Hepatitis

Overview

By Sarah Maurer

In the general sense, the term "hepatitis" refers to inflammation (swelling) of the liver. The liver's main job is to filter harmful chemicals and toxins from the blood. It also converts proteins and sugars into useful substances, stores them, and releases them when your body needs them. Inflammation can make it difficult for the liver to perform these functions, leading to illness.

Hepatitis has many causes, including poisoning, bacterial infection and autoimmune conditions (diseases in which the body's immune system attacks healthy cells). However, it's most commonly caused by a group of viruses that attack the liver and spread from person to person.

The hepatitis viruses can cause acute (sudden, short-term) illness that comes on quickly and lasts a few weeks or months. Some hepatitis viruses also cause chronic (long-term) hepatitis. The chronic form can lead to cirrhosis (scarring of the liver), liver failure and liver cancer.

Chronic hepatitis affects an estimated 4.4 million Americans. It is a leading cause of liver cancer and the number one reason for liver transplant in the country.

Many people with hepatitis have mild symptoms or none at all. They may go decades or a lifetime without a diagnosis, but can still spread the disease to others.

The most common forms of hepatitis are:

  • Hepatitis A (HAV), a relatively mild form of acute hepatitis. In rare cases, it can cause acute liver failure (usually in older people or in people who already have liver disease).
  • Hepatitis B (HBV), a form of hepatitis that often starts as acute illness but may become chronic in some people.
  • Hepatitis C (HDV), which causes acute illness in 20–30 percent of infected persons and chronic illness in 75–85 percent.

Less common forms include:

  • Hepatitis D (HDV), a virus that only affects people with hepatitis B.
  • Hepatitis E (HEV), which is similar to hepatitis A and rare in the United States.

Causes and Risk Factors

The hepatitis viruses are transmitted from person to person in different ways:

  • Hepatitis A (HAV) is spread by ingesting even microscopic amounts of feces from an infected person. This can happen through close personal contact or infected food or water. Raw shellfish that has been contaminated by sewage is a common source of infection.
  • Hepatitis B (HBV) is transmitted through contact with the body fluids of an infected person, including blood, vaginal fluid and semen. In the United States, about two-thirds of new adult cases are sexually transmitted. The virus can also be passed from mother to baby during birth. 
  • Hepatitis C (HDV) is usually spread by contact with infected needles (either during IV drug use or accidental needle sticks) or during childbirth. It's also sometimes transmitted during sexual contact or by sharing personal hygiene products like shaving razors.

Symptoms

Not all people with hepatitis experience symptoms, and many people with the disease don't realize they're infected. When present, symptoms include:

  • Fever
  • Tiredness
  • Poor appetite
  • Nausea
  • Abdominal pain (especially around the liver, which is on the right side below the lower ribs)
  • Dark urine
  • Clay-colored bowel movements
  • Painful joints
  • Jaundice (yellowing of the skin and eyes)

Diagnosis and Treatment

If you think you've been exposed to viral hepatitis, seek immediate medical attention. In some cases, your doctor may recommend vaccination or injections of immune globulin (a product containing antibodies made from human blood plasma) to prevent or halt infection.

Hepatitis is diagnosed based on your history and a blood test (or series of tests). Acute infection may last weeks to months. Some people with acute hepatitis need to be hospitalized, but many can remain at home.

Self-care for hepatitis includes:

  • Get plenty of rest.
  • Stay hydrated.
  • Eat a balanced, nutritious diet. Choose high-calorie foods if your appetite is poor.
  • To protect the liver, avoid alcohol and check with a healthcare professional before taking medications or supplements.

In addition, some people with acute hepatitis C and chronic hepatitis benefit from medications.

People with chronic hepatitis should be monitored regularly by a healthcare provider who understands the condition. To protect the liver, patients should avoid alcohol and check with their provider before taking medications or supplements.

Prognoses (long-term outcomes) vary depending on the form of hepatitis:

  • Most people with hepatitis A recover fully within two to six months.
  • Some people with hepatitis B develop chronic hepatitis. Risk ranges from about 90 percent in infants to 6–10 percent in older children and adults. About 15–25 percent of people with chronic hepatitis B go on to develop serious complications.
  • About 75–85 percent of people with hepatitis C develop chronic hepatitis. Of these, 60-70 percent develop chronic liver disease; 5–20 percent eventually develop cirrhosis; and 1–5 percent die from cirrhosis or liver cancer. In addition, people with hepatitis C are at risk for serious illness if they later develop hepatitis A or B.

Prevention

There are many steps you can take to reduce the risk of viral hepatitis:

  • Consider getting vaccinated against hepatitis A and B if you weren't vaccinated as a child. This is the number one way to prevent these illnesses.
  • Wash your hands with soap and water after using the bathroom or changing a baby's diaper and before handling food.
  • When traveling in developing countries, avoid unpeeled or raw foods. Drink only bottled, boiled or chemically treated water.
  • Practice safe sex. Hepatitis B is about 50–100 times more transmissible during sex than HIV. Condoms and other barrier methods greatly reduce the risk.
  • Never share syringes, shaving razors, toothbrushes or tattooing or piercing supplies.
  • Wear gloves when performing first aid.
  • Disinfect blood spills (including dried ones) with diluted bleach and wear gloves during cleanup.
  • Follow all occupational safety precautions in your workplace.
  • If you are pregnant, seek early and regular prenatal care.

To reduce the risk of non-viral hepatitis, avoid excessive alcohol consumption and consult with a healthcare professional about medications and supplements.

Sources

  • "Diseases and Conditions: Hepatitis A," Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/hepatitis-a/basics/definition/con-20022163. Accessed March 31, 2014.
  • "Liver Basics," US Department of Veterans Affairs. http://www.hepatitis.va.gov/patient/basics/liver-index.asp. Accessed March 31, 2014.
  • "Hepatitis A FAQs for the Public," Centers for Disease Control. http://www.cdc.gov/hepatitis/A/aFAQ.htm#overview. Accessed March 29, 2014.
  • "Hepatitis B FAQs for the Public," Centers for Disease Control. http://www.cdc.gov/hepatitis/B/bFAQ.htm#overview. Accessed March 29, 2014.
  • "Hepatitis C FAQs for the Public," Centers for Disease Control. http://www.cdc.gov/hepatitis/C/cFAQ.htm#overview. Accessed March 29, 2014.
  • "Hepatitis," KidsHealth (The Nemours Foundation). http://kidshealth.org/teen/sexual_health/stds/hepatitis.html. Accessed March 31, 2014.
  • "Viral Hepatitis," Centers for Disease Control. http://www.cdc.gov/hepatitis/index.htm. Accessed March 29, 2014.