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Hepatitis

Overview, Causes, & Risk Factors

Hepatitis is an inflammation of the liver that can affect how the liver works.

What is going on in the body?

The liver is an important organ in the body located in the upper right quadrant of the abdomen. It is responsible for:

filtering the blood

making bile, a substance that aids in digestion and helps rid the body of harmful substances

processing fats and sugars, helping the body store energy for later use

making important proteins, such as those involved in blood clotting

metabolizing many medications, such as barbiturates, sedatives, and amphetamines

storing vitamins A, B1\ \B2\ \B6\ \pantothenic acid\ \folic acid\ \niacin\ \biotin\ Cobalamin is the general name for vitamin B12. ',CAPTION,'Vitamin B12');" onmouseout="return nd();">B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.

If the liver becomes inflamed, its ability to perform these functions may be impaired. Liver disease can be caused by a variety of conditions including viral infections, bacterial invasion, and chemical or physical changes within the body.

Symptoms of hepatitis may be acute, occurring suddenly, or chronic, developing slowly over a long period of time. Hepatitis may range from mild to severe depending on the type of hepatitis infection. There are 5 main forms of hepatitis, each named for the type of virus causing the inflammation. These are:

hepatitis A, which usually only causes problems in the liver. It is primarily spread through food or water that is contaminated by the hepatitis A virus from an infected person. Hepatitis A often occurs in epidemic settings.

hepatitis B, which has been found in blood, saliva, semen, and vaginal secretions. It can be spread through sexual contact with an infected individual, passed on to a newborn from an infected mother during childbirth, or transmitted from contact with infected blood or bodily fluids.

hepatitis C, which may be spread by infected IV drug users, by blood transfusions that were not screened for hepatitis, and by some organ transplants. Sharing contaminated personal hygiene items, such as toothbrushes and razors, may also cause the spread of hepatitis C.

hepatitis D, which is spread through contaminated needles or sexual contact. Hepatitis D cannot survive in the body unless the person is also infected with the hepatitis B virus.

hepatitis E, which is found primarily in underdeveloped countries with poor sanitation. It is primarily spread through food or water contamination.

Hepatitis B, C, and D can cause lifelong symptoms and problems in the liver as well as in other parts of the body.

What are the causes and risks of the disease?

The causes and risks of hepatitis vary, depending on the form of hepatitis. The hepatitis virus may be spread a number of ways, including:

sexual contact with a person who is infected by the virus

shared IV drug needles

intranasal cocaine use

exposure to infected healthcare workers, including dentists

contamination of a healthcare worker during patient care

contaminated blood transfusions that were given prior to the screening for hepatitis C

food or water that has been contaminated by feces from an infected person

contaminated water and food consumed during travel to Third World countries

exposure to the infected mother during childbirth

organ transplantation

sharing contaminated personal hygiene items, such as razors, toothbrushes, or nail clippers.

Symptoms & Signs

What are the signs and symptoms of the disease?

Symptoms partly depend on the type of hepatitis and the degree of inflammation and infection. In many cases, no symptoms are present. Signs and symptoms may include:

jaundice, or yellowing of the skin

darkened urine

nausea

loss of appetite

vomiting

diarrhea

light-colored stools

abdominal pain in the upper right part of the stomach

malaise, or a general feeling of illness

fatigue

hypoglycemia, or low blood sugar

mild low grade fever

muscle aches and pains

In a rare but severe form of hepatitis called acute fulminant hepatitis, symptoms are associated with signs of liver failure, including:

an enlarged and tender liver

enlarged spleen

susceptibility to bleeding

encephalopathy, which is a disorder that affects how the brain functions

changes in mental status and level of consciousness

ascites, which is an accumulation of fluid inside the abdomen

edema, or swelling under the skin

aplastic anemia, a condition in which the bone marrow cannot make blood cells

Diagnosis & Tests

How is the disease diagnosed?

