- Diseases, Disorders & Conditions
Hepatitis Causes and Treatment
Unfortunately there are still some diseases where medical science has been unable to significantly improve the method of treatment for many decades. One such disease is hepatitis. Most people know of hepatitis as a liver infection that makes a patient turn yellow. Fewer know that there are two main forms of hepatitis - type A and type B - which differ greatly in the way they are caught and in their long-term outcome. To confuse matters slightly, there is also another less common type of hepatitis called 'non-A, non-B', or hepatitis C. All these types of hepatitis are caused by those smallest of all living particles, viruses, and doctors are unable to cure the vast majority of these infections anywhere in the body.
There is no cure for hepatitis, but it is rare for hepatitis A to cause long-term problems in the same way as hepatitis B.
Hepatitis A (infective hepatitis)
Hepatitis A is caught by eating food that has been handled by someone else who has the disease. The virus lives in the liver, but large numbers pass down the bile duct and into the gut, and contaminate the faeces. If a sufferer is not careful with his/her personal hygiene, the virus may be passed onto someone else. Contrary to earlier beliefs, it is now thought that there are no long-term carriers of hepatitis A in the community.
If virus particles are swallowed, they are absorbed with the food into the bloodstream and migrate to the liver, where after an incubation period lasting two to six weeks they start causing damage to the liver cells.
The liver is used by the body to process food and eliminate waste products through the bile. If it is damaged, it cannot work efficiently, and the main constituent of the bile (bilirubin) builds up in the blood stream. Because of the yellow colour of bilirubin, the victim's skin slowly turns a dark yellow. The whites of the eyes are affected first, and this may be the only sign of the disease in a dark-skinned person. The other symptoms are nausea, vomiting, marked tiredness, loss of appetite, generalised aches and pains, fever and a large tender liver.
Sophisticated tests are now available to diagnose hepatitis and monitor its progress. Blood tests are performed frequently during the disease, so that doctors can detect any deterioration. The main treatment available is the same one that has been in use for almost a century — rest, and a good diet that is low in protein and high in carbohydrate. Alcohol is forbidden.
The usual course of the disease is an initial worsening of symptoms after diagnosis to a peak when jaundice (yellowing of the skin) is most marked, followed by a slow recovery period that may take from one to four months. If the disease continues to worsen, drugs may be used in an attempt to reduce the liver damage, but nothing can be done to kill the infecting virus. In rare cases (2 in 1000), the disease may progress despite all efforts of doctors and result in death. This is more common in the elderly.
Hepatitis A can be prevented in the short term by an injection of gammaglobulin, and close contacts and family members of a patient are usually given this to prevent them from developing the disease. Unfortunately its effects last only a few months. The vital preventative factor is the standard of hygiene in the community. As a result, hepatitis A is far more common in third-world countries than in Australia. Gammaglobulin injections can also be given to travellers who plan a visit to third-world countries (e.g. Indonesia, India), particularly if they are camping or backpacking.
Hepatitis B (serum hepatitis)
Until 40 years ago, doctors did not realize that there were two different types of hepatitis, and it is only in the last decade that we have been able to easily differentiate between them using sophisticated blood tests. These tests are now routine for anyone who catches hepatitis.
Hepatitis B was first identified as a separate disease in Australian Aborigines, and the specific antigen that could be detected in the bloodstream to diagnose the disease was called the 'Australia antigen' for many years. There is no way for a doctor to tell which form of hepatitis a patient has without these tests. Both types cause the patient to be very ill with a liver infection, fever, jaundice (yellow skin), nausea and loss of appetite. Most recover from this episode after a few weeks, but about 1% of patients will develop rapidly progressive liver damage that will lead to death. Unfortunately some people who have hepatitis B develop a very mild form of the disease which may be passed off by the patient as being slightly unwell for a few days, but that illness may be enough to totally alter his/her future life.
Hepatitis B can only be caught by intimate contact with the body fluids "of a person who has the disease or is a carrier of the disease. These body fluids are generally blood and semen, so you can catch Hepatitis B by receiving blood from such a person, using a contaminated needle, rubbing your graze or cut on an infected person's graze or cut, being bitten by an infected person, or having sex with them. Babies born to mothers who are hepatitis B carriers have a more than 50% chance of catching the disease. Blood banks screen all donations for hepatitis B, so it is virtually impossible to catch the disease by this route. Drug addicts who share needles are at great risk. Splashes of blood into an eye or onto a cut or graze can be enough to spread the disease. For this reason, doctors, dentists, nurses and other health workers are at greater risk than the rest of the community. Nine out of ten people who catch hepatitis B will recover from it completely, but the other one in ten will become chronic carriers of the disease and may be able to pass it on to others for the rest of their lives.
Hepatitis B has a long incubation period of six weeks to six months from initially coming into contact with the virus. The infection cannot be detected during this period.
The long-term problem with hepatitis B is that a significant percentage of all people who catch the disease will develop cirrhosis and failure of the liver, which may ultimately prove fatal. Liver cancer (hepatoma) is also more common in these patients. It is for this reason that the medical profession is becoming so concerned by the spread of the disease through the community by promiscuous sex and drug abuse. Some patients are found to have a 'Delta agent' present in their blood as well, and they are more likely to develop the long- term, severe complications of hepatitis B.
On the other hand, it is possible to vaccinate against hepatitis B, but not against hepatitis A. Three vaccinations are necessary within six months and then another after five years to give lifelong immunity to the disease. It is currently recommended that everyone in the medical or dental profession who is exposed to blood should be vaccinated against hepatitis B. Others who feel their lifestyle puts them at risk (e.g. other health workers, policemen, prison guards and others who may be in direct contact with people who have the disease) should also have this series of injections. At present the vaccine is quite expensive, but its manufacture is extremely complex, involving genetic engineering to make an exact but safe copy of the hepatitis B virus, in order to stimulate a person's immune system appropriately.
If you have had hepatitis B, you must ensure that you are no longer infectious before having sex with anyone and have regular blood tests throughout your life to detect any liver damage at an early stage.
Non-A non-B hepatitis (hepatitis C)
This is a form of hepatitis, presumably caused by a virus, in which the specific blood tests for the A and B types remain negative. Because it cannot be detected by blood tests, it is possible although unlikely to catch this form of hepatitis by a blood transfusion. The incubation period is variable between two and 20 weeks, but otherwise the symptoms and treatment are the same as hepatitis A.
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