Viral hepatitis- Things to know

The liver can be termed as the motor of a human body where it has several vital functions to its name. It is responsible for creating bile that allows food digestion, it stores vitamins and minerals for the body to function normally and helps the body to get rid of harmful toxins that come along with food, and water that the body takes in to name the major roles that the organ plays. Liver basically is exposed to a lot of toxins and it has the job of filtering all these things out from reaching the rest of the body. The functions of liver puts it in harm’s way, and it can get damaged or inflamed. The importance of liver function can be understood by the fact that complete loss of liver function is incompatible with life.  The importance of liver function can be understood by the fact that complete loss of liver function is incompatible with life. Functions of the liver are so complex that we don’t even understand them completely, even after years of research. No mechanical pump, dialysis machines, processed amino acids, or hormones can replace the void left from loss of liver function.  Every year millions die from hepatitis world over. You may get all possible information on it from your health practitioner but here is something that could help you keep your facts clear and understand the illness in a better way.

Image of human liver

What is viral hepatitis?

Hepatitis is inflammation or swelling of the liver. Hepatitis cause by virus infection is called viral hepatitis. This results in the loss functionality of the organ and thus causing normal health to deteriorate. When the infection reaches its peak, there are chances of liver failure, fibrosis, cirrhosis and at times hepatocellular carcinoma which is also termed as cancer of the liver.

What are the types of viral Hepatitis?

Viral Hepatitis has five categories of A, B, C, D and E depending on the virus causing the infection. Different viruses have different ways of entering the human body. Hepatitis A and E viruses enter human body through the oral route, which means ingesting virus contaminated food or drinks. Thats why these viral hepatitis subtypes are more common in poorly sanitised geographical areas.

Hepatitis B, C, and E which is often spread through contact with contaminated bod fluids from an infected individual. This can happen with blood transfusions, unprotected sex, sharing contaminated needles or blades, mother to child transmission, unsanitary tattoos, and contact with other bodily fluids.

Besides these viruses, there are other viruses which cause hepatitis but their infection is infrequent and often goes undiagnosed.

What is acute viral hepatitis?

Viral hepatitis is categorised into two groups based on appearance of symptoms from the time of entry of virus in the body. Acute hepatitis refers to the symptoms that happen within a few weeks after entering the body. The symptoms begin after an incubation period, ranging from 5-45 days for hepatitis A, for hepatitis B and D from 30-180 days, for hepatitis C from 15-160 days, and for hepatitis E from 14-60 days. After the initial incubation period, the symptoms may be non-specific like anorexia, nausea and vomiting, fatigue, malaise, arthralgias or joint pains, and myalgias which may last a couple of weeks before onset of jaundice. 

After the initial constitutional symptoms, phase of jaundice sets in. Yellowing of skin and sclera in eyes, dark urine, itching, is associated with pain in right upper abdomen. Patients may experience 2-3 kg weight loss in this period, with anorexia and excessive fatigue. Massive damage to the liver, also called fulminant hepatitis is a life threatening complication of acute viral hepatitis. Fulminant hepatitis has over 50% mortality without liver transplantation.

The duration of the post jaundice is variable, and ranges from 2-12 weeks. It is usually more prolonged in acute hepatitis B and C. Complete recovery is to be expected 1 to 2 months after all cases of hepatitis A and E and 3 to 4 months after the onset of jaundice in three-quarters of uncomplicated, self-limited cases of hepatitis B and C. A large proportion of patients with viral hepatitis never become icteric.

What is Chronic viral hepatitis?

If the virus causing hepatitis persists in the body after the acute phase is over, it is called chronic viral hepatitis. Hepatitis A, and E does not cause chronic hepatitis. Hepatitis B, Hepatitis C, and Hepatitis D in co-infections with Hepatitis B cause chronicity.

The likelihood of developing chronic infection after acute hepatitis B varies as a function of age of patient. Infection at birth does not produce any symptoms during acute infection but a 90% chance of chronic infection. On the other hand, infection in young adults is associated with clinically apparent acute hepatitis but the risk of chronicity of only approximately 1%.

Hepatitis C infections produce a much higher rate of chronicity. 75-85% of patients with acute infection will become chronically infected with the virus.

Hepatitis D can only exist in co-infection with hepatitis B or as an add-on infection in patients already infected with type B virus. Presence of type D virus along with hepatitis B worsens the clinical outcome of the disease and makes it much more lethal.

How can your doctor diagnose Hepatitis?

If you notice the above symptoms, visiting a doctor is the best precautionary measure that you can take. A doctor takes detailed history and conducts physical examination to feel for tenderness of the liver along with visible yellowing of the body and the eyes.

Blood tests ordered include an assessment of liver function tests for liver enzymes, bilirubin and evaluation of blood coagulation profile. The degree of derangement seen in these tests is directly proportional to the amount of liver damage and thus prognosis. There are specific tests to confirm viral hepatitis and the tests differ for different virus types. These tests are based on either detection of antigen from the virus in blood, or detection of antibodies against virus antigens generated by the immune response of the body. As these tests require careful interpretation, it should be left to an expert.

What is the treatment of acute viral hepatitis?

Acute viral hepatitis is a self limited disease. All previously healthy patients with hepatitis A infection recover completely with no long term problems.
In acute hepatitis B, 95-99% of previously healthy individuals recover completely. Elderly patients and those with serious underlying medical disorders may have a prolonged course and complications also. If the initial presenting features such as abdominal distension with fluid, swelling in hands and feet, and difficulty in staying awake or altered mental status,
then the clinical outcome may not be good. In addition, a prolonged PT(blood test to assess blood clotting ability), low-serum albumin level, low blood sugar levels, and very high-serum bilirubin values suggest extensive liver cell damage. These patients deserve hospital admission. The mortality rate in uncomplicated hepatitis A and B is very low (0.1%) but in patients who need hospitalisation based on above mentioned criteria, for acute hepatitis B, the mortality rate is ten times higher at 1%.
Hepatitis C is much less severe during the acute phase than hepatitis B and may not even have jaundice. Death in acute hepatitis C is rare.
In outbreaks of orally transmitted hepatitis E outbreaks in India and Asia, the mortality rate is 1-2%. Hepatitis E may be very dangerous in pregnant women with mortality upto 10-20%.

Hepatitis B immunisation
Hepatitis B immunisation

How can one stay protected from the infection?

Vaccination is available for Hepatitis A and B. Hepatitis A vaccine provides long lasting immunity upto 20 years and can be safely administered in children more than 1 year of age. Most babies who are born almost immediately receive Hepatitis B shots that allow them to stay immunised for a long time. These vaccination shots are also available for adults also. For all those who have multiple sexual partners or intend to travel to locations that have high levels of contamination of this infection should positively avail these vaccines.

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2 thoughts on “Viral hepatitis- Things to know

  1. Thanks for such a simplified explanation. I was recently diagnosed with Acute hepatitis B a couple of months back and fortunately did not become a chronic carrier. Now I am completely healthy.
    I had taken Hepatitis B vaccine around 20 years back and thought I could not get it. Doctor told me that immunity gradually diminishes over time, and reimmunisation should have been done. I wish you could include some information regarding that also.

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