If you are looking for information about hepatitis, follow this article.
Hepatitis is an inflammatory disease of the liver. This complication can be limited (that is, it goes away on its own or without special treatment) or can lead to fibrosis, cirrhosis, or liver cancer. Hepatitis viruses are the most common cause of hepatitis worldwide. But other infections, toxins (such as alcohol and some medications), and autoimmune diseases can also cause the disease. This disease identifies five major viruses, identified by the letters A, B, C, D, and E (hepatitis A, B, C, D, and C). These viruses are highly concerned about the disease and its mortality and the potential for its spread, especially hepatitis B and C, which cause chronic disease in hundreds of millions of people and are a significant cause of cirrhosis and liver cancer. Are. (Fatty Liver: Symptoms, Prevention, Causes, And Treatment)
Hepatitis A and E are usually caused by eating contaminated food or water. Hepatitis B, C, and D are usually the result of transient contact with infected body fluids. Standard methods of transmitting these viruses include receiving contaminated blood or blood products, invasive medical procedures using contaminated tools for hepatitis B, mother-to-child transmission at birth, family members, and sexual contact. Acute infection may be asymptomatic or with limited symptoms. It may present with jaundice (darkening of the skin and whites of the eyes), dark urine, extreme tiredness, nausea, vomiting, and abdominal pain.
What is viral hepatitis?
Many viruses, such as EBV mononucleosis and cytomegalovirus, can cause inflammation of the liver. Although most viruses do not explicitly attack the liver, the liver is just one of several organs affected by the virus. When doctors talk about viral hepatitis, they mean the disease is caused by certain viruses that mainly attack the liver and are responsible for half of all human cases. There are several types of viral hepatitis known as A, B, C, D, E, F, and G. The most common types of hepatitis A virus are B, B, and C. The symbols HAV, HBV, and HCV is often used to denote hepatitis A, B, and C viruses.
Hepatitis viruses multiply primarily in liver cells. This prevents the liver from performing its functions. The following is a list of the most important liver functions:
- The liver helps purify the blood by converting harmful chemicals into harmless ones. The source of these chemicals can be external; Such as drugs or alcohols, or of internal origins such as ammonia or bilirubin. These harmful chemicals are broken down into smaller chemicals or attached to other chemicals that can be excreted in the urine or feces.
- The liver is the site of the production of some proteins vital to health; for example, the liver produces albumin and proteins involved in the blood coagulation process.
- The liver stores many sugars, fats, and vitamins as long as they are needed elsewhere in the body.
- The liver converts smaller chemicals into larger, more complex chemicals that the body needs. Examples of this type of action are making a fat called cholesterol and a protein called bilirubin.
When the liver becomes inflamed, it cannot perform these functions properly. The consequence of this disability is the development of many symptoms and health problems associated with any hepatitis.
Types of viral hepatitis:
The most common types of viral hepatitis are HAV, HBV, and HCV. Today, however, prevention techniques and vaccines have significantly reduced the prevalence of viral hepatitis infections.
In developing countries with poor health, most children become infected with the hepatitis A virus before 10. People who become infected in childhood do not experience significant symptoms. In such cases, epidemics are uncommon, as older children are generally immune. In these areas, the prevalence of the symptomatic disease is low. On the other hand, among developing countries, countries with transition economies, and areas where health conditions are changing, children often escape infection early in childhood and reach adulthood without safety. This condition can lead to an accumulation of adults who are not infected and do not have immunity.
This high susceptibility in older age groups may lead to increased disease rates and widespread disease prevalence in these communities. In developed countries with the right health conditions, the rate of infection is low. The disease can occur in adolescents and adults in high-risk groups such as injecting drug users, men having sex with other men, travelers to high-prevalence areas, and isolated populations such as closed communities. However, when the virus enters such communities, a high level of hygiene stops the transmission of the virus between individuals and prevents its spread. According to the study results, the serological prevalence (based on antibodies to the virus in individuals’ blood) of the hepatitis A virus in Tehran, Golestan, and Hormozgan was generally 86%.
