HEPATITIS AND THE HINDRANCE TO HEALTH

7 min


According to researches, almost 257 million people were affected by a chronic condition and struggled through it. Further, 900 thousand people die each year. This condition is ‘hepatitis’. The word hepatitis is derived from 2 words. Firstly, ‘Hepar’ is the Greek word for liver. Secondly, the word ‘itis ‘ refers to inflammation. Therefore, hepatitis can be roughly translated as the inflammation that occurs in the liver. Also, the liver might be subjected to a number of different infections.

Firstly, there are many different types of viruses that can cause this condition. But, the most severe and common forms are the hepatitis viruses that are named from A to E (A, B, C, D and E).

VIRUSES THAT CAUSE HEPATITIS:

Firstly, apart from the hep virus, there are different forms of viruses that can cause hepatitis in humans. Further, some of them include the Cytomegalovirus, Ebstein Barr virus and the Herpes Simplex virus. On the other hand, the majority of hep cases in humans are caused by the hepatitis virus.

Type of virus Feature of the virus Incubation period ROUTESEVERITYCHRONICITY
Hepatitis AssRNA; No envelope2-6 weeksfaecal-oral routemildNone
Hepatitis BdsDNA; enveloped4-26 weeksParenteralsevere10%
Hepatitis C ssRNA; enveloped 2-22 weeks Parenteralmild50-60%
Hepatitis DssRNA; enveloped6-26 weeks
Hepatitis EssRNA; No envelope2-6 weeks faecal-oral routemildNone
PS: ds- double-stranded; ss-single stranded

DIFFERENCE BETWEEN THE ROUTES OF TRANSMISSION:

faecal-oral routeParenteral route
In the faecal-oral route of transmission, the infected person excretes or sheds viruses in the faeces. Moreover, this shed virus infects the water or food. Also, this infection spreads to another person.The word ‘Par’ means outside and ‘enteral’ refer to anything that enters the body through the food pipe. So the hep infection occurs through other modes like the skin, muscles or veins.

PATHOPHYSIOLOGY OF THE VIRUS:

Pathophysiology refers to how the virus damages the liver in humans. The virus can enter the body through any means mentioned above. Once they enter the body, the virus has a special affinity to the liver cells. The viruses are able to reach the liver through blood circulation in general. Further, when the viral body enters the liver they tend to innoculate in the hepatocytes of the liver cells. Consequently, these hepatocytes are arranged in large numbers within the livers in clusters called lobules.

Further, as with any other viral cell activity, the hep virus also enters and the liver cells and multiply. Moreover, the cells of the liver give a very conducive environment for these viruses to multiply. Most importantly, the growth or the multiplication of the virus alone does not lead to the condition. Further, the growth leads to a change in the antigen structure of the hepatocytes. Further, the produced new hepatocytes are recognized as foreign substances by the body and the immune system starts to destroy them through self mediated damage of the liver cells.

Moreover, the immune system of the body recognizes these cells and tries to destroy them through 3 mechanisms namely, apoptosis, necrosis and fibrosis.

RISK OF INFECTION:

The above mechanism is common and not an issue in the case of Hepatitis A and E. This really becomes an issue when the virus causes Hepatitis B and C. The major difference between the two is the period of incubation and the chronicity of the virus. Also, hepatitis A and E are pretty acute, meaning they have a sudden onset and a short window of infectivity. Further, Hepatitis B and C have a pretty long onset and can the infection can be for longer periods of time.

The major issue with the latter is these viruses can live dormant within the cells for many months or even years. Further, these can become active at any point in time and infect new cells. Moreover, when this mechanism happens over an extended period of time, the liver cells bear irreparable damage, might fibrosis and the liver architecture can become distorted. To sum up, the basic function of the liver deteriorates.

TRANSMISSION:

Hepatitis is a massive transmissible disease.

  • It can easily spread from mother to child during birth, if the mother is positive for hepatitis.
  • Further, sexual activity great increases the chance of transmission of hepatitis.
  • Contaminated needles also spread hepatitis. Needles not only from hospitals, but through tatoos, parlors etc. For instance, the exchange of body fluids like saliva, vaginal, seminal can lead to an infection with the virus.

SYTMPTOMS OF AN ACUTE ATTACK OF HEPATITIS:

Once the virus enters the body, the symptoms produced by the body are widely varied. Further, depending upon the onset of the symptoms they are widely classified as acute and chronic. The symptoms and the onset also widely depend upon the age of the patient, the type of virus, health of the patient and status of the immune system. Firstly, when we talk about the clinical symptoms these symptoms are widely divided into 3 phases based on the presentation. They are prodromal, icteric and convalescent.

