Hepatitis

Hepatitis

While some types of hepatitis bring on a flu-like illness and disappear, others cause chronic liver disease that can lead to life-threatening complications. New therapies are proving effective for such stubborn infections, even offering a cure for some.

What is hepatitis?

Hepatitis is inflammation of the liver, an organ that performs many vital functions. Your liver not only produces bile to help digest fats, it also stores nutrients and filters toxic substances (such as alcohol and other drugs and digestive by-products) out of your blood. Hepatitis damages liver cells. As a result, the liver can’t do its filtering job properly and toxins can build up. The disease can occur suddenly and last only weeks (called acute hepatitis) or persist for several months or even years (known as chronic hepatitis). You may not know you’re infected because symptoms may not appear for years.

Hepatitis is usually caused by a virus. There are five different hepatitis viruses, but the most common are hepatitis A, B, and C.

Hepatitis A (the most common type) can spread when you eat food or drink water contaminated with feces. This may occur when food preparers don’t follow proper sanitary practices such as washing hands after using the toilet and before preparing food. Consuming contaminated raw or undercooked shellfish, contaminated fruits and vegetables, and contaminated drinking water or ice cubes can also lead to infection. Once you’re infected with hepatitis A you can transmit it to others for a period of time ranging from a week to more than a month. If you’re infected, you must be scrupulous about hygiene, because exposing others to your blood or stools can infect them. North Americans are more likely to get hepatitis A when traveling abroad, but up to 50 percent of all North Americans have had the virus and, as a result, are now immune to it. Recovery is usually quick—most people are back to normal within one week and have no permanent liver damage.

Hepatitis B is transmitted through blood and other infected body fluids, including semen. You can contract it through unprotected sex (sex without a condom), infected needles, or blood transfusions. Unlike Hepatitis A, this virus can turn into a chronic infection (in up to 10 percent of people), leading to liver disease and liver cancer.

Hepatitis C is spread through infected blood, either by transfusions given before 1990 (when blood was first screened for hepatitis C) or by contaminated needles. Doctors aren’t sure if hepatitis C can be transmitted during sexual intercourse. For now, it’s safest to always use a condom. This virus affects people in a variety of ways. Some develop a severe (acute) form of hepatitis but recover in several months with no liver failure. But up to 60 percent of those infected with hepatitis C go on to have chronic hepatitis. Some even develop liver failure and liver cancer. Hepatitis C kills some 10,000 people in North America every year.

Hepatitis can also have nonviral causes including excessive alcohol consumption, certain medications, toxins (arsenic or poisonous mushrooms), and some herbal remedies (comfrey and chaparral leaf). Alcohol poisons the liver and over time causes cirrhosis (scarring), which cannot be reversed. Prescription drugs that can lead to liver failure include the antibiotic trimethoprim/sulfamethoxazole (Septra), the heart drug amiodarone (Cordarone), the tuberculosis drug isoniazid (INH), and anabolic steroids (in overdoses). Talk to your doctor before you stop taking any drug.

• Sexually Transmitted Diseases (STDs)

Another cause of hepatitis is the over-the-counter pain reliever acetaminophen (Tylenol). When taken in overdoses (more than twenty 500 mg pills per day) or with alcohol, acetaminophen can cause sudden and severe hepatitis and rapid death if not treated.

Who is at risk for hepatitis?

You’re more likely to get hepatitis if you:

• Had a blood transfusion before 1990.
• Have unprotected vaginal or anal sex with an infected person.
• Use intravenous drugs.
• Get a tattoo or body piercing.
• Share a razor or toothbrush with an infected person.
• Have a family member who has had liver disease.
• Abuse alcohol.
• Take large amounts of acetaminophen (such as Tylenol).
• Travel to high-risk areas of the world; these include Mexico, Central or South America, the Caribbean, Asia (except Japan), Africa, southern or eastern Europe, or Pacific Islander communities.

Treatment for hepatitis

There is no medication to cure viral hepatitis; your body’s immune system has to battle it on its own. If your hepatitis was caused by something other than a virus, your doctor will recommend that you stop using the causative substance to speed your recovery. Hospitalization is rarely needed for hepatitis, but for several months after you are diagnosed, blood tests may be done periodically to check how your liver is functioning.

Lifestyle Changes

Drink plenty of fluids, get lots of rest, and limit your activities until you feel better. Don’t use alcohol or acetaminophen until you are completely recovered. To prevent spreading any form of hepatitis, be scrupulous about hygiene and always use a condom during sex.

Related Procedures for Hepatitis

If you have symptoms of hepatitis, your doctor will ask about your medical history and perform a physical exam, checking the area near your liver for tenderness and your skin for the telltale yellowing of jaundice. Your doctor might also use one of the following tests to confirm a diagnosis of hepatitis:

• Blood tests check for specific markers that can reveal if you’ve had the disease in the past and if you have an acute or chronic infection now.
• Liver function tests (LFTs) help your doctor evaluate how well your liver is operating. The tests can confirm the presence of jaundice and may be used to monitor your condition. LFTs aren’t done routinely as part of a physical exam. If you have any hepatitis risk factors, ask your doctor whether it makes sense to order LFTs.
• Computed tomography (CT) scan of your abdominal area lets your doctor see a picture of your liver.
• Liver biopsy is a procedure in which a tiny piece of liver tissue is removed and studied under the microscope. For a liver biopsy, your skin is numbed with an anesthetic and a needle is guided into your liver to take the tissue sample.

Questions for Your Doctor

Therapy with high-dose interferon and ribavirin (Virazole) has helped some people with hepatitis C. Discuss this therapy with your doctor.

Prevention of hepatitis

• Cook it right. Thoroughly cook all foods, especially shellfish, to kill the hepatitis A virus.
• Please peel. Peel all fruits and vegetables imported from countries where sanitary conditions are poor. Washing produce will not remove the hepatitis A virus.
• Water warning. When traveling abroad, buy bottled water or make sure tap water has been boiled before you drink it or use it to brush your teeth, and ask for drinks without ice.
• Get vaccinated. Vaccines are available for hepatitis A and B. Three doses provide full and lasting protection. If you are traveling to high-risk areas, start the hepatitis A vaccine at least one month before your trip. Get the hepatitis B vaccine if you might be exposed to infected blood or body fluids or if you are at high risk. People at high risk include health care workers, acupuncturists, tattoo artists, and people with multiple sex partners.
• Boost your immunity. If you think you’ve eaten contaminated food, or if someone in your household has been diagnosed with hepatitis, ask your doctor for a shot of immune globulin (if you haven’t had the hepatitis vaccine). It offers short-term protection against the virus.
• Helpful herb. Milk thistle (Silybum marianum) improves the liver’s ability to function in people with hepatitis, although it won’t reverse liver damage. It’s available in capsules, or the crushed seeds can be brewed as a tea. Take 200 mg two or three times a day.
• Limit the liquor. Drink alcohol in moderation. It’s best to avoid it completely if someone in your family has had liver disease.
• Play it safe. Practice safe sex and always use a condom. Be especially careful if your partner has been diagnosed with hepatitis.
• Wash up. Wash your hands with soap and hot water before preparing food and after using the toilet and changing diapers to help prevent the spread of infection.
• Skip the needle. Contaminated needles can spread hepatitis A and B. Avoid tattoos and body piercings, and don’t inject illegal drugs.
• Don’t share. Don’t share a razor or toothbrush with someone who’s infected with hepatitis B or C, because the virus is spread through blood and body fluids.