Hepatitis

Hepatitis

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Hepatitis is an inflammation of the liver.

Viruses cause most cases of hepatitis. The type of hepatitis is named for the virus that causes it; for example, hepatitis A, hepatitis B or hepatitis C. Drug or alcohol use can also cause hepatitis. In other cases, your body mistakenly attacks healthy cells in the liver.

Some people who have hepatitis have no symptoms. Others may have

• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Dark-colored urine and pale bowel movements
• Stomach pain
• Jaundice, yellowing of skin and eyes

Some forms of hepatitis are mild, and others can be serious. Some can lead to scarring, called cirrhosis, or to liver cancer.

Sometimes hepatitis goes away by itself. If it does not, it can be treated with drugs. Sometimes hepatitis lasts a lifetime. Vaccines can help prevent some viral form

Types of hepatitis

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. The virus is one of several types of hepatitis viruses that cause inflammation and affect your liver’s ability to function.

You’re most likely to get hepatitis A from contaminated food or water or from close contact with a person or object that’s infected. Mild cases of hepatitis A don’t require treatment. Most people who are infected recover completely with no permanent liver damage.

Practicing good hygiene, including washing hands frequently, is one of the best ways to protect against hepatitis A. Vaccines are available for people most at risk.

Symptoms

Hepatitis A signs and symptoms typically don’t appear until you’ve had the virus for a few weeks. But not everyone with hepatitis A develops them. If you do, hepatitis signs and symptoms can include:

• Fatigue
• Sudden nausea and vomiting
• Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver)
• Clay-colored bowel movements
• Loss of appetite
• Low-grade fever
• Dark urine
• Joint pain
• Yellowing of the skin and the whites of your eyes (jaundice)
• Intense itching

These symptoms may be relatively mild and go away in a few weeks. Sometimes, however, hepatitis A infection results in a severe illness that lasts several months.

When to see a doctor

Make an appointment with your doctor if you have signs or symptoms of hepatitis A.

Getting a hepatitis A vaccine or an injection of immunoglobulin (an antibody) within two weeks of exposure to hepatitis A may protect you from infection. Ask your doctor or your local health department about receiving the hepatitis A vaccine if:

• You’ve traveled out of the country recently, particularly to Mexico or South or Central America, or to areas with poor sanitation
• A restaurant where you recently ate reports a hepatitis A outbreak
• Someone close to you, such as a roommate or caregiver, is diagnosed with hepatitis A
• You recently had sexual contact with someone who has hepatitis A

Causes

Hepatitis A is caused by a virus that infects liver cells and causes inflammation. The inflammation can affect how your liver works and cause other signs and symptoms of hepatitis A.

The virus most commonly spreads when you eat or drink something contaminated with fecal matter, even just tiny amounts. It does not spread through sneezing or coughing.

Here are some of the specific ways the hepatitis A virus can spread:

• Eating food handled by someone with the virus who doesn’t thoroughly wash his or her hands after using the toilet
• Drinking contaminated water
• Eating raw shellfish from water polluted with sewage
• Being in close contact with a person who’s infected — even if that person has no signs or symptoms
• Having sex with someone who has the virus

Risk factors

You’re at increased risk of hepatitis A if you:

• Travel or work in areas of the world where hepatitis A is common
• Attend child care or work in a child care center
• Live with another person who has hepatitis A
• Are a man who has sexual contact with other men
• Have any type of sexual contact with someone who has hepatitis A
• Are HIV positive
• Are experiencing homelessness
• Have a clotting-factor disorder, such as hemophilia
• Use any type of illegal drugs (not just those that are injected)

Complications

Unlike other types of viral hepatitis, hepatitis A does not cause long-term liver damage, and it doesn’t become chronic.

In rare cases, hepatitis A can cause a sudden loss of liver function, especially in older adults or people with chronic liver diseases. Acute liver failure requires a stay in the hospital for monitoring and treatment. Some people with acute liver failure may need a liver transplant.

Prevention

The hepatitis A vaccine can prevent infection with the virus. The vaccine is typically given in two shots. The first one is followed by a booster shot six months later.

The Centers for Disease Control and Prevention recommends a hepatitis A vaccine for the following people:

• All children at age 1, or older children who didn’t receive the childhood vaccine
• Anyone age 1 year or older who is experiencing homelessness
• Infants ages 6 to 11 months traveling internationally
• Family and caregivers of adoptees from countries where hepatitis A is common
• People in direct contact with others who have hepatitis A
• Laboratory workers who may come in contact with hepatitis A
• Men who have sex with men
• People who work or travel in parts of the world where hepatitis A is common
• People who use any type of illicit drugs, not just injected ones
• People with clotting-factor disorders
• People with chronic liver disease, including hepatitis B or hepatitis C
• Anyone wishing to obtain protection (immunity)

Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood.

Until recently, hepatitis C treatment required weekly injections and oral medications that many HCV-infected people couldn’t take because of other health problems or unacceptable side effects.

That’s changing. Today, chronic HCV is usually curable with oral medications taken every day for two to six months. Still, about half of people with HCV don’t know they’re infected, mainly because they have no symptoms, which can take decades to appear. For that reason, the U.S. Centers for Disease Control and Prevention recommends a one-time screening blood test for everyone at increased risk of the infection. The largest group at risk includes everyone born between 1945 and 1965 — a population five times more likely to be infected than those born in other years.

