Basics of Hepatitis - Research Paper Example

? Hepatitis: Causes, Symptoms, Kinds 25 June Table of contents Basics of Hepatitis 3 The Liver 3 Causes of Hepatitis 5 Kinds of Hepatitis 6 Symptoms of Hepatitis 10 Diagnosis of Hepatitis 10 Treatment of Hepatitis 13 Works Cited 14 Basics of Hepatitis Hepatitis refers to the inflammation of the liver, which happens when the certain viruses infect it. Acute viral hepatitis is a viral infection that has short-term duration. It occurs when people are infected initially by the virus and can range from being mild to severe (Gould 6). Sometimes, acute viral infection can lead to chronic infection (Women’s Health.gov). Chronic viral hepatitis is an infection that lasts longer than acute viral hepatitis, and it can sometimes last for a lifetime (Women’s Health.gov). Hepatitis A only produces acute infection. Hepatitis viruses B and C can lead to both acute and chronic infections. Chronic hepatitis B and C are severe health conditions, because they can lead to cirrhosis, liver failure, and liver cancer, and sometimes, even death. Viral hepatitis is the principal cause of liver cancer and the most frequent reason for people, who need liver transplantation. Around 4.4 million Americans have chronic hepatitis, and most are not even aware that they are infected (Centers for Disease Control and Prevention (CDC)). In the United States in 2007, there were an estimated “25,000 new hepatitis A infections; 43,000 new hepatitis B infections; and 17,000 new hepatitis C infections” (Women’s Health.gov). Around 800,000 to 1.4 million people are infected with chronic hepatitis B and 3.2 million people are infected with chronic hepatitis C in America (Women’s Health.gov). In addition, “between 75 and 85 percent of people who get infected with the hepatitis C virus develop a chronic infection” (Women’s Health.gov). The Liver The liver is situated in the upper right hand side of the abdomen, usually behind the rib cage. The liver of an adult weighs almost three pounds on average. The liver performs several important bodily functions: 1) Detoxifies the body through filtering harmful elements from the blood, such as alcohol and drugs 2) Collects and processes biluribin, the substance that red blood cells release, when they age and die 3) Stores important vitamins, particularly vitamins A, D, K and B12, and minerals like copper and iron 4) Synthesizes protein that assists blood clotting and turns into amino acids, which are the fundamental blocks of human muscles 5) Creates biochemicals used during digestion, such as bile, which is required in breaking down fatty foods 6) Preserves proper levels of glucose in the blood 7) Makes 80% of cholesterol, which is needed for healthy cells 8) Eliminates excess cholesterol from the body 9) Converts carbohydrates and sugars to glucose that can be easily used by the body when it needs it 10) Synthesizes plasma protein 11) Produces hormones 12) Creates urea, the primary substance of urine (Goldsmith 12-13). The symptoms of hepatitis impair the ability of the liver to perform these crucial functions (Goldsmith 13). For example, some people with hepatitis have yellow skin and the white parts of their eyes are yellow. This indicates that their livers can no longer adequately collect and process bilirubin. If the liver cannot process this element, it builds up in the blood and yellows the skin and the sclera (visible white part of the eyes). Causes of Hepatitis Numerous illnesses and conditions can be the causes of swelling of the liver: medicine, alcohol, chemicals, and autoimmune diseases. Several viruses, for example, the virus of mononucleosis and the cytomegalovirus can inflame the liver (CDC). Some viruses do not directly infect the liver, but also affect it when it attacks the immune system (CDC). When doctors discuss viral hepatitis, they refer to hepatitis that few particular viruses have caused and predominantly attack the liver. There are a number of hepatitis viruses: types A, B, C, D, E, F (not fully established), and G. The most prevalent hepatitis viruses are types A, B, and C. Causes for each kind of Hepatitis can vary. Hepatitis A Hepatitis A virus (HAV) is largely spread through the fecal–oral route through person-to-person contact, or through contaminated water and food, mostly tainted shellfish, fruits and salads (Hollinger and Emerson 2001 qtd. in Sanchez, Bosch, and Pinto 1). Anal-oral contact during sex can also cause HAV. Hepatitis B Hepatitis B is a form of a sexually transmitted disease (STD). It is a product of the virus HBV (Hepatitis B Virus) and can be spread through contaminated blood, semen, and other body fluids (CDC). People with HIV are increasingly infected