Hepatitis

Hepatitis is a liver disease that describes the inflammation of the liver.

The liver does not work properly as a consequence of the inflammation and its main functions are altered.

The main functions of the liver are:

• Remove toxins from the bloodstream.
• Produce essential substances for the body (cholesterol, albumin, and other plasma proteins).
• Store and dispense glucose, vitamins, and minerals.
• Secrete the bile for the digestion of lipids.

Hepatitis is a group of diseases that can be classified according to their underlying cause. The main types are:

• Viral hepatitis (caused by viruses)
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
• Alcoholic hepatitis (caused by excessive alcohol consumption)
• Autoimmune hepatitis (where the immune system attacks the liver)
• Toxic or drug-induced hepatitis (an adverse reaction to certain substances or drugs)

Depending on the duration, hepatitis can be classified into:

• Acute (rapid onset and short-term)
• Chronic (long-term)

When the underlying cause of hepatitis is a virus, it is considered an infectious disease. Therefore, it is a contagious disease. The main modes of transmission are:

• Hepatitis A: It has a fecal-oral transmission. It spreads through contact with food (such as crustaceans) or water that was previously contaminated with infected stool. It can also be transmitted through contaminated objects.
• Hepatitis B: It is transmitted through contact with infected blood (contaminated blood transfusions or needles), sweat, semen, saliva, or tears. It may also be transmitted through vaginal secretions via open wounds or mucous membranes. The placenta may also spread the virus to the fetus. Hepatitis B may also be sexually transmitted.
• Hepatitis C: It is mainly transmitted parenterally through transfusions, injections, etc. It may also be transmitted sexually, although to a lesser degree than hepatitis B. Finally, it can also be transmitted during labor to the newborn.
• Hepatitis D: It is transmitted to similarly to hepatitis B, but it is frequently linked to intravenous illegal drugs or blood transfusions. The hepatitis D virus needs the hepatitis B virus to develop, so it is associated with hepatitis B.
• Hepatitis E: It is transmitted similarly to hepatitis A (fecal-oral transmission). The virus may be present in the stools. Stools with the virus may contaminate water. This water may be later used to wash food and even to drink.

The symptoms depend on the type of hepatitis. It may be asymptomatic (only detected in blood tests done for other purposes) or it may appear flu-like symptoms.

The most common symptoms of all types of hepatitis are:

• General malaise and fatigue.
• Moderate fever.
• Loss of appetite.
• Upper abdominal pain.
• Nausea and vomiting.
• Choluria (dark urine).
• Acholia (pale, white or putty colored stools).
• Jaundice (yellowing of the skin and eyes).

Other less common symptoms may be:

• Muscle pain
• Headache
• Itchy skin
• Arthritis

If jaundice (yellowing of the mucous membranes and skin) appears, hepatitis is a distinct possibility. The urine will be darker and the stools may be pale because of the excess of bilirubin.

When hepatitis is a possibility, it is advisable to perform a blood test to detect the disease. The blood test will show an increase in transaminases (liver enzymes that appear in the bloodstream).

Once hepatitis is diagnosed, it is appropriate to discern the type of hepatitis.

For viral hepatitis, a serology is recommended to diagnose the specific type of viral hepatitis, since the evolution and prognosis are different depending on each type.

Treatment depends on the type of hepatitis. Only certain types have specific treatments. However, there are some general recommended rules:

• Rest
• Drink plenty of fluids
• Avoid medication that may have liver toxicity (pain relievers, sedatives, etc.)
• Follow a diet high in protein and low in fats until blood transaminase levels decrease

Hepatitis A and hepatitis B may require specific immunoprophylaxis that may prevent or reduce the symptoms, even if it is administered two weeks after the infection.

In case of alcoholic or drug-induced hepatitis, it is essential to stop drinking alcohol or withdraw the medication.

In severe cases, a liver transplant may be necessary as a last resort.

Most people will recover on their own with no lasting liver damage. Sometimes, depending on the type of hepatitis, the disease may come chronic (for example, hepatitis C has a high chance of becoming chronic). In rare cases, hepatitis may be fulminant with sudden death as a consequence of hepatic failure.

In some cases, hepatitis may progress to cirrhosis or liver cancer.

Some types of hepatitis can be prevented. For example, there are vaccines for viral hepatitis A and B that can be administered to people at risk.

To avoid alcoholic hepatitis, it is advisable to reduce alcohol consumption.

Risk factors depend on the type of hepatitis, but the following can be noted:

• Viral hepatitis
  • Hepatitis A: Lack of hygiene practices during meals or in the food processing, as well as drinking contaminated water, are the most common cause of infection.
  • Hepatitis B: The main risk factor is working as a health care provider due to the use of needles and wound care, etc. Additionally, living with chronic carriers of the virus is also a risk factor. Other factors include intravenous drugs, promiscuity, or hemophilia.
  • Hepatitis C: The risk factors are similar to those of hepatitis B since it is spread through the blood or body fluids and secretions.
  • Hepatitis D: The most significant risk factor is having a previous hepatitis B infection.
  • Hepatitis E: The most important risk factor is the consumption of contaminated water or undercooked meat from infected animals.
• Alcoholic hepatitis: The combination of alcohol abuse and malnutrition are the main risk factors.