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Hepatitis is an inflammation of the liver that can affect how the liver works.
What is going on in the body?
The liver is an important organ in the body located in the upper right quadrant of the abdomen. It is responsible for:
If the liver becomes inflamed, its ability to perform these functions may be impaired. Liver disease can be caused by a variety of conditions including viral infections, bacterial invasion, and chemical or physical changes within the body.
- filtering the blood
- making bile, a substance that aids in digestion and helps rid the body of harmful substances
- processing fats and sugars, helping the body store energy for later use
- making important proteins, such as those involved in blood clotting
- metabolising many medications, such as barbiturates, sedatives, and amphetamines
- storing vitamins A, B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.
Symptoms of hepatitis may be acute, occurring suddenly, or chronic, developing slowly over a long period of time. Hepatitis may range from mild to severe depending on the type of hepatitis infection. There are 5 main forms of hepatitis, each named for the type of virus causing the inflammation. These are:
Hepatitis B, C, and D can cause lifelong symptoms and problems in the liver as well as in other parts of the body.
- hepatitis A, which usually only causes problems in the liver. It is primarily spread through food or water that is contaminated by the hepatitis A virus from an infected person. Hepatitis A often occurs in epidemic settings.
- hepatitis B, which has been found in blood, saliva, semen, and vaginal secretions. It can be spread through sexual contact with an infected individual, passed on to a newborn from an infected mother during childbirth, or transmitted from contact with infected blood or bodily fluids.
- hepatitis C, which may be spread by infected IV drug users, by blood transfusions that were not screened for hepatitis, and by some organ transplants. Sharing contaminated personal hygiene items, such as toothbrushes and razors, may also cause the spread of hepatitis C.
- hepatitis D, which is spread through contaminated needles or sexual contact. Hepatitis D cannot survive in the body unless the person is also infected with the hepatitis B virus.
- hepatitis E, which is found primarily in underdeveloped countries with poor sanitation. It is primarily spread through food or water contamination.
What are the signs and symptoms of the disease?
Symptoms partly depend on the type of hepatitis and the degree of inflammation and infection. In many cases, no symptoms are present. Signs and symptoms may include: In a rare but severe form of hepatitis called acute fulminant hepatitis, symptoms are associated with signs of liver failure, including:
What are the causes and risks of the disease?
- an enlarged and tender liver
- enlarged spleen
- susceptibility to bleeding
- encephalopathy, which is a disorder that affects how the brain functions
- changes in mental status and level of consciousness
- ascites, which is an accumulation of fluid inside the abdomen
- oedema, or swelling under the skin
- aplastic anaemia, a condition in which the bone marrow cannot make blood cells
The causes and risks of hepatitis vary, depending on the form of hepatitis. The hepatitis virus may be spread a number of ways, including:
What can be done to prevent the disease?
- sexual contact with a person who is infected by the virus
- shared IV drug needles
- intranasal cocaine use
- exposure to infected healthcare workers, including dentists
- contamination of a healthcare worker during patient care
- contaminated blood transfusions that were given prior to the screening for hepatitis C
- food or water that has been contaminated by faeces from an infected person
- contaminated water and food consumed during travel to Third World countries
- exposure to the infected mother during childbirth
- organ transplantation
- sharing contaminated personal hygiene items, such as razors, toothbrushes, or nail clippers.
Preventing types A, B, and C hepatitis is possible by receiving the hepatitis A, hepatitis B, or hepatitis C vaccine. Other ways to decrease the risk of hepatitis include:
How is the disease diagnosed?
- practicing good hygiene, such as washing hands well after using the restroom or changing nappies
- avoiding drinking or using tap water when travelling internationally
- avoiding behaviours like sharing drug needles, or having unprotected sexual intercourse with an infected person
- avoiding the sharing of personal hygiene items, such as razors or nail clippers
- avoiding toxic substances and decreased alcohol consumption
- an injection of immune globulin after exposure to hepatitis A or B, which may prevent the infection from developing
- the use of safety precautions by healthcare and day care workers
Hepatitis may be diagnosed using a variety of tests. It can be suspected after a physical examination. Further tests may be ordered, including: A liver biopsy may be recommended in some cases. This involves obtaining a piece of liver tissue with a needle for evaluation. Liver biopsy specimens can be graded in terms of severity. Liver biopsies may have to be done repeatedly to detect progression of the disease or response to therapy.
What are the long-term effects of the disease?
Chronic hepatitis can lead to:
What are the risks to others?
- cirrhosis and liver failure in adults, which does not generally occur in children. Cirrhosis causes multiple problems, including the possibility of liver cancer.
- illnesses in other parts of the body, such as kidney damage or low blood counts
- cancer of the liver
- increased risk of death in people with HIV
Hepatitis is highly contagious and can be spread to others. The risk of exposure to others will depend on the type of hepatitis.
What are the treatments for the disease?
Treatment of hepatitis varies according to the type and severity of the disease, but may include: Further treatment will depend on the type of hepatitis and the extent of the infection. For example, treating hepatitis B, C, and D may involve the use of medications such as the antiviral medication alpha interferon. Other medications may include ribavirin, lamivudine, steroids, and antibiotics.
Acute fulminant hepatitis can cause life-threatening liver failure. This requires a hospital stay and treatment for the bleeding disorder and for neurological and nutritional problems. Sometimes the only effective treatment is a liver transplant.
What are the side effects of the treatments?
Side effects will depend on the treatments used. Side effects of interferon include a flu-like illness, with fever and body aches.
Liver transplant can cause many problems, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful anti-rejection medications for the rest of his or her life. Side effects of these medications increase the risk for infections, certain cancers, and other problems.
What happens after treatment for the disease?
What occurs after treatment will depend on the type of hepatitis and the response to treatment. For example, with hepatitis A and hepatitis E, people will not usually need medication after the disease has been resolved. They can return to a normal lifestyle when symptoms are gone even if they still have some jaundice.
A person with hepatitis B, C, and D will be monitored for side effects and benefits during and after interferon treatment. Alpha interferon treatment might be repeated if the disease flares up again.
A person who has received a liver transplant is checked for viral hepatitis as well as for function of the new liver.
How is the disease monitored?
Monitoring of hepatitis will depend on the type of hepatitis. Periodic visits to the doctor and liver function tests will be used to monitor the hepatitis and to see how the liver is working. The status of the liver may require repeated liver biopsies. Decisions for further treatment or liver transplantation are frequently made based on these tests. Any new or worsening symptoms should be reported to the doctor.
Author: Eileen McLaughlin, RN, BSN
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request