HAV-induced hepatitis is an acute disease that never becomes chronic. Hepatitis A was once referred to as infectious hepatitis because it could be easily transmitted from person to person like other viral infections. Hepatitis A virus infections can be transmitted through the consumption of contaminated food or water, especially in areas that are not in good health and where food and water can be contaminated with human-infected feces. Hepatitis A is also spread through close contact between people and contact with oral secretions and fecal contamination.
According to the World Health Organization statistics, the highest prevalence of hepatitis B is in the western Pacific and Africa, accounting for 2.6% and 1.6% of adults, respectively. In the Eastern Mediterranean, Southeast Asia, and Europe, 3.3%, 2%, and 1.6% of the total population are infected. 0.7% of the American population is also infected.
In the past, HBV hepatitis was referred to as serum hepatitis; Because it was thought that the only way HBV could be spread was through infected blood or serum. It has now been shown that HBV can be transmitted through sexual contact, blood or serum transfusions, through shared needles in people who inject drugs, accidental contact of clean needles with infected blood needles, blood transfusion, hemodialysis, and through infected mothers. Transfer their babies. The infection can also be transmitted through tattooing (contamination of the tools used), body piercing, sharing razors, and toothbrushes (if contaminated with infected blood). About 5 to 10 percent of patients with HBV hepatitis will develop a chronic HBV infection (an infection that can last at least six months and often years and even decades) and infect others during that time. Patients with chronic HBV infection are also at risk for developing cirrhosis, liver failure, and liver cancer. It is estimated that there are 2 billion people worldwide who suffer from chronic HBV infections.
Cirrhosis is the final stage of liver fibrosis caused by various liver diseases such as hepatitis and chronic alcoholism. Cirrhosis occurs in response to liver damage. Every time the liver is injured, it tries to repair itself. In this process, wound healing tissue is created. Many of these repair tissues are formed with cirrhosis progression, and due to their presence, the liver function becomes difficult.
In total, there are about 71 million people with chronic hepatitis C infection in the world. A significant number of those with chronic infections develop cirrhosis and liver cancer. About 399,000 people die of hepatitis C each year. Hepatitis C is found all over the world. In this regard, the most polluted areas are the Eastern Mediterranean and Europe, with a prevalence of 2.3 and 1.5 percent. The prevalence of HCV infection in other areas varies between 0.5 and 1%. Depending on the country, hepatitis C virus infection may be more prevalent in some populations (for example, among people who inject drugs). Specifically, HCV prevalence was 2.52% among people who inject drugs and 5.7% in the population with liver problems. HCV is usually spread by sharing needles with injecting drug users, blood transfusions, hemodialysis, and accidental contamination of needles by contact with infected needles. About 75 to 90% of hepatitis associated with blood transfusions is HCV. Hepatitis C virus transmission is also reported through sexual contact, But it is rare. 75 to 85% of patients with acute HCV infection will continue to develop a chronic infection. Patients with chronic infection can infect others. Patients with chronic HCV infection are at risk for disease progression to cirrhosis, liver failure, and liver cancer.
Type D, E, and G hepatitis
There are also types of hepatitis D, E, and G. The most important of these is the hepatitis D virus, also known as the delta virus. It is a small virus that needs to be co-infected with HBV to survive. HDV cannot live because it needs the protein that HBV makes (envelope protein, also called a surface antigen). Ways of spreading the HDV virus through shared needles, injecting drug users, contaminated blood, and sexual contact; Necessarily the same ways that HBV is transmitted. People with chronic hepatitis caused by HBV and HDV develop liver cirrhosis quickly. Also, it is tough to treat a combination of HDV and HBV infections.
The hepatitis E virus is similar to HAV in disease and is found mainly in Asia and is transmitted through contaminated water. The hepatitis C virus (HGV or GBV-C) has recently been discovered, and although it is similar to HCV, it is more like a virus flavor. The virus and its effects are being studied, and its role in causing disease in humans is still unknown.
Who is most at risk for viral hepatitis?