Hepatitis may be diagnosed using a variety of tests. It can be suspected after a physical examination. Further tests may be ordered, including:

liver function tests

X-rays

ultrasounds

barium studies

liver-spleen scans

A liver biopsy may be recommended in some cases. This involves obtaining a piece of liver tissue with a needle for evaluation. Liver biopsy specimens can be graded in terms of severity. Liver biopsies may have to be done repeatedly to detect progression of the disease or response to therapy.

Prevention & Expectations

What can be done to prevent the disease?

Preventing types A, B, and C hepatitis is possible by receiving the hepatitis A, hepatitis B, or hepatitis C vaccine. Other ways to decrease the risk of hepatitis include:

practicing good hygiene, such as washing hands well after using the restroom or changing diapers

avoiding drinking or using tap water when traveling internationally

avoiding behaviors like sharing drug needles, or having unprotected sexual intercourse with an infected person

avoiding the sharing of personal hygiene items, such as razors or nail clippers

avoiding toxic substances and decreased alcohol consumption

an injection of immune globulin after exposure to hepatitis A or B, which may prevent the infection from developing

the use of safety precautions by healthcare and day care workers

What are the long-term effects of the disease?

Chronic hepatitis can lead to:

cirrhosis and liver failure in adults, which does not generally occur in children. Cirrhosis causes multiple problems, including the possibility of liver cancer.

illnesses in other parts of the body, such as kidney damage or low blood counts

cancer of the liver

increased risk of death in people with HIV

What are the risks to others?

Hepatitis is highly contagious and can be spread to others. The risk of exposure to others will depend on the type of hepatitis.

Treatment & Monitoring

What are the treatments for the disease?

Treatment of hepatitis varies according to the type and severity of the disease, but may include:

bed rest

drinking extra fluids to prevent dehydration

avoiding unnecessary medications

avoiding alcohol

eating a well balanced diet for liver disease

antinausea medications

Further treatment will depend on the type of hepatitis and the extent of the infection. For example, treating hepatitis B, C, and D may involve the use of medications such as the antiviral medication alpha interferon. Other medications may include ribavirin, lamivudine, steroids, and antibiotics.

Acute fulminant hepatitis can cause life-threatening liver failure. This requires a hospital stay and treatment for the bleeding disorder and for neurological and nutritional problems. Sometimes the only effective treatment is a liver transplant.

What are the side effects of the treatments?

Side effects will depend on the treatments used. Side effects of interferon include a flu-like illness, with fever and body aches.

Liver transplant can cause many problems, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful antirejection medications for the rest of his or her life. Side effects of these medications increase the risk for infections, certain cancers, and other problems.

What happens after treatment for the disease?

What occurs after treatment will depend on the type of hepatitis and the response to treatment. For example, with hepatitis A and hepatitis E, people will not usually need medication after the disease has been resolved. They can return to a normal lifestyle when symptoms are gone even if they still have some jaundice.

A person with hepatitis B, C, and D will be monitored for side effects and benefits during and after interferon treatment. Alpha interferon treatment might be repeated if the disease flares up again.

A person who has received a liver transplant is checked for viral hepatitis,as well as for function of the new liver.

How is the disease monitored?

Monitoring of hepatitis will depend on the type of hepatitis. Periodic visits to the healthcare provider and liver function tests will be used to monitor the hepatitis and to see how the liver is working. The status of the liver may require repeated liver biopsies. Decisions for further treatment or liver transplantation are frequently made based on these tests. Any new or worsening symptoms should be reported to the healthcare provider.

Attribution

Author:Eileen McLaughlin, RN, BSN
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:01/31/01
Reviewer:Barbara Mallari, RN, BSN, PHN
Date Reviewed:07/13/01

Sources

http://www.liverfoundation.org/html/livheal.dir/livheal.htm/ http://www.niddk.nih.gov/health/digest/pubs/hep/index.htm/ Harrison's Principles of Internal Medicine, Fauci ET al, 1998

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