with Hepatitis B. Some practices or activities that spread Hepatitis B are: Unprotected sexual intercourse with a contaminated person; Using a syringe that was formerly used by an infected person (most frequently happens with drug addicts and people who inject steroids); Having the skin punctured with unsterilized needles, such as getting a tattoo, or being unintentionally pricked; Sharing personal items, such as a toothbrush or razor, with a contaminated person; Being bitten by an infected person (Women’s Health.gov). People, who are employed in health care settings, risk being infected by accident (Women’s Health.gov). A baby can also become infected through his/her mother's milk, if she has this virus (Chen 20). Hepatitis C Hepatitis C is frequently spread through direct contact with the blood of a person, who has the disease. It is caused by the virus HCV (Hepatitis C Virus) (CDC). Hepatitis D Hepatitis D virus or HDV is “transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in persons with HBV infection” (CDC). Hepatitis E Transmission of Hepatitis E happens through ingestion of fecal matter, even in microscopic quantities (CDC). Outbreaks are frequently connected with unhygienic water supply in countries with poor sanitation (CDC). Kinds of Hepatitis Hepatitis A Hepatitis A has an incubation period of around “28 days (range: 15–50 days)” (CDC). HAV multiplies in the liver and is released in high amounts in feces from 2 weeks before, to 1 week after, the beginning of clinical illness (CDC). HAV infection creates a “self-limited disease” that does not produce chronic infection or chronic liver disease (CDC). Nevertheless, 10% to 15% of patients might go through a relapse of symptoms, six months subsequent to acute illness (CDC). Acute liver failure from Hepatitis A is rare (overall case, the fatality rate is 0.5%) (CDC). The danger for symptomatic infection is directly connected to age, with less than 80% of adults having symptoms well-matched with acute viral hepatitis, and the preponderance of children having either asymptomatic or undetected infection (CDC). Antibody that the body makes to respond to HAV infection lasts for life and ensures protection against recurring infections (CDC). In the United States, almost fifty percent of all reported Hepatitis A cases have no explicit risk factor (CDC). For adults with known risk factors, the predominance of cases is among “men who have sex with other men; persons, who use illegal drugs; and international travelers” (CDC). Hepatitis B Hepatitis B has an incubation period from the time of contact to beginning of symptoms is 6 weeks to 6 months (CDC). In adults, only around half of recently acquired HBV infections show symptoms, and roughly 1% of reported cases end up with acute liver failure and death (CDC). The danger for chronic infection is “inversely related to age”: “around 90% of infected infants and 30% of infected children aged 97% of persons by 6 months after exposure” (CDC). Chronic HCV infection occurs in 70% to 85% of HCV cases and 60% to 70% of chronically infected persons have proof of active liver disease (CDC). The bulk of infected persons might not be conscious of their infection, because they are not clinically sick (CDC). Nevertheless, infected persons can transmit their diseases to others and are at risk for chronic liver disease, or other HCV-related chronic diseases, even years after the infection (CDC). Hepatitis D Hepatitis D, also called as “delta hepatitis," is a serious liver disease that comes from infection with the Hepatitis D virus (HDV), “which is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses” (CDC). Hepatitis D, which can be acute or chronic, is rare in the United States (CDC). HDV is an unfinished virus that needs the helper function of HBV to reproduce and only happens among people, who are infected with the Hepatitis B virus (HBV) (CDC). Hepatitis E Hepatitis E is a severe liver disease caused by the Hepatitis E virus (HEV) that generally produces an acute infection (CDC). It can result to a chronic infection. While uncommon in the United States, Hepatitis E is widespread in many parts of the world (CDC). Even though HEV epidemiology is poorly studied in developed countries, there is growing proof that “hepatitis E is a zoonosis with a swine reservoir, which might be a source of contamination for humans” (Colson, Dhiver, and Gerolami 1177). Hepatitis F, G, and TT Viruses Acute hepatitis that are not related to hepatitis viruses A to E or to alcohol, drugs, or autoimmune disease is of clinical significance, because it can be related to “fulminant hepatic failure, aplastic anemia, and progression to chronic hepatitis and cirrhosis in 29% of