- Workers working in health professions
- Asians and Inhabitants of the Pacific Islands
- Sewage and wastewater treatment workers
- People with multiple sexual partners
- Injecting drug users
- Patients with HIV infection
- People with hemophilia who receive blood clotting factors
Once a standard tool in the spread of viral hepatitis, blood transfusions are now a rare cause of hepatitis. In general, viral hepatitis is ten times more common among people with low educational and socioeconomic status. About one-third of cases of hepatitis comes from an unknown or unidentified source. This means that a person does not have to be in a high-risk group to become infected with the hepatitis virus; in countries with poor sanitation, food and water contamination with HAV increases the risk.
Signs and symptoms of viral hepatitis:
The period between exposure to the hepatitis virus and the disease’s onset is called the incubation period. This period varies depending on the type of hepatitis virus. The hepatitis A virus has an incubation period of about 15 to 45 days; The hepatitis B virus has 45 to 160 days. The incubation period of hepatitis C can last from about two weeks to 6 months. Many patients with HAV, HBV, and HCV have few or no symptoms. Viral hepatitis symptoms include loss of appetite, nausea, vomiting, fever, weakness, fatigue, and shooting in the abdomen. Of course, dark urine, light-colored stools, jaundice (on the skin and whites of the eyes) may sometimes be seen in these people.
Acute fulminant hepatitis:
Rarely, people with acute HAV and HBV infections develop severe inflammation and liver failure (acute fulminant hepatitis). These patients become severely ill with the symptoms of acute hepatitis mentioned above, as well as additional confusion or coma (due to the liver’s inability to detoxify chemicals) as well as bruising or bleeding. Up to 80% of people with acute fulminant hepatitis may die within a few days to a few weeks. Fortunately, this disease is sporadic; for example, less than 0.5% of adults with acute HBV infection will also develop acute fulminant hepatitis. This is less common with HCV alone; But when both HBV and HCV are present, the frequency increases.
Chronic viral hepatitis:
Patients infected with HBV and HCV viruses may develop chronic hepatitis. Doctors define chronic hepatitis as hepatitis that lasts more than six months. In chronic hepatitis, the viruses remain in the liver for many years or even decades and multiply. For unknown reasons, their immune systems cannot eradicate the viruses, and the virus causes chronic inflammation of the liver. Chronic hepatitis can lead to extensive liver cirrhosis, liver failure, and liver cancer over time. Liver failure due to chronic hepatitis C infection is the most common cause of liver transplantation in American patients. Patients with chronic viral hepatitis can spread the infection through blood or body fluids (for example, sharing needles, having sex, and sometimes organ donation). The virus is sometimes transmitted from an infected mother to a newborn.
Diagnosis of viral hepatitis:
Diagnosis of viral hepatitis is based on physical symptoms and blood tests for liver enzymes, viral antibodies, and viral genetic material.
Acute viral hepatitis is often easy to diagnose, but chronic hepatitis can be challenging to diagnose. When a patient reports signs of fatigue, nausea, abdominal pain, and dark urine and then develops jaundice, there is a possibility of acute viral hepatitis and should be confirmed by blood tests. On the other hand, patients with chronic hepatitis caused by HBV and HCV often have no symptoms and only mild and nonspecific symptoms such as chronic fatigue. Typically, these patients do not show jaundice signs until their liver damage has progressed, so their disease may remain unknown for years or decades.
There are three types of blood tests to evaluate for patients with hepatitis: liver enzymes, antibodies to hepatitis viruses, viral proteins, or genetic material (viral DNA or RNA).
One of the most sensitive and standard blood tests used to evaluate patients with hepatitis is liver enzymes called aminotransferases. These enzymes include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are generally present in liver cells. If the liver is damaged (such as in viral hepatitis), the liver cells release these enzymes into the bloodstream, and the blood’s enzyme level rises. The normal range for AST is 5 to 40 units per liter of serum (blood fluid fraction), while stock levels for ALT are 7 to 56 units per liter of serum. Of course, these normal levels may vary slightly depending on the laboratory. Patients with acute viral hepatitis (HAV or HBV) may have very high AST levels and ALT, sometimes reaching thousands of units per liter. These high AST and ALT levels return to normal within a few weeks or months of the patient recovering from acute hepatitis.
