Hepatitis

The word hepatitis comes from the Ancient Greek word hepar (root word hepat) meaning 'liver', and the Latin itis meaning inflammation. Hepatitis means injury to the liver with inflammation of the liver cells.

Contents of this article:

1. What is the liver?
2. Types of hepatitis
3. Signs and symptoms
4. How is it treated?
5. Preventing hepatitis

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.

Fast facts on hepatitis
Here are some key points about hepatitis. More detail and supporting information is in the main article.

• The five main types of hepatitis are caused by viruses.
• Globally, around 250 million people are affected by hepatitis C and 300 million people are estimated to be hepatitis B carriers.
• Hepatitis A is caused by consuming contaminated food or water.
• Hepatitis B is a sexually transmitted disease.
• Hepatitis C is commonly spread via direct contact with the blood of a person who has the disease.
• A person can only become infected with hepatitis D if they are already infected with hepatitis B.
• Person can become infected with the hepatitis E virus (HEV) by drinking contaminated water.
• Hepatitis that cannot be attributed to one of the viral forms of the disease is called hepatitis X.
• Hepatitis G is another type of hepatitis caused by a specific virus (HGV).
• The initial symptoms of hepatitis are similar to those of flu.

What is the liver?

The liver is the largest gland in the human body. It weighs approximately 3 lb (1.36 kg). It is reddish brown in color and is divided into four lobes of different sizes and lengths. It is also the largest internal organ (the largest organ is the skin). It is below the diaphragm on the right in the thoracic region of the abdomen. Blood reaches the liver through the hepatic artery and the portal vein. The portal vein carries blood containing digested food from the small intestine, while the hepatic artery carries oxygen-rich blood from the aorta.

Most liver damage is caused by 3 hepatitis viruses, called hepatitis A, B and C.

The liver is made up of thousands of lobules, each lobule consists of many hepatic cells - hepatic cells are the basic metabolic cells of the liver.
The liver has a wide range of functions, including:

• Detoxification (filters harmful substances form the blood, such as alcohol)
• Stores vitamins A, D, K and B12 (also stores minerals)
• Protein synthesis (makes certain amino acids - the building blocks of proteins)
• The production of biochemicals needed for digestion, such as bile
• Maintains proper levels of glucose in the blood
• Produces 80% of your body's cholesterol (cholesterol is vital)
• The storage glycogen (also converts glucose to glycogen)
• Decomposing red blood cells
• Synthesizing plasma protein
• The production of hormones
• Produces urea (the main substance of urine).

Hepatitis can heal on its own with no significant consequence, or it can progress to scarring of the liver. Acute hepatitis lasts under six months, while chronic hepatitis lasts longer.
Most liver damage is caused by 3 hepatitis viruses, called hepatitis A, B and C. However, hepatitis can also be caused by alcohol and some other toxins and infections, as well as from our own autoimmune process (the body attacks itself).
About 250 million people globally are thought to be affected by hepatitis C, while 300 million people are thought to be carriers of hepatitis B.
Not all forms of hepatitis are infectious. Alcohol, medicines, and chemical may be bad for the liver and cause inflammation. A person may have a genetic problem, a metabolic disorder, or an immune related injury. Obesity can be a cause of liver damage which can lead to inflammation. These are known as non-infectious, because they cannot spread form person-to-person.

Types of hepatitis

There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E - plus types X and G.

Hepatitis A

This is caused by eating infected food or water. The food or water is infected with a virus called HAV (hepatitis A virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery - it does not lead to chronic disease.

Hepatitis B

This is an STD (sexually transmitted disease). It is caused by the virus HBV (hepatitis B virus) and is spread by contact with infected blood, semen, and some other body fluids. You get hepatitis B by:

• Unprotected sexual intercourse with an infected person (unprotected sex means without using a condom) Using a syringe that was previously used by an infected person (most commonly happens with drug addicts and people who inject steroids).
• Having your skin perforated with unsterilized needles, as might be the case when getting a tattoo, or being accidentally pricked. People who work in health care risk becoming infected by accident in this way. Sharing personal items, such as a toothbrush or razor, with an infected person.
• A baby can become infected through his mother's milk if she is infected.
• Being bitten by someone who is infected.

The liver of a person infected with hepatitis B swells. The patient can suffer serious liver damage due to infection, resulting in cancer. For some patients the hepatitis becomes chronic (very long-term or lifelong). Donated blood is always tested for hepatitis B.

Hepatitis C

Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by the virus HCV (hepatitis C Virus). The liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people with cirrhosis and only 20% of hep C patients get cirrhosis. Feces is never a route of transmission in hepatitis C. Donated blood is also tested for hepatitis C.
Misuse of anesthesia can result in the transmission of hepatitis B and hepatitis C viruses, researchers reported in the journal Gastroenterology. The cause of infection tends to be from anesthesia contamination, and not endoscopy contamination. Experts say that more effort is needed to better educate the health care community about the importance of strict sterile techniques when using any type of anesthesia.

Hepatitis D

Only a person who is already infected with hepatitis B can become infected with hepatitis D. It is caused by the virus HDV (Hepatitis D Virus). Infection is through contact with infected blood, unprotected sex, and perforation of the skin with infected needles. The liver of a person with Hepatitis D swells.

Hepatitis E

A person can become infected by drinking water that contains HEV (hepatitis E virus). The liver swells but there is no long-term consequence. Infection is also possible through anal-oral sex.

Hepatitis X

If a hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called hepatitis X. In other words, hepatitis of an unknown virus.

Hepatitis G

This is a type of hepatitis caused by the hepatitis G virus (HGV). Usually there are no symptoms. When there are symptoms, they are very mild.

