Hepatitis is the inflammation of the liver as a result of a virus particularly one of the five hepatitis virus-A, B, C, D or E. Other causes include excessive alcohol intake and drugs, such as isoniazid (used to treat tuberculosis). Some disorders and various other infections can result in small areas of inflammation in the liver. Which are asymptomatic and cause little or no problem. Hepatitis can be acute (short-lived) or chronic (lasting at least 6 months).
Acute viral hepatitis
Acute viral hepatitis is the inflammation of the liver caused by infection with one of the five hepatitis viruses. It is characterized clinically by symptoms of malaise, nausea, poor appetite, vague abdominal pain and jaundice. Occasionally, especially with hepatitis B, infected people develop joint pains and itchy red hives on their skin (wheals or urticarial). The severity of symptoms and speed of recovery depend on the particular virus and on the person’s response to the infection. Whilst hepatitis A and C cause vary mild symptoms if at all, hepatitis B and E produce more severe symptoms. Fulminant hepatitis B occur in 1 to 2% of patient and may persist to cause jaundice, ascites, liver failure and may be fatal especially in adults.
A low-grade fever between 38° and 39°C is more often present in hepatitis A and E than in hepatitis B or C.
Icteric phase: Jaundice, tender hepatomegaly appears. Splenomegaly and lymphadenopathy is seen in 20% of patients.
Recovery/post ictal phase: Hepatomegaly and change in liver enzymes still evident. Duration is 2-12weeks but can be prolonged in hepatitis B and C.
• Hepatitis A is spread primarily through the fecal-oral route. Fecal-oral transmission leads to spread between close contacts. Therefore, places that are at a risk are day care centers, where caregivers and children can come in contact with infected stool in diapers. Associated with poor personal hygiene and overcrowding. Travel to endemic place as a common source of infection for adults from non-endemic places. Greatest period of communicability is 2 weeks before onset of jaundice.
• Hepatitis B, C and D are blood-borne viral hepatitis. Hepatitis B which is common in the Gambia is more serious and less easily transmitted than hepatitis A. Transmission commonly occur between sex partners, both heterosexual and homosexual. It can also occur through body fluid such as blood transfusion, reused of infected needles in clinical practice and tattooing, vaginal fluid and semen. A pregnant woman infected with hepatitis B can transmit the virus to her baby during birth. Hepatitis B can also be transmitted by healthy people who have the virus (carriers).
Hepatitis C is most commonly transmitted among people who share needles to inject drugs, transfusion and transplant from infected donor. Infection can also be transmitted through sex, needles used for tattoos and body piercing. Hepatitis D occurs most often among people who share needles to inject illicit drugs. Whilst hepatitis E is spread through fecal-oral route as viral hepatitis A.
Vaccines are available to prevent hepatitis A, B and E infections. Hepatitis B vaccine is recommended for everyone as it is the commonest in the Gambia. Catch-up vaccination for older children and adolescent. Prevention of iatrogenic transmission can be through routine screening of transfuse blood, safe injection practices and proper infection control practices. If people who have not been vaccinated are exposed to hepatitis B virus, they are given hepatitis B immune globulin and are vaccinated. Hepatitis B immune globulin contains antibodies to hepatitis B, which help the body fight the infection. Though there are no vaccines for hepatitis C and D virus. However, vaccination against hepatitis B virus also reduces the risk of infection with hepatitis D virus. Other preventive measures against infection with the hepatitis viruses can be taken:
· Washing hands thoroughly before handling food.
· Not sharing needles to inject drugs.
· Not sharing toothbrush, razor, or other items that could get blood on them.
· Practicing safe sex_ for example, using barrier protection such as a condom
· Limiting the number of sex partners.
Donated blood is unlikely to be contaminated because it is screened.
Treatment and prognosis
• In most people, Special treatment is not necessary, although people with unusually severe acute hepatitis may require hospitalization. Patients with hepatitis should not drink alcohol until they have fully recovered. This is because the amount of alcohol consumed (how much and how often) determines the risk and degree of liver damage. People with acute viral hepatitis usually recover in 4 to 8 weeks, even without treatment. However, people infected with hepatitis C and, to lesser extent, those infected with hepatitis B may become carriers of the virus. In rare instances of severe acute hepatitis B, treatment with a nucleoside analogue at oral doses used to treat chronic hepatitis B has been attempted successfully.
FULMINANT HEPATITIS: Supportive therapy (ABC), correct hypoglycemia and control bleeding. Carriers have no symptoms but are still infected and can transmit the virus to others.
Chronic hepatitis is the inflammation of the liver that last at least 6 months. Common causes are hepatitis B and C viruses and drugs such as isoniazid (used in the treatment of tuberculosis). Unfortunately, many people develop the symptoms when the liver is severely scarred. Chronic hepatitis can result in cirrhosis, with an enlarged spleen, fluid accumulation in the abdominal cavity, and deterioration of brain function. Biopsy is normally done to confirm the diagnosis. Chronic hepatitis, although much less common than acute hepatitis, can persist for years, even decades. In most people, it is quite mild and causes little or no significant liver damage. However, in some people, continued inflammation slowly damages the liver, eventually resulting in cirrhosis. Chronic hepatitis may not be diagnosed until after cirrhosis develops which might eventually lead to hepatocellular carcinoma (liver cancer).
Chronic hepatitis is usually caused by one of the hepatitis viruses except hepatitis A and E. Certain drugs like isoniazid can cause chronic hepatitis, particularly when they are taken for a long time. Other causes include alcohol hepatitis and fatty liver (nonalcoholic steato-hepatitis). In many people with chronic hepatitis, no obvious cause can be found. In some of these people, the chronic inflammation resembles inflammation caused by the body attacking its own tissues (an autoimmune reaction). Autoimmune hepatitis is more common among women than men.
In about two thirds of people, chronic hepatitis develops gradually without causing any obvious symptoms until cirrhosis occurs. In the remaining one third, it develops after a bout of acute viral hepatitis that persists or returns (often several weeks later).
Symptoms often include a vague feeling of illness, poor appetite, and fatigue. Fever and upper abdominal discomfort develops a times. Complications of chronic liver disease and cirrhosis may eventually develop. They include an enlarged spleen, spiderlike blood vessels in the skin, redness of palms, and accumulation of fluid in the abdominal cavity. In many people, chronic hepatitis does not progress for years. In others, it gradually worsens. The outlook depends partly on which virus is the cause. Chronic Hepatitis B tends to worsen, sometimes rapidly, and increases the risk of liver cancer. Chronic co-infection with hepatitis B and D causes cirrhosis in up to 70%.
People with progressive chronic hepatitis B and C are usually given antiviral drugs. Hepatitis B tends to recur once the treatment is stopped and may need to be taken indefinitely. If family members and close contacts of people with chronic hepatitis B have not been vaccinated, they should be.