Hepatitis is one of the most serious causes of liver disorder and dysfunction, which is responsible for one to two million deaths a year. Hepatitis can occur as infectious or non-infectious. Although major causes of hepatitis include viruses, the other common causes are autoimmune liver disease, obesity, alcohol, tobacco consumption and certain other medications and herbs. Viral hepatitis is a viral-induced necroinflammatory disease of the liver caused by one of the hepatitis viruses, namely, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis E and Hepatitis G . Hepatitis and A and E are enterically transmissible viruses, while Hepatitis B, C and D are blood-borne viruses. The blood-borne viruses are chronic in nature, which gradually progress to end-stage liver disease and premature mortality. Hepatitis also occurs as a consequence of infection with other common viruses, such as Epstein-Barr virus, herpes simplex and cytomegalovirus .
Except under unusual circumstances, none of the Hepatitis viruses are directly cytopathic. The enterically transmissible viruses, Hepatitis A and E survive exposure to bile in the binary system and intestine . They shed in feces as intact virus particles. The consequences are acute, but result in high fatality rates. On the other hand, blood-borne Hepatitis viruses cause extensive morbidity and mortality. In addition to acute hepatitis, the blood-borne viruses also cause persistent viremia and chronic liver disease. The deaths that occur due to blood-borne Hepatitis viruses are mostly due to liver failure from end stage disease. Scientists proved that the infection by one hepatitis virus of an individual chronically infected by a second hepatitis virus may affect the replication of one or both viruses and lead to increased liver injury and clinical severity . Due to shared risk factors, co-infections between the blood-borne pathogens exhibit viral replication.
Hepatitis caused by virus are potentially infectious to others as they are easily transmissible by food, interpersonal or sexual contact. The three types of hepatitis are acute hepatitis, chronic hepatitis and fulminant hepatitis. In acute hepatitis, the inflammation of liver lasts for less than six months, while it lasts for more than six months in chronic hepatitis . Fulminant hepatitis is the severe form of acute hepatitis, associated with jaundice, coagulopathy and encephalopathy. The inflammation of liver subsides in people, who do not progress to chronic or fulminant hepatitis from acute hepatitis. People suffering from chronic hepatitis have the risk of acquiring cirrhosis. In people with fulminant hepatitis, liver failure occurs abruptly, approximately within eight to nine weeks from the onset of the symptoms .
Symptoms in acute hepatitis are similar to that of chronic hepatitis, however the intensity of the damage caused to the liver varies. Moreover, the symptoms in chronic hepatitis are absent or minor, unless liver damage progresses to an irreversible stage. In a majority of the cases, symptoms are absent in acute hepatitis and the individual is unaware about the occurrence of the infection . Symptoms in non-viral hepatitis are vague and go undetected unless liver tests are done. If due to drugs, the symptoms disappear over time after the discontinuation of the drugs. The amount of virus present in the body also determines the nature of the symptoms. The most common symptom of hepatitis is loss of appetite, which progresses to nausea and vomiting . The symptoms occur so rapidly that anorexia may go unrecognized as having been present before nausea. Vomiting disappears after the first few days; however, nausea may persist for up to six weeks.
In a few cases, vomiting prolongs to cause dehydration and requires the administration of intravenous fluids. Mild fever, joint pains, muscle aches and skin rash occur as a result of hepatitis, but they are not prominent . Abdominal pain, jaundice and malaise are also common symptoms in the acute stage. Since nausea and vomiting are common symptoms in most of the diseases, the infection goes unnoticed unless the eyes turn yellow or the urine turns dark brown. In exceptional cases, vomiting prolongs for several days and turns severe. Vomiting results in the loss of fluids, electrolytes, such as potassium, sodium and chloride, and acids present in the stomach . The replacement of the fluids in the body through eating or drinking is inadequate to replenish the water content. The dark color of the urine is due to bilirubin, which is a serum removed by the kidneys. Since the sick liver fails to produce bile as usual, the stool turns light in color.
