HEPATITIS

INTRODUCTION Hepatitis means "inflammation of the liver." It is a disorder in which viruses or other mechanisms produce inflammation in liver cells, resulting in their injury or destruction. The liver is the largest internal organ in the body, occupying the entire upper right quadrant of the abdomen. It performs over 500 vital functions. The esophagus, stomach, large and small intestine -- aided by the liver, gallbladder, and pancreas -- convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Definitions Inflammation of the liver, usually caused by bacterial or viral infection, drugs (including alcohol), toxins, or parasites. This disease is characterized by an enlarged liver, jaundice, diminished appetite, nausea, and abdominal pain. There are at least three forms of viral hepatitis (hepatitis A, hepatitis B, and non-A, nonB hepatitis). Hepatitis A, also known as infectious hepatitis, is transmitted by contaminated food or water and personal contact, and is most often found in children or young adults. Hepatitis B, formerly called serum hepatitis, may be transmitted through contaminated blood or needles, as well as sexually, and has a longer incubation period than that of hepatitis A. Hepatitis B can result in chronic active hepatitis. Non-A, non-B hepatitis is also transmitted through blood and can cause severe liver damage. Radioimmunoassays and enzyme-linked immunosorbent assays may be used to screen for hepatitis.

Types: 1. the hepatitis A virus 2. the hepatitis B virus 3. the hepatitis C virus

Hepatitis A Hepatitis A (also called infectious hepatitis) is a common form of hepatitis in children. It's caused by the hepatitis A virus (HAV), which is present in the stool (feces or poop) of infected people. Infected stool might be found in small amounts in food and on objects (such as doorknobs and diapers). Hepatitis A can remain in the stool for several months after the initial illness, especially in younger babies and children. HAV is spread:

when someone ingests anything contaminated with HAV-infected stool (making it easy for the virus to spread in overcrowded, unsanitary living conditions) in water, milk, and foods (especially shellfish)

Because hepatitis A can be a mild infection, particularly in children, some people might not know that they've had it.

HAV can cause prolonged illness for up to 6 months, but usually only causes short-lived, mild illness.

Hepatitis B Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide range of symptoms, from a mild illness and general feeling of being unwell to more serious chronic liver disease that can lead to liver cancer.

HBV spreads through: infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine

a contaminated blood transfusion (this is uncommon in the United States) shared contaminated needles or syringes for injecting drugs sexual activity with an HBV-infected person transmission from HBV-infected mothers to their newborn babies

Hepatitis C The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. Symptoms can be very similar to those of hepatitis A and B. However, infection with HCV can lead to chronic liver disease and is a leading reason for liver transplantation in the United States. Chronic HCV infection is also associated with liver cancer. HCV is more common in adults than in children. In kids, it's often acquired through transmission from a mother to her newborn. It also can be spread by:

sharing drug needles and intranasal drug use (snorting drugs) getting a tattoo or body piercing with unsterilized tools blood transfusions or organ transplants (especially before 1992; since then the U.S. blood supply and donated organs have been routinely screened for hepatitis C) sexual contact (although this is less common)

hemodialysis (especially before 1990) Rarely, people living with an infected person can contract HCV by sharing items that might contain that person's blood, such as razors, toothbrushes, or scissors.

causes:

jaundice foul breath

a bitter taste in the mouth dark or "tea-colored" urine white, light, or "clay-colored" stools Abdominal pain also can occur, which may be centered below the right ribs (over a tender, swollen liver) or below the left ribs (over a tender spleen).

DIAGNOSIS All of these viral hepatitis conditions can be diagnosed throughblood tests. Liver function tests might be used to determine how well the liver is working or if it is damaged. Sometimes, a liver biopsy (the removal of a small liver tissue sample for examination) is done to further check for organ damage. A liver biopsy also can help doctors choose the best treatment. Ultrasounds or CAT scans can check for any progression to cancer, particularly in chronic HBV and HCV infection.

Signs and Symptoms Hepatitis, in its early stages, may cause flu-like symptoms, including:

malaise (a general ill feeling) fever muscle aches abdominal pain loss of appetite nausea vomiting diarrhea

jaundice (a yellowing of the skin and whites of the eyes) But some people with hepatitis have no symptoms and might not know they're infected. Children with hepatitis A, for example, usually have mild symptoms or none at all. If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

jaundice foul breath a bitter taste in the mouth dark or "tea-colored" urine white, light, or "clay-colored" stools Abdominal pain also can occur, which may be centered below the right ribs

(over a tender, swollen liver) or below the left ribs (over a tender spleen).