In contrast, these enzyme levels are less elevated in patients with chronic HBV and HCV infection; But this anomaly can last for years or even decades. Because most patients with chronic hepatitis have no symptoms (neither jaundice nor nausea), this increase in liver enzymes is not considered a sign of hepatitis in annual examinations and tests.
Elevated blood levels of AST and ALT do not always mean inflammation of the liver. This increase can be caused by various factors besides viral hepatitis, including drugs, alcohol, bacteria, and fungi.
To confirm that a hepatitis virus is responsible for this increase in enzymes.
Another test must be performed on the antibodies to each of the hepatitis viruses and the viral genetic material.
Antibodies are proteins produced by white blood cells that attack invaders such as bacteria and viruses. Antibodies to the hepatitis A, B, and C viruses are usually detectable in the blood within a few weeks of infection. These antibodies remain in the blood for decades afterward. Blood tests for antibodies help diagnose both acute viral hepatitis and chronic viral hepatitis.
Antibodies in acute viral hepatitis help eradicate the virus; They also protect the patient from future infections with the same virus. In chronic hepatitis, antibodies and other organs of the immune system cannot eradicate the virus. Viruses continue to multiply and are released from liver cells into the bloodstream, where their presence is detected by measuring genetic material and viral proteins. Therefore, in chronic hepatitis, both virus-specific antibodies and viral proteins, and genetic materials can be detected in the blood.
Gallbladder obstruction resulting from gallstones or cancer can sometimes cause a condition similar to acute viral hepatitis. Ultrasound can be used to determine the actual cause.
Treatment of viral hepatitis
Treatment for acute viral hepatitis and chronic viral hepatitis is different. Treatment for the acute type includes rest, relief of symptoms, and proper fluid intake. Treatment for chronic viral hepatitis includes medications to kill the virus and measures to prevent further liver damage.
Treatment of acute viral hepatitis:
In patients with acute viral hepatitis, initial treatment includes relief of nausea, vomiting, and abdominal pain. Drugs and compounds with adverse effects on patients with abnormal liver function (e.g., acetaminophen and alcohol) should be considered. Only essential drugs should be used because the damaged liver cannot eliminate drugs naturally, and drugs may be used in blood to accumulate and reach toxic levels. Also, painkillers and sedatives should be avoided; Because they can exacerbate liver failure in the brain and cause coma. It is sometimes necessary to use intravenous fluids to prevent dehydration caused by vomiting.
Acute HBV is not treated with antiviral drugs. Acute HCV (although rarely diagnosed) can be treated with several medications that are also used to treat chronic HCV. HCV treatment is mainly recommended for 80% of patients who have not had the virus removed from their bodies. This treatment leads to the eradication of the virus in most patients.
Treatment of chronic viral hepatitis:
Treatment for chronic hepatitis B and hepatitis C infections usually involves medication or a combination of drugs to kill the virus. Successful removal of the virus can stop liver damage and prevent the progression of cirrhosis, liver failure, and liver cancer. Alcohol exacerbates liver damage in chronic hepatitis and can cause rapid progression to cirrhosis. Therefore, patients with chronic hepatitis should stop drinking alcohol. Smoking can also aggravate liver disease.
Strategies for treating chronic hepatitis can be complicated and should be guided by gastroenterologists, hepatologists (doctors trained to treat liver disease), or infectious disease specialists because:
Diagnosing chronic viral hepatitis is not always easy. Sometimes a liver biopsy (liver tissue biopsy) may be needed to confirm liver damage. Experienced physicians managing chronic liver disease should evaluate liver biopsy risks against their potential benefits and decide.
Not all patients with chronic viral hepatitis are candidates for treatment. Some patients do not need treatment; Because some chronic hepatitis B and C do not progress to liver damage or liver cancer. In some cases, chronic infection medications are not effective in treating hepatitis B and C. In some cases, long-term treatment for up to 6 months is required. The success rate for a stable viral response in chronic hepatitis C virus is about 90%.
Treatment of acute fulminant hepatitis should be performed at centers that can perform liver transplants; Because acute fulminant hepatitis without liver transplantation has a high mortality rate (about 80%).