Hepatitis is a non-specific prodromal infection. Firstly in the prodromal phase, there is no major involvement of the liver. The virus enters the body and the symptoms presented are due to the presence of the virus in the blood. This state of the body, when the virus inhabits and circulates through the body through the blood is called viraemia. Further, it releases chemicals and toxins like IL-1 and TNF -A.

SYMPTOMS IN THE PRODORMAL PHASE (Flu-like symptoms)
FEVER
FATIGUE
HEADACHE
ANOREXIA AND NAUSEA
SKIN RASHES (rarely)
JOINT AND MUSCLE PAIN

Further, the prodromal phase progresses to the icteric phase. In the icteric phase, the virus from the general circulation gets to the liver. Moreover, the liver is damaged in this phase.

ICTERIC PHASE OF HEPATITIS
JAUNDICE (both conjugated and unconjugated)
DARK URINE (due to leak of unconjugated bilirubin into the blood)
HEPATOMEGALY (enlargement of the liver due to inflammation)
BLOOD (raised transaminase)

Usually, during this stage, various biochemical tests can reveal valuable information about the virus and the damage it has caused.

WHAT ARE CONJUGATED AND UNCONJUGATED BILIRUBIN?

The conjugated bilirubin comes into the duct due to the damage of the bile ductules. Further, the hepatocytes also line the bile ductules. Therefore, the bile ductule damage causes the release of the conjugated bilirubin.

On the other hand, the unconjugated bilirubin comes into the blood due to damage of the bile duct and the loss in the conjugation ability of the liver.

CONVALESCENT PHASE:

Finally, the convalescent phase occurs. This phase is usually the recovery phase.

CONVALESCENT PHASE OF HEPATITIS
The symptoms become mild and gradually improves
The liver size returns to normal
Appetite improves
Jaundice decreases
The stool and urine return to normal colour.

Further, this phase also depends on the type of virus in the body. In the case of Hepatitis A and E, this phase might last for a period of 1 to 2 months. Further, in the case of Hepatitis B and C, the phase usually results for 3-4 months, due to the chronicity of the virus.

Usually, during this stage, various biochemical tests can reveal valuable information about the virus and the damage it has caused.

MANAGING HEPATITIS:

The recovery from hepatitis usually depends on factors like,

  • The type of the virus
  • The health and immune system status
  • And, the age of the patient

The age of the patient plays a major role in recovery. Further, whether the infection is acute or chronic is also of great importance. For instance, the chances of hepatitis A and E affecting children is high but the symptoms produced are very less. On the other hand, in adults hepatitis, A and E are responsible for 70% -90% of jaundice. Whereas in hepatitis B, the chronicity is 90%, but the chance of jaundice is 5%-10%.

VACCINATION FOR HEPATITIS:

In the case of vaccination, hepatitis B is the only virus of the 3 bloodborne types, to have a vaccine. Moreover, this vaccine offers 98%- 100% efficiency against hepatitis. Further, the WHO recommends that all infants receive the vaccine 24 hours after birth. Also, the hepatitis B vaccine must be administered over a 6 month period.

After the administration of the first dose, the following booster doses can be administered at an interval of 6 months. Health care workers, emergency personnel and other people at high risk of transmission should get vaccinated mandatorily.

TREATING HEPATITIS:

Vaccines are just preventive measures against hepatitis. The actual treatment protocol differed hugely. There is as such no protocol for treating hepatitis. However, that care is aimed at maintaining comfort and adequate nutritional balance.

  • Fluid replacement is very important. Moreover, this makes sure that the patient is not dehydrated and ensures adequate maintenance of homeostasis. Further, vomitting and diarrhea are common in chronic infections.
  • Also, oral anti-virals agents can slow down the progression to cirrhosis and reduce incidence of liver cancer and improve longevity.
  • Further, it’s very impotant to talk to your health care provider and discuss options of management tailored to your needs.

To sum up, maintaining personal hygiene and being a bit extra care can go a long way in avoiding contracting infections. It is also very important to watch out for the symptoms and get the proper treatment as early as possible. World hepatitis day is celebrated on July 28th. Further, the purpose of this day is to create awareness among the general public. Also, make sure you and your family are vaccinated against this virus. Stay happy and healthy!


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Dr Kavitha M

I am an undergraduate degree holder in dentistry. I have a great interest in music and reading. I am a linguaphile. My areas of interest lie in psychology, medical imaging, diagnostics, and oncology. I am a person who focuses more on the emerging areas of forensics.

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