cases” (National Center for Biotechnology Information (NCBI)). For the past decades, additional hepatitis viruses have been determined. Hepatitis F virus (HFV) was first seen as “togavirus-like 60- to 70-nm enveloped particles that were recovered from the hepatocytes of a number of patients transplanted for fulminant hepatic failure” (NCBI). Hepatitis G virus (HGV, or GBV-C) is an “RNA virus of the Flaviviridae family” and it has been through “RT-PCR in the blood or liver tissue of patients with fulminant hepatic failure of chronic liver disease of unknown etiology” (NCBI). The commonness of HGV in the general population is quite high: “1.5% of blood donors in the United States and 12.9% of commercial donors worldwide” (NCBI). HGV may infrequently result to acute hepatitis and can continue in a carrier state (NCBI). Nevertheless, there is lack of evidence that chronic HGV infection creates hepatic inflammation or cirrhosis, or is connected with hepatocellular carcinoma (NCBI). The incidence of HGV RNA in these patients most likely suggests concurrent HGV infection as a consequence of “antecedent transfusion of blood products rather than as a causative agent for chronic liver disease” (NCBI). Another Hepatitis virus is the TT virus: “The TT virus (TTV) is an unenveloped, single-stranded DNA virus that shares characteristics with parvoviruses and circoviruses” (NCBI). Similar to HGV, TTV has been seen in “PCR assays in the blood and liver tissue of patients with fulminant hepatic failure or with chronic hepatitis of unknown etiology” (NCBI). Still, TTV has also been found out in the blood of up to 10% of the population and “50% in patients with unselected pathologies” (NCBI). There is at present no proof that chronic TT viremia can be the cause of “hepatic inflammation, cirrhosis, or eventual development of hepatocellular carcinoma” (NCBI). Symptoms of Hepatitis Some people with viral hepatitis do not show visible signs of infection (Women’s Health.gov). When symptoms emerge, they typically do so about 15 to 180 days after the person has become infected. The first phase of hepatitis is called the acute phase. The symptoms are similar to a mild flu, and may comprise of: “diarrhea, fatigue, loss of appetite, mild fever, muscle or joint aches, nausea, slight abdominal pain, vomiting, and weight loss” (Women’s Health.gov). The acute phase is not frequently hazardous, unless it develops into a quickly progressing type, which can lead to death. As the patient worsens, these symptoms may be observed: “circulation problems (only toxic/drug-induced hepatitis), dark urine, dizziness (only toxic/drug-induced hepatitis), drowsiness (only toxic/drug-induced hepatitis), enlarged spleen (only alcoholic hepatitis), headache (only toxic/drug-induced hepatitis), hives, itchy skin, light colored feces, the feces may contain pus, and jaundice” (Women’s Health.gov). Patient outcomes subsequent to the acute phase rely on different factors, particularly the type of hepatitis (Women’s Health.gov). Diagnosis of Hepatitis Doctors identify hepatitis based on a physical examination and the outcomes of blood tests (CDC). Also, aside from specific tests for hepatitis antibodies, doctors can use other types of blood tests to assess liver function (CDC). Hepatitis A Blood tests are used to recognize IgM anti-HAV antibodies, which are substances that the body makes to fight hepatitis A infection. Hepatitis B There are many diverse blood tests for recognizing the hepatitis B virus. Standard tests comprise of: 1) Hepatitis B surface antigen (HBsAg). A positive result indicates active infection, either acute or chronic. 2) Antibody to hepatitis B core antigen (Anti-HBc). A positive result indicates either recent infection or previous infection. 3) Antibody to HBsAg (Anti-HBs). A positive result indicates immunity to hepatitis B either from having been infected with the virus in the past or having had received the vaccine. 4) Hepatitis E surface antigen (HBeAg) indicates that someone with a chronic infection is more contagious. (CDC). Hepatitis C The standard first test for diagnosing hepatitis C is called the “enzyme-linked immunosorbent assay (ELISA), which is used to test for hepatitis C antibodies” (CDC). Antibodies can be seen in ELISA four to ten weeks after infection (CDC). Further tests called “hepatitis C virus RNA assays” may be used to verify the diagnosis (CDC). Doctors employ a polymerase chain reaction (PCR) to distinguish the RNA (the genetic material) of the virus (CDC). These tests should be done if ELISA results show positive HCV antibody and if there is some uncertainty about a diagnosis, but the doctor thinks that the virus is at hand (CDC). HCV RNA can be