Prevention of viral hepatitis:
Prevention of hepatitis includes measures to avoid exposure to viruses, immunoglobulins in exposure, and vaccines. The use of immunoglobulin is called passive protection; Because, in this case, the patient is given antibodies from patients with viral hepatitis. Vaccination is called active protection. In this case, the patient is given killed viruses or non-infectious viruses; these viruses and compounds stimulate the immune system and produce antibodies in the recipient’s body.
Avoid exposure to viruses:
Prevention of viral hepatitis, like any other illness, is better than cure. Beware of exposure to others’ blood (contaminated needles), unprotected sex, and other body secretions (stools and vomit) helps prevent these viruses’ spread.
Use of immunoglobulins:
ISG is a human serum that contains antibodies against hepatitis A. ISG can be used to prevent infection in people who have been exposed to hepatitis A. The ISG is useful long after use and has a protection period of several months. ISG is usually given to people who go to areas where the prevalence of hepatitis A is high or places where hepatitis A patients are present.
Hepatitis B Immune Globulin HBIG is a human serum that contains antibodies against hepatitis B. Up to ten days after exposure to the virus, HBIG is effective in preventing infection, but if more time passes, HBIG may only reduce the severity of HBV infection. Protection against hepatitis B lasts for about three weeks after using HBIG. HBIG is also given at birth to babies born to mothers with hepatitis B. Also, HBIG is given to people who have been exposed to HBV as a result of sexual contact or to health care workers who suddenly come in contact with a needle infected with the blood of an infected person.
Hepatitis A: There are two hepatitis A vaccines in the United States (Hawaii and Wacta). Both vaccines contain inactivated A (extinct) viruses. Two doses of the vaccine are recommended for adults. After the first dose, protective antibodies are produced in 70% of vaccine recipients within 70 weeks, and approximately 100% of recipients will have antibodies within four weeks. After receiving two doses of type A vaccine, immunity to infection of this type of disease will continue for several years. People at risk for this disease A and people with chronic liver disease (cirrhosis or chronic hepatitis C) should be vaccinated.
People at risk for hepatitis A include:
- Travelers to countries where the prevalence of hepatitis A is high
- Men who have sex with other men
- Drug users (both injectable and non-injectable)
- Researchers working with hepatitis A or animals that are susceptible to hepatitis A infection
- Patients receiving coagulation factors that may contain hepatitis A
Because protective antibodies’ production takes several weeks, travelers to countries where hepatitis A is common should be vaccinated at least four weeks before departure. If the passenger leaves before four weeks, it is best to give immunoglobulin in addition to the vaccine. Immunoglobulin provides faster protection than a vaccine but has a shorter duration of action.
Hepatitis B: For active vaccination, a harmless hepatitis B antigen is given to stimulate the immune system to produce antibodies against the hepatitis B surface antigen. Vaccines currently available in the United States are made using recombinant DNA technology. These hepatitis B vaccines (Energex B and Recambivax HB) are made to contain only part of the surface antigen, which is very strong in stimulating the immune system to produce antibodies. The vaccine does not contain any part of the virus other than the same surface antigen and cannot cause HBV infection.
Hepatitis B vaccines should be given in three doses. For best results, the vaccine should be given to the deltoid (shoulder) muscle, not the buttock muscle. Hepatitis B vaccines are 90% effective in healthy adults and 95% in infants, children, and adolescents. 5% of vaccinated people cannot produce the antibodies needed to make them safe after three shots. Patients with weakened immune systems (such as those with HIV infection), the elderly, and patients undergoing renal hemodialysis may not be able to respond to the vaccine.
The hepatitis B vaccine is recommended for:
- All babies
- Adolescents under 18 years of age who did not receive the hepatitis B vaccine during infancy
- People who work in such a way that they are regularly exposed to blood or body fluids
- Residents and staff of institutions for the care of people with disabilities
- Patients undergoing renal hemodialysis
- People with hemophilia and other patients receiving coagulation factors
- People with contact with relatives and sexual partners with hepatitis B.