Recent developments on hepatitis causes from MNT news
Frozen fruit blend linked to hepatitis A outbreak
The "Townsend Farms Organic Antioxidant Berry Blend" sold under the Harris Teeter brand, could be the cause of a recent outbreak of hepatitis A.
Smoking results in lower immune system responses after transplants
According to a study published in Liver Transplantation, liver transplant recipients who continue to smoke or have smoked in the past are more likely to acquire viral hepatitis reinfection after the procedure.

Signs and symptoms

Many people with hepatitis experience either mild symptoms or none at all. Remember that an infected person's feces are always infectious to other people. When symptoms appear, they usually do so about 15 to 180 days after the person has become infected.

The acute phase of hepatitis - symptoms

The initial phase of hepatitis is called the acute phase. The symptoms are like a mild flu, and may include:

• Diarrhea
• Fatigue
• Loss of appetite
• Mild fever
• Muscle or joint aches
• Nausea
• Slight abdominal pain
• Vomiting
• Weight loss.

The acute phase is not usually dangerous, unless it develops into the fulminant or rapidly progressing form, which can lead to death.
As the patient gets worse, these symptoms may follow:

• Circulation problems (only toxic/drug-induced hepatitis)
• Dark urine
• Dizziness (only toxic/drug-induced hepatitis)
• Drowsiness (only toxic/drug-induced hepatitis)
• Enlarged spleen (only alcoholic hepatitis)
• Headache (only toxic/drug-induced hepatitis)
• Hives
• Itchy skin
• Light colored feces, the feces may contain pus
• Yellow skin, whites of eyes, tongue (jaundice).

Patient outcomes after the acute phase depend on various factors, especially the type of hepatitis.

Recent developments on hepatitis diagnosis from MNT news
Baby boomers should be tested for hepatitis C, says panel
The U.S. Preventive Services Task Force has just issued new screening recommendations for adults, specifically baby boomers, at risk of hepatitis C virus infection.
Only half of hepatitis C patients get needed follow-up tests
Only half of all patients who have tested positive for hepatitis C have had follow-up testing to see if they are still infected, according to a new report by the CDC (Centers for Disease Control and Prevention).

How is it treated?

There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E - plus types X and G.

Hepatitis A

There is no treatment specifically for hepatitis A. The doctor will advise the patient to abstain from alcohol and drugs during the recovery. The vast majority of patients with hepatitis A will recover spontaneously.

Hepatitis B

A patient with hepatitis B needs to rest. He will require a diet that is high in protein and carbohydrate - this is to repair damaged liver cells, as well as to protect the liver. If this is not enough, the doctor may prescribe interferon. Interferon is an antiviral agent.

Hepatitis C

A patient with hepatitis C will be prescribed pegylated interferon and ribavirin.
, researchers reported in the journal Gut. The authors explained that by adding vitamin B12 to standard treatment, the body's ability to fight the virus is greatly improved. According to their study results, patients who are difficult to treat effectively benefit especially well.
 A new study found that an interferon-free combination of drugs was safe, well tolerated and cured over 90% of 380 trial patients with liver cirrhosis in 12 weeks. The research was published in the New England Journal of Medicine in April 2014.

Hepatitis D or E

So far, there is no effective treatment for either hepatitis D or E.

Non-viral hepatitis

If the patient has non-viral hepatitis, the doctor needs to remove the harmful substance. It will be flushed out of the stomach by hyperventilation or induced vomiting. Patients with drug-induced hepatitis may be prescribed corticosteroids.

Currently, doctors treating hepatitis C patients with cirrhosis (liver scarring) can only offer treatments that rely on the drug interferon, which unfortunately, only works for less than half of patients. Now, a new study found that an interferon-free combination of drugs was safe, well tolerated and cured over 90% of 380 trial patients with liver cirrhosis in 12 weeks.


Trial shows 79% of patients adding danoprevir to their treatment regimen (peginterferon alfa-2a/ribavirin) showed early response and were eligible for a shorter treatment schedule.

Researchers reveal how a vaccine has shown promise against hepatitis C infection a phase 1 clinical trial. In their study, published in the journal Science Translational Medicine, the researchers reveal how they developed a two-tier vaccine approach that triggers and enhances an immune response to HCV, protecting against infection.

Preventing hepatitis

How to prevent hepatitis A

• Wash your hands with soap after going to the toilet
• Only consume food that has just been cooked
• Only drink commercially bottled water, or boiled water if you're unsure of local sanitation
• Only eat fruits that you can peel if you are somewhere where sanitation is unreliable
• Only eat raw vegetables if you are sure they have been cleaned/disinfected thoroughly
• Get a vaccine for hepatitis A if you travel to places where hepatitis may be endemic.

How to prevent hepatitis B

• Tell the partner if you are a carrier or try to find out whether he/she is a carrier
• Practice safe sex
• Only use clean syringes that have not been used by anyone else
• Do not share toothbrushes, razors, or manicure instruments
• Have a hepatitis B series of shots if you are at risk
• Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.).

How to prevent hepatitis C

• If you are infected do not let others share your toothbrush, razor, manicure equipment
• If you are infected cover open wounds
• Do not share needles, toothbrushes, or manicure equipment
• If your skin is to be pierced, make sure equipment is well sterilized (tattoo, etc.)
• Go easy on the alcohol
• Do not share drug equipment.

How to prevent hepatitis D

• Use the same guidelines as for hepatitis B. Only a person who is infected with hepatitis B can become infected with hepatitis D.

How to prevent hepatitis E

• Do the same as you would to protect yourself from hepatitis A infection.

How to prevent alcoholic hepatitis

• Go easy on the alcohol, or abstain from consuming alcohol.

How to prevent toxic/drug induced hepatitis

• Make sure you know about the lethal contents of all chemicals
• Make sure the spray is not pointing at you
• Make sure you wear protective gear if you have to.