seen through blood tests as early as 2 to 3 weeks after contagion (CDC). Hepatitis C RNA assays can detect virus levels (viral load) (CDC). These levels do not reveal the relentlessness of the condition or pace of progression, as they do for other viruses, such as HIV (CDC). Still, high viral loads may hint a poorer response to the use of interferons as treatment (CDC). Patients with obvious viral loads should have HCV genotyping (CDC). Determining the particular genotype of the virus is useful in choosing a treatment strategy (CDC). There are six primary genetic kinds of hepatitis C and more than 50 subtypes (CDC). They do not emerge to influence the speed of progression of the disease itself, but they can vary considerably in their consequences on the response to treatment (CDC). Particular genotypes differ in rate around the world (CDC). Genotype 1 is the most complex to treat and is the grounds of up to 75% of the cases in the U.S. (CDC). The other widespread “genetic types in the U.S. are types 2 (15%) and 3 (7%), which are more responsive to treatment than genotype 1” (CDC). People with hepatitis C should have their genotype tested, so that doctors can make proper treatment recommendations (CDC). Liver biopsy may be useful both for diagnosis and for determining treatment approaches (CDC). Only a biopsy can find out the degree of injury in the liver. Some doctors suggest biopsies only for patients, who do not contain genotypes 2 or 3 (as these genotypes tend to react well to treatment) (CDC). A liver biopsy in patients with other genotypes may help illuminate risk for disease progression and permit doctors to hold back treatment for patients with “moderate-to-severe liver scarring (fibrosis)” (CDC). For patients with normal “alanine aminotrasferase (ALT) liver enzyme levels,” a liver biopsy can divulge noteworthy damage (CDC). For people who might have viral hepatitis, doctors will determine certain substance levels in the blood. Bilirubin is one of the most vital factors indicative of hepatitis (CDC). It is a red-yellow color that is usually metabolized in the liver and then emitted in the urine (CDC). Enzymes called aminotransferases, as well as aspartate (AST) and alanine (ALT), are discharged when the liver is damaged (CDC). Assessments of these enzymes, predominantly ALT, are the least costly and most noninvasive tests for determining harshness of the fundamental liver disease and monitoring handling effectiveness (CDC). Enzyme levels vary, nevertheless, and are not constantly a precise indicator of disease activity (CDC). Alkaline Phosphatase (ALP) can also be checked. High ALP levels can designate bile duct blockage. Serum albumin determines protein in the blood (low levels indicate poor liver function) (CDC). Prothrombin Time (PT) test determines “in seconds the time it takes for blood clots to form (the longer it takes the greater the risk for bleeding)” (CDC). Treatment of Hepatitis People with viral hepatitis will frequently get better after a number of weeks to several months. Hepatitis A and E usually end without treatment. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis. Nevertheless, when hepatitis becomes a chronic or long-term disease, the infection may need to be treated with particular medications called antivirals. Vaccines provide protection from hepatitis A and hepatitis B. No vaccines are presently approved for hepatitis C, D, and E. Decreasing exposure to the viruses provides the best kind of protection. Works Cited Centers for Disease Control and Prevention (CDC). Viral Hepatitis. CDC, 2012. Web. 23 June 2012. < http://www.cdc.gov/hepatitis/>. Colson, P., Dhiver, C., and R. Gerolami, R. “Hepatitis E Virus as a Newly Identified Cause of Acute Viral Hepatitis During Human Immunodeficiency Virus Infection.” Clinical Microbiology & Infection 14.12 (2008): 1176-1180. Print. Chen, Ding-Shinn. “Toward Elimination and Eradication of Hepatitis B.” Journal of Gastroenterology & Hepatology 25.1 (2010): 19-25. Print. Goldsmith, Connie. Hepatitis. Minneapolis: Twenty-First Century Books, 2011. Print. Gould, Barbara. Pathophysiology for the health-related professions. 4th Ed.: Philadelphia: W.B. Saunders, 2011. Print. National Center for Biotechnology Information (NCBI). “Hepatitis F, G, and TT Viruses.” U.S. National Library of Medicine, 2003. Web. 23 June 2012. . Sanchez, G., Bosch, A., and R.M. Pinto. “Hepatitis A virus detection in food: current and future prospects.” Letters in Applied Microbiology 45.1 (2007): 1-5. Print. Women’s Health.gov. Viral Hepatitis Fact Sheet. Women’s Health.gov, 2010. Web. 23 June 2012. < http://womenshealth.gov/publications/our-publications/fact-sheet/viral-hepatitis.cfm#f>. Read More