Hepatitis is an overall term for the inflammation of the liver. The liver is a vital organ in the human body which performs several functions that aid in metabolisms such as the breakdown of certain nutrients, activation of enzymes, toxin filtration, blood protein and clotting factors syntheses.
Inflammation of the liver could be self-resolving or progressive leading to cirrhosis, cirrhosis or liver cancer. The most common cause of hepatitis is viruses, which accounts for about 50% of all cases. However, certain medications, excessive alcohol intake and other toxins could also lead to liver inflammation. Also, the body itself could produce antibodies against the liver, thus leading to autoimmune hepatitis.
Statistics About Hepatitis
By the end of 2015, according to the WHO, approximately 325 million people were living with chronic hepatitis and 1.34 million deaths were recorded in the same year due to viral hepatitis, which is more than those caused by HIV. Nigeria is one of the 11 countries which carry 50% of the burden of the global burden of chronic hepatitis with about 13.7% (20-30 million people) of the population affected by the disease.
However, hepatitis is highly preventable via safe practices and vaccines. Treatment and management strategies are also available.
This is caused by viruses and is the most common presentation of hepatitis. There are 5 main hepatitis virus strains; A, B, C, D, E. Only about 7% of existing cases in every year are actually reported. These viruses could lead to acute or chronic hepatitis and there are various ways these viruses are transmitted.
Hepatitis A (HAV)
Formerly known as infectious hepatitis because of the ease of transmission between individuals, HAV causes acute hepatitis. It is spread mostly via the consumption of infected food and water or the fecal-oral route. It can also be spread through the exchange of oral secretions (as in intimate kissing) and through sexual (anal-oral route).
Most of the worldwide spread of this virus happens in areas with low socioeconomic status, poor hygiene or common fecal-oral contact, like daycare centres. The incubation period is 2 to 6 weeks and there are safe and effective vaccines to prevent Hepatitis A.
Hepatitis B (HBV)
This is one of the most common forms of hepatitis. The HBV virus is transmitted via body fluids like semen, blood from an infected person. This could be through sexual contact, drug-injection equipment like needles, sharp objects like razors or from mother-to-child during birth. The effect of this virus could be short-term or chronic. The risk for chronic infection is related to age at infection as 90% of infected infants become chronically infected, compared with 2%–6% of adults. The incubation period is 2 to 5 months and vaccination is available to prevent HBV infection.
Hepatitis C (HCV)
HCV can be transmitted via the percutaneous contact with blood which could be via blood transfusion, shared needles in drug abusers or haemodialysis, among others. Viral transmission is possible via perinatal or sexual means, but this is rare. Together with HBV, Hepatitis C constitute the most common source of liver cancer and cirrhosis. The incubation period is 2 weeks to 6 months and HCV has no vaccines available yet.
Hepatitis D (HDV)
Hepatitis D usually occurs concomitantly with HBV because the virus cannot survive without the presence of HBV. A combination of both viruses usually leads to faster disease progression and a more difficult treatment regimen. It is usually transmitted in similar ways as HBV.
Hepatitis E (HEV)
This is mostly contracted through the oral intake of fecal matter present in contaminated water and food. It is usually self-limiting and does not result in chronic infections. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.
Hepatitis G Virus (HGV) has been found to be present as a co-infection in Hepatitis B and C but clears in 75% of the infection.
Cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella-zoster virus (VZV) may also cause inflammation of the liver, but they do not primarily target the liver.
Common Symptoms Of Hepatitis
Most people with HAV, HBV and HCV infections usually have little symptoms or are asymptomatic. When the symptoms do occur, they are usually similar across viruses and are usually flu-like. They include;
Loss of appetite, nausea, vomiting, abdominal pain, fever, weakness.
Other symptoms include; yellowing of eyes or skin (which may be jaundice), dark urine, light coloured stools, unexplained weight loss.
Diagnosis Of Hepatitis
Prior to any laboratory investigations, the doctor will take a comprehensive history of the patient’s health to determine signs and risk factors. Acute viral hepatitis is commonly confirmed by blood tests after the presence of the aforementioned symptoms has been ascertained.
However, chronic infections are usually asymptomatic or have mild non-specific symptoms, hence, patients could remain undiagnosed for years.
There are three types of blood tests for evaluating patients with hepatitis: liver enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic material (viral DNA or RNA).
An abdominal ultrasound may be requested and is useful for differential diagnosis. a liver biopsy may also be done to see the extent of liver tissue damage.
Prevention of Viral Hepatitis
Like other diseases, prevention of hepatitis is preferable to treatment.
Increased hygiene practices such as proper refuse disposal, thorough washing of food, proper handwashing practices, should be encouraged and promoted in communities.
Precaution should be taken to protect oneself from bodily fluids of others. Having unprotected sex with multiple partners is highly discouraged. Personal effects such as toothbrushes should not be shared. Unnecessary exposure and careless handling of sharp objects like razors, needles must be minimized.
Vaccination is available for HAV, HBV (consequently, HDV) and HEV. When given to infants, children and adults who have not been exposed to the virus, they provide protection from the disease for a long time. Hepatitis B vaccines are 90% effective in infants and 95% effective in adults
Immunoglobulins could also be given to people who have been exposed to the virus to prevent infection. There are different types for the viruses.
Treatment/ Management of Hepatitis
This is usually dependent on whether it is an acute or chronic phase of/ the disease. Alcohol intake and smoking should be totally eliminated and drug use minimized. These could hasten the progression of the disease.
This is usually acute and self-limiting, hence, it mostly requires a symptomatic resolution until it resolves. For example, hydration and proper nutrition after vomiting. Care should be taken when giving the patient med
The acute phase is not treated with drugs but the chronic phase is treated with antiviral medication.
Chronic Hepatitis B is treated with prescription-only antiviral medication. They may be taken for a long time and the regimen requires monitoring. Vaccines are available, for all ages, to protect against this disease.
Antiviral drugs are used to treat both acute and chronic forms of the disease. A combination of drugs may be needed for effectiveness.
Due to the constant development of safer, more effective antiviral drugs for hepatitis B and C, the drug regimen is likely to be reviewed every year.
There is no antiviral treatment regimen available currently but a 2013 study has suggested the use of alpha interferon. However, this has been effective in about 25% to 30% of all cases.
Currently, there are no medical therapies for this disease. However, it usually resolves on its own. Patients are advised to stay hydrated, get enough rest and avoid alcohol.
Corticosteroids such as prednisolone and budesonide are usually effective in about 80% of cases. Immunosuppressants like azathioprine and budesonide are usually very used alone or in combination with corticosteroids.
Hepatitis could lead to complications such as cancer (hepatocellular carcinoma), liver cirrhosis, liver failure and possibly death. on the other hand, the prognosis is usually as virtually all patients with acute HAV infection and over 95% of adults with acute Hepatitis B recover fully.
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