Contagiousness Hepatitis A, hepatitis B, and hepatitis C are all contagious. The hepatitis A virus spreads through contaminated food or water, as well as unsanitary conditions in childcare facilities or schools. Toilets and sinks used by an infected person should be cleaned with antiseptic cleansers. People who live with or care for someone with HAV should wash their hands after contact with the infected person. In addition, before traveling to countries where HAV is common, kids should receive at least two doses of the hepatitis A vaccine. The hepatitis B virus can be found in virtually all body fluids, though its main routes of infection are through sexual contact, contaminated blood transfusions, and shared needles for drug injections. Household contact with adults with HBV can put people at risk for contracting hepatitis. But frequent hand

washing and good hygiene practices can reduce this risk.All kids in the United States are routinely vaccinated against hepatitis B at birth and use of the hepatitis B vaccine can greatly decrease the risk of infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they're at risk. The hepatitis C virus can spread through shared drug needles, contaminated blood products, and less commonly through sexual contact. It can spread from a mother to her fetus during pregnancy, but this risk is about 5%. If you're pregnant, contact your doctor if you think you may have been exposed to hepatitis C.

Duration For viral hepatitis, the incubation period (the time it takes for a person to become infected after being exposed) varies depending on which hepatitis virus causes the disease:

hepatitis A: 2 to 6 weeks hepatitis B: 4 to 20 weeks hepatitis C: 2 to 26 weeks Hepatitis A is usually active for a short period of time and, once recovered, a

person can no longer pass the virus to others. It's very rare for someone to become a chronic carrier of hepatitis A. Almost all previously healthy people who develop hepatitis A will completely recover from it in a few weeks or months without longterm complications. With hepatitis B, 85% to 90% of patients recover from their illness completely within 6 months without long-term complications. However, 75% to 85% of those who are infected with hepatitis C do not recover completely and are more likely to continue to have a long-term infection. People with hepatitis B (the percentage who don't recover completely) or hepatitis C who

continue to be infected can go on to develop chronic hepatitis and cirrhosis of the liver (the chronic degeneration and disruption of the structure of the liver). Some people with hepatitis B or C also may become lifelong carriers of these viruses and can spread them to others.

Prevention In general, to prevent viral hepatitis you should:

Follow good hygiene and avoid crowded, unhealthy living conditions. Take extra care, particularly when drinking and swimming, if you travel to areas of the world where sanitation is poor and water quality is uncertain.

Never eat shellfish from waters contaminated by sewage. Remind everyone in your family to wash their hands thoroughly after using the toilet and before eating.

Use antiseptic cleansers to clean any toilet, sink, potty chair, or bedpan used by someone in the family who develops hepatitis.

Because contaminated needles and syringes are a major source of hepatitis infection, it's wise to encourage drug awareness programs in your community and schools. At home, speak to your kids frankly and often about the dangers of drug use. It's also important to encourage abstinence and safe sex for teens to protect them from hepatitis infection through sexual contact.

A hepatitis A vaccine is available for anyone 12 months of age or older. In the past, it was recommended only for those at high risk for infection (such as those who lived in or traveled to areas with high rates of HAV), but is now available to anyone seeking immunity to HAV. If you plan to travel, consult your doctor in advance so you and your family have time to complete any required immunizations. The HAV vaccine also is useful for staff of childcare facilities or schools where they may be at risk of exposure.

The hepatitis B vaccine is given to both children and adults as part of routine immunization. Unfortunately, there's no vaccine for hepatitis C studies indicate that it may not be possible because the virus doesn't cause the kind of response needed for a vaccine to be successful.

Treatment Hospitalization might be necessary when symptoms are severe or laboratory tests show liver damage. Here's a quick look at the treatments available for the various hepatitis viruses:

No medications are used to treat hepatitis A because it's a short-term infection that goes away on its own.

Chronic hepatitis B can sometimes be treated using medications. Several drugs are approved for use in adults. Most are not approved for use in children but some are used in select circumstances. Not all patients with hepatitis B require medication.

The treatment of chronic hepatitis C has improved significantly with the use of two medications, interferon and ribavirin, often used in combination. Other treatments and medications are approved for use in adults, which are sometimes used in children on a research basis or if a child is nearing adulthood. Not every patient will benefit from treatment, and the treatments also have side effects.