Symptoms

Long-term infection with the hepatitis C virus (HCV) is known as chronic hepatitis C. Chronic hepatitis C is usually a “silent” infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Among these signs and symptoms are:

• Bleeding easily
• Bruising easily
• Fatigue
• Poor appetite
• Yellow discoloration of the skin and eyes (jaundice)
• Dark-colored urine
• Itchy skin
• Fluid buildup in your abdomen (ascites)
• Swelling in your legs
• Weight loss
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)
• Spider-like blood vessels on your skin (spider angiomas)

Every chronic hepatitis C infection starts with an acute phase. Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms. When signs and symptoms are present, they may include jaundice, along with fatigue, nausea, fever and muscle aches. Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months.

Acute hepatitis C infection doesn’t always become chronic. Some people clear HCV from their bodies after the acute phase, an outcome known as spontaneous viral clearance. In studies of people diagnosed with acute HCV, rates of spontaneous viral clearance have varied from 14 to 50 percent. Acute hepatitis C also responds well to antiviral therapy.

Causes

Hepatitis C infection is caused by the hepatitis C virus. The infection spreads when blood contaminated with the virus enters the bloodstream of an uninfected person.

Globally, HCV exists in several distinct forms, known as genotypes. The most common HCV genotype in North America and Europe is type 1. Type 2 also occurs in the United States and Europe, but is less common than type 1. Both type 1 and type 2 have also spread through much of the world, although other genotypes cause a majority of infections in the Middle East, Asia and Africa.

Although chronic hepatitis C follows a similar course regardless of the genotype of the infecting virus, treatment recommendations vary depending on viral genotype.

Risk factors

Your risk of hepatitis C infection is increased if you:

• Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
• Have ever injected or inhaled illicit drugs
• Have HIV
• Received a piercing or tattoo in an unclean environment using unsterile equipment
• Received a blood transfusion or organ transplant before 1992
• Received clotting factor concentrates before 1987
• Received hemodialysis treatments for a long period of time
• Were born to a woman with a hepatitis C infection
• Were ever in prison
• Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection

Complications

Normal liver vs. liver cirrhosis

Liver cancer

Hepatitis C infection that continues over many years can cause significant complications, such as:

• Scarring of the liver (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
• Liver cancer. A small number of people with hepatitis C infection may develop liver cancer.
• Liver failure. Advanced cirrhosis may cause your liver to stop functioning.

Prevention

Protect yourself from hepatitis C infection by taking the following precautions:

• Stop using illicit drugs, particularly if you inject them. If you use illicit drugs, seek help.
• Be cautious about body piercing and tattooing. If you choose to undergo piercing or tattooing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won’t answer your questions, look for another shop.
• Practice safer sex. Don’t engage in unprotected sex with multiple partners or with any partner whose health status is uncertain. Sexual transmission between monogamous couples may occur, but the risk is low.

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis — a condition that permanently scars of the liver.

Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic (long-lasting) hepatitis B infection.

A vaccine can prevent hepatitis B, but there’s no cure if you have the condition. If you’re infected, taking certain precautions can help prevent spreading the virus to others.

Symptoms

Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you’ve been infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms.

Hepatitis B signs and symptoms may include:

• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)

When to see a doctor

If you know you’ve been exposed to hepatitis B, contact your doctor immediately. A preventive treatment may reduce your risk of infection if you receive the treatment within 24 hours of exposure to the virus.

If you think you have signs or symptoms of hepatitis B, contact your doctor.

Causes

Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.

Common ways that HBV can spread are:

• Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person’s blood, saliva, semen or vaginal secretions enter your body.
• Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
• Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
• Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant.

Risk factors

Hepatitis B spreads through contact with blood, semen or other body fluids from an infected person. Your risk of hepatitis B infection increases if you:

• Have unprotected sex with multiple sex partners or with someone who’s infected with HBV
• Share needles during IV drug use
• Are a man who has sex with other men
• Live with someone who has a chronic HBV infection
• Are an infant born to an infected mother
• Have a job that exposes you to human blood
• Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and Eastern Europe

Complications

Having a chronic HBV infection can lead to serious complications, such as:

• Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver’s ability to function.
• Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
• Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to sustain life.
• Other conditions. People with chronic hepatitis B may develop kidney disease or inflammation of blood vessels.

Prevention

The hepatitis B vaccine is typically given as three or four injections over six months. You can’t get hepatitis B from the vaccine.

The hepatitis B vaccine is recommended for:

• Newborns
• Children and adolescents not vaccinated at birth
• Those who work or live in a center for people who are developmentally disabled
• People who live with someone who has hepatitis B
• Health care workers, emergency workers and other people who come into contact with blood
• Anyone who has a sexually transmitted infection, including HIV
• Men who have sex with men
• People who have multiple sexual partners
• Sexual partners of someone who has hepatitis B
• People who inject illegal drugs or share needles and syringes
• People with chronic liver disease
• People with end-stage kidney disease
• Travelers planning to go to an area of the world with a high hepatitis B infection rate