- Travelers who spend more than six months in areas with high rates of hepatitis B infection
- Injecting drug users and their sexual partners
- Men who have sex with other men and women who have multiple sexual partners
- Prisoners who are held in correctional facilities for a long time
All pregnant women should have a blood test for type B virus antigen antibodies. Women who test positive for the B virus are at risk for transmitting the virus to their baby during childbirth, and babies born to these mothers should receive the HBIG vaccine in addition to the hepatitis B vaccine. Both immunoglobulin and the vaccine should be given because even if the hepatitis B vaccine can provide long-term active immunity, it may take weeks or months. Temporary and inactive HBIG antibodies can protect the child until active immunity is established.
Unvaccinated people exposed to hepatitis B-infected substances (such as health center staff infected with a needle) also need HBIG in addition to the hepatitis B vaccine.
Hepatitis C and D.
There is currently no vaccine for type C disease. The production of such a vaccine is challenging because of the six different forms (different genotypes) of the hepatitis C virus. There is no vaccine for type D, although HBV vaccines can prevent a healthy person from getting hepatitis D because the D virus needs HBV to multiply in the body.
What is the prognosis for viral hepatitis?
The prognosis (predicting the future of the disease) Viral hepatitis is suitable for most patients; However, this prognosis depends in part on the infectious virus. For example, patients with chronic hepatitis have a poor prognosis because of the potential for developing cirrhosis, liver failure, liver cancer, and sometimes death. Symptoms of viral hepatitis such as fatigue, poor appetite, nausea, and jaundice usually subside within a few weeks or months without any specific treatment. Virtually all patients with acute HAV infection and most adults (more than 95%) fully recover from acute HBV. Complete cure of viral hepatitis means:
- The hepatitis virus is completely removed from the liver by the immune system.
- Inflammation of the liver subsides.
- The patient will be immune to infection with the same virus in the future.
- The patient cannot transmit the infection to others.
About 5 to 10 percent of patients with acute HBV infection and about 75 to 80 percent of patients with acute HCV infection will develop chronic hepatitis. Patients (about 0.5 to 1%) with fulminant hepatitis have an 80% mortality rate. Chronic HCV infections are a significant cause of liver transplantation.
Non-viral hepatitis is an inflammation of the liver that can cause cirrhosis, liver cancer, liver failure, and death. There are three types of non-viral hepatitis:
Toxic hepatitis caused by chemicals, medications (prescription and over-the-counter), and dietary supplements
Alcoholic hepatitis caused by excessive alcohol consumption
Autoimmune hepatitis is caused by an immune system attacking the liver. For unknown reasons, the immune system can attack the liver and cause inflammation, injury, cancer, and liver failure. Certain diseases and certain toxins and medications can also cause this condition.
Symptoms of toxic hepatitis appear within hours, days, or months after exposure to the toxin and may include: jaundice, abdominal pain, nausea and vomiting, dark urine, itching and rash, fatigue, loss of appetite. Overuse of acetaminophen can also lead to liver failure and even death. It causes nausea, sweating, vomiting, upper abdominal pain, or coma.
Diagnosis of non-viral hepatitis
To diagnose the non-viral type of the disease, the doctor performs a physical examination by asking the patient for an explanation. Other procedures such as imaging tests (ultrasound, MRI, or CT scan) and liver tissue biopsies may be done. A blood test detects autoimmune hepatitis. Sometimes a liver biopsy is needed. This medication is used to prevent the immune system from invading the liver. If the liver damage is severe, a liver transplant may be needed.
Treatment for toxic hepatitis can include the following:
- It was not being exposed to the substance that caused it.
- Use of medication
- Liver Transplant
- To treat the symptoms, your doctor may prescribe medication (corticosteroid) to reduce inflammation of the liver, or you may need to be hospitalized. If a person has alcoholic hepatitis, they should stop drinking alcohol altogether to prevent the disease from getting worse and dying.
Prevention of toxic hepatitis by observing the following:
- Take the drug only if prescribed and in the necessary amount.
- Reduce the number of drugs used if possible; This includes supplements.
- Avoid alcohol, especially if the person is taking medication, especially acetaminophen.
- If a person works with hazardous chemicals, be sure to heed the advice and warnings about those substances, and if exposed to them, be sure to take the necessary health and medical measures.