to the World Health Organisation (WHO), approximately 500 million people are affected by hepatitis every year, which comes to the ratio of 1:12 being affected by the condition at a given time. The incidence of hepatitis is especially high in developing countries like India, implying that there is an increased need for awareness about the condition.

What is hepatitis?

The term ‘hepatitis’ refers to inflammation of the liver. But it is mainly used to address a life threatening condition caused due to viral infection of the liver.

Causes of hepatitis:

There are various factors that can cause inflammation of the liver. Here are the main causes:

Viral infection: Infection caused by viruses such as hepatitis A, hepatitis B or hepatitis C is the main cause of hepatitis all over the world.
Autoimmune condition: In some cases, the immune cells of the body can recognize liver cells as harmful and raise a response against them. This causes destruction due to inflammation of the liver cells.
Alcohol intake: Alcohol is directly metabolized by the liver diverting it from its several other main functions. Heavy intake of alcohol therefore can lead to hepatitis.
Medication overdose: Certain medicines like acetaminophen when taken in more quantities or intake of some poisonous substances can cause inflammation of the liver cells.

Types of hepatitis

Hepatitis caused by viral infection is categorized into 5 main types depending on the viral agent causing the disease. These five types of hepatitis are currently of the greatest concern all over the world because they account for a huge burden of illness, outbreaks and epidemic spread, resulting in increased death cases.

1. Hepatitis A: According to the WHO globally there are about 1.4 million cases of hepatitis A every year. It is caused by Hepatitis A virus (HAV) that is transmitted through contaminated food and water. It can also be acquired through certain unsafe sex practices. HAV infection is usually mild and patients can fully recover. But in some cases HAV infections can be potentially severe as well as life threatening. Mostly people living in poor hygienic conditions are more prone to acquire the virus.

2. Hepatitis B: As per the WHO fact sheet, about 6 lac people die every year due to the hepatitis B. The condition is caused by Hepatitis B virus (HBV). HBV is mainly transmitted due to transfusion of infected blood or exposure to infected semen and other body fluids. Mothers carrying HBV can transmit the virus to their babies at the time of birth. Transmission may also occur by using of contaminated injections during medical procedures and through injectable drug use. Here’s a detailed account on causes, symptoms, diagnosis and treatment of hepatitis B.

3. Hepatitis C: It is caused by Hepatitis C virus (HCV), mostly transmitted by exposure to infected blood, transfusion contaminated blood and blood products, usage of contaminated injections during medical procedures, and through injected drugs. HCV can also be transmitted through sexual transmission, but is much less common. On an average, more than 130–150 million people get affected globally with HCV. Here’s everything you should know about hepatitis C.

4. Hepatitis D: It is caused by Hepatitis D virus (HDV). It occurs only in people who are already infected with HBV. Infection of HDV and HBV together can be extremely serious and may result in worse outcome. Vaccination against HBV can provide effective protection against HDV infection.

5. Hepatitis E: It is caused by Hepatitis E (HEV) virus. It is the most common cause of hepatitis outbreaks occurring in most developing parts of the world. It is transmitted through contaminated water or food. WHO estimates indicate that there are approximately 20 million incidents of hepatitis E infections every year.

Hepatitis can be either acute or chronic depending on the severity of the condition.

Acute hepatitis: It is sudden onset of inflammation of liver that may last for less than 6 months. Patients show quick recovery. HAV infection usually results in acute hepatitis.

Chronic hepatitis: It can last longer than 6 months and can also lead to severe liver damage, liver failure or even liver cancer. Chronic HCV infection affects 13—150 million people worldwide causing a significant number of deaths due to liver cancer and failure. HEV infection can also become chronic in patients with compromised immune system.

Symptoms of Hepatitis

Acute infection may occur with limited or no symptoms but in chronic cases the following symptoms may be seen:

Jaundice, yellowing of the skin and eyes
Dark coloured urine
Extreme fatigue
Nausea
Vomiting
Stomach pain and bloating
Itching
Loss of appetite
Weight loss

A person may not develop symptoms at first when infected with HBV or HCV. But such cases can still progress to liver failure.

Diagnosis of hepatitis

Based on your symptoms, your doctor will conduct a physical examination to look for enlargement of the liver, yellowing of the skin and presence of fluid in the abdomen. Further you may be required to undergo the following tests.

Liver function tests: When the liver cells get damaged, liver enzymes get released into the bloodstream which serve as a marker to diagnose hepatitis. For example, increased levels of enzymes like alkaline phosphatase and alanine transaminase can indicate hepatitis. Here are some more liver function tests you should know about

Ultrasound of the abdomen: Ultrasound uses sound waves to produce image of the abdomen. It enables the doctor to visualize the size and structure of liver. It also helps in evaluating jaundice or abnormal liver function tests. It can also show the presence of solid mass, cyst or tumor in the liver.

Autoimmune blood markers: In case autoimmune hepatitis is suspected, the doctor can recommend you to take blood tests for autoimmune blood markers (autoantibodies specific to liver cells).

Tests to diagnose Hepatitis A, B, or C: There are several blood tests like immunoassasy and genetic material testing that can specifically identify the type of virus causing hepatitis.

Liver biopsy: A liver biopsy is a helpful procedure to identify the extent of liver injury.

Paracentesis: It is a diagnostic procedure in which a thin tube is inserted into the abdomen for collecting fluid (ascites). Further testing of the fluid is carried out to identify whether or the not the fluid build up is caused due to hepatitis.

Treatment and prevention

Acute hepatitis (HAV and HEV) gets relieved within a few weeks of infection. Chronic hepatitis is treated with oral medication.

Hepatitis B is treated with antiviral medicines like lamivudine and adefovir dipivoxi.
HCV infection is treated with ribavirin. A combination of drugs including peginterferon and ribovarin is relatively moer effective than a single drug.
Liver transplantation is an option for patients with liver failure and irreversible liver damage.

Here are some preventive measures for keeping hepatitis away:

Hepatitis B and C can be prevented by reducing the risk of transmission of the virus through the following ways:

Do not share razors, toothbrushes and needles to prevent risk of infection.
Be careful about equipment used while tattooing.
Ensure body piercings are done with equipment that is clean.
Practice safe sex.

Hepatitis A infection can be prevented by:

Maintaining high level of hygiene.
Washing your hands well after using the restroom and before eating meals.
Avoiding eating at unhygienic or contaminated places.

Children should be vaccinated against hepatitis. According to recommendation by the Center for Disease Control and Prevention (CDC), infants as well as individuals up to 18 years of age and adults should be vaccinated with 3 doses over a period of six to 12 month to gain full protection.

References:

Hepatitis. World Health Organization (WHO) (www.who.int)

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Published: June 3, 2014 4:12 pm | Updated:June 12, 2014 2:28 pm

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