HEPATITIS

Hepatitis is a viral infection of the liver marked by liver cell destruction, and necrosis (death of living cells). The liver is a dark reddish-brown organ that is located in the upper right-hand portion of the abdomen, below the diaphragm, and on top of the stomach, right kidneys and intestines. The functions of the liver include:

  1. The liver helps in metabolizing drugs into forms that are nontoxic or forms that are easier to use for the rest of the body. Also helps in metabolism of fats, protein and carbohydrates.
  2. Helps in storage of glycogen, vitamins and minerals
  3. Helps in protein synthesis
  4. The liver helps in bile production and excretion
  5. Helps in blood detoxification and purification
  6. Enzyme activation

Hepatitis is commonly as a result of viral infection, but there are other possible causes of hepatitis which include heavy alcohol use, toxins, certain medical conditions and some medications.

Types of Hepatitis

There are five major viral classification of hepatitis that are caused by different viruses. They are:

  1. Hepatitis A Virus (HAV): This virus causes Hepatitis A. This is common among homosexuals and people with Human Immunodeficiency Virus (HIV). The onset is acute and severity is mild. Incubation period is 15 to 45 days. The primary mode of transmission is when a person takes in the virus from food, drinks or objects that have been contaminated by stool from an infected person parenteral (fecal-oral) and sexual (especially oral, anal) contact with an infected person.
  2. Hepatitis B Virus (HBV): This virus causes Hepatitis B. The onset is gradual and progresses into a chronic condition. The incubation period is 30 to 180 days. Hepatitis B is transmitted through blood-borne parenteral route, sexual contact and maternal-neonatal route. The virus is shed in all body fluids.
  3. Hepatitis C Virus (HCV): This virus causes Hepatitis C. The incubation period is 15-160 days. The onset is also gradual and progresses into a chronic condition. This condition is common in adults. The common route of transmission is contact with the virus in body fluids, such as blood, vaginal secretions, or semen.
  4. Hepatitis D Virus (HDV): This virus causes Hepatitis D. Incubation period is 14 to 64 days. This is a rare form of Hepatitis. Most people infected with Hepatitis D are also infected with Hepatitis B. The route of transmission is through contact with blood containing HDV.
  5. Hepatitis E Virus (HEV): This virus causes Hepatitis E. It is uncommon and mainly found in areas with poor sanitation and water supply. The onset is usually acute but can be dangerous in pregnant women. The common route of transmission is exposure to the virus in food or water. Incubation period is 14 to 60 days.

Predisposing Factors of Hepatitis

Factors that could make an individual liable to this condition are:

  1. Poor sanitation
  2. Over-crowding
  3. Use of non-sterile syringe needles
  4. Tattooing
  5. Improper use of blood products
  6. Acupuncture

Signs and Symptoms of Hepatitis

Common signs and symptoms of hepatitis include:

  1. Abdominal pain
  2. Loss of appetite
  3. Jaundice: Yellow skin and eyes
  4. Fatigue
  5. Fever
  6. Dark colored urine
  7. Unexplained weight loss
  8. Irritability
  9. Blood in urine
  10. Photophobia
  11. Pale stool
  12. Vomiting
  13. Indigestion
  14. Pruritus (Itching)

Diagnoses of Hepatitis

Diagnostic procedures include:

  1. History Taking and Physical Examination: Here, the physician takes medical history to identify any predisposing factors. Also, a physical examination by examining the patient’s abdomen for swelling, pain or tenderness may be performed. The patient’s eyes and skin may also be examined for discoloration.
  2. Liver Function Test: This will show the stage at which the disease is. It will also determine how the liver works.
  3. Liver Biopsy: A sample of tissue is taken from the liver to determine how the infection has affected the liver.
  4. Ultrasound: An abdominal ultrasound scan can be done to view the liver and other nearby organs for abnormalities.
  5. Blood Tests: These tests can be used to determine if it is an infectious hepatitis. It can also check for any signs of autoimmune hepatitis.
  6. Radioimmunoassay: This detects IgM antibody to Hepatitis B core antigen, especially in acute phase.

Management of Hepatitis

Treatment of Hepatitis varies. It depends on the type of hepatitis and whether the condition is acute or chronic. Management includes:

  1. Bed rest is advised in the early stages of illness to relieve patient of fatigue
  2. Frequent small feedings of high calorie, low fat diet. Eat in a sitting position to decrease pressure on the liver.
  3. Maintain a calm and quiet environment to avoid irritation
  4. Ensure adequate fluid intake to prevent or treat dehydration
  5. Avoid alcohol consumption
  6. Antiviral Medications: Medications like Tenofovir (Viread), Lamivudine (Epivir), Adefovir (Hepsera) may be prescribed to treat Hepatitis B. A combination of ledipasvir and sofosbuvir, elbasvir and grazoprevir, sofosbuvir and velpatasvir, etc. may be used in the treatment of Hepatitis C. These medications can help fight the virus and slow the progression of liver disease and reverse liver damage.
  7. Pegylated interferon alpha can be used as a treatment for Hepatitis D but it has serious side effects, therefore, it is not recommended for people with autoimmune disease, psychiatric conditions and liver cirrhosis.
  8. For autoimmune hepatitis; a condition whereby the individual’s immune system attacks the liver, Corticosteroids like Prednisolone may be prescribed for treatment of autoimmune hepatitis. Azathioprine (Imuran), Tacrolimus (Prograf) may also be a part of treatment programs.

Prevention of Hepatitis

  1. Get the vaccines for hepatitis A and B at a nearby clinic
  2. Ensure protected sexual intercourse
  3. Do not share needles, blades and sharp objects
  4. Ensure proper environmental sanitation
  5. Ensure proper hand washing with soap and water after caring for client, after potential exposure to blood, and before eating or handling food.
  6. Avoid direct contact with blood and other bodily fluids
  7. Ensure all cuts and wounds are covered properly
  8. Prevent transmission of hepatitis by following standard precautions on infection prevention and control.
  9. Blood should be properly screened of hepatitis antigen before transfusion
  10. Identify persons or groups at high risk and educate them on proper hygiene waste disposal methods, food preparation, use of condoms and other preventive measures.

Complications of Hepatitis

Hepatitis, most especially Hepatitis B and C can lead to severe health problems, which include:

  1. Hypokalemia: When there is low level of potassium in the blood.
  2. Liver cancer e.g., Hepatocellular carcinoma
  3. Cholestatic hepatitis: This occurs when the flow of bile from the liver is reduced or blocked.
  4. Fulminant hepatitis: This is a sudden degeneration of liver functions.
  5. Liver cirrhosis: A condition whereby healthy liver cells are replaced with scar tissues, leaving the liver permanently damaged.
  6. Dehydration
  7. Liver failure
  8. Death

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