Jaundice or icterus is another major symptom. Jaundice is not possible to diagnose unless the total serum bilirubin level, made up of bilirubin reach above 3mg/dL. Levels of 30mg/dL are frequent in acute hepatitis, especially in those cases caused by problems other than viral infections . The sick liver fails to perform the functions as usual in removing bilirubin from the body. As a symptom of hepatitis, some patients transiently experience an irritating itching of the skin due to the accumulation of the bile. Some patients complain about a foul taste in the mouth. In patients suffering from hepatitis, the body tolerates starches and sweets in a better way when compared to fatty foods or meat. Another major symptom of Hepatitis is acute ulceration or stress ulcers, which affects the gastrointestinal tract . Bleeding from such ulcers is severe and massive in certain circumstances due to the depression in the levels of prothrombin.
In rare cases of hepatitis, dilated veins in the esophagus, called esophageal varices develop and rupture with massive hemorrhage. Liver failure is the most devastating complication of hepatitis. Acute liver failure is common in the first week in about 50 percent of the patients. In the first four weeks following the onset of the disease, it is common in about 90 percent of the patients. In some patients, it develops in one to three months of the illness. Fulminant hepatic failure develops extremely rapidly, with death occurring only several hours or days after the first appearance of the symptoms . It is because of the death or injury of the hepatic cells. Failure of the hepatic cells to carry on the myriad functions of the vital organ and replacement of hepatic cells by the process of regeneration too slowly to adequately keep up with cell destruction.
Low blood level of prothrombin is the most reliable indication of the development of fulminant hepatitis. In some cases, hepatitis leads to the cessation of breathing. As swelling increases in the patients, the pressure in the brain exceeds the blood pressure. As a result, it slows down the flow of blood to the brain and finally halts, leading to brain death, which is impossible to recover . Hepatic encephalopathy implies that the liver damage is severe and recovery is questionable. In such cases, liver transplant is the only option for the patients. In the case of chronic hepatitis, the body shows its inability to get rid of the virus. It occurs due to the patient’s failure to discontinue an injurious drug and the occurrence of spontaneously developing antibodies. The severity of the disease is a function of the host’s reaction to the infection, not the virulence of the virus or the severity of case from which the transmission of the virus took place .
Heavy infecting load of virus results in more severe disease, due to the infection of more number of hepatic cells. In patients suffering from severe hepatitis, symptoms are more severe, complications occur more frequently and mortality rate is much higher. The severity of hepatitis and its outcomes depend on three major factors, such as the activity of the immune system, number of infected cells and the rapidity of replacement of destroyed hepatic cells . Cytokines released as a result of cell destruction are the reason for most of the symptoms. Acute symptoms of nausea and vomiting occur in relapsing hepatitis for a period of six to ten weeks. Regardless of the severity of the disease, acute hepatitis never lasts longer than six months. Hepatitis also leads to the onset of signs and symptoms of autoimmune diseases, such as rheumatoid arthritis and autoimmune liver disease .
The disease of hepatitis dates back to the fourth century B.C. in the writings of Hippocrates and Chinese medical texts. Outbreaks of jaundice were common in the military campaigns with crowded and unsanitary conditions between the seventeenth and nineteenth centuries. Epidemics of infectious hepatitis hit hard during Napoleon’s Egyptian campaign, the Civil War and the British invasion of Mesopotamia during the First World War . During the Second World War, over 150,000 soldiers of the United States and over five million soldiers and civilians of Germany suffered from hepatitis. The outbreak of hepatitis was also common during the Korean and Vietnamese wars. Hepatitis is common in developed nations, such as the United States and several other parts of the world. Men and women are equally susceptible to infection . Hepatitis is more common in lower socioeconomic groups when compared to the higher classes of the society.
Every year, more than 140,000 people in the United States develop hepatitis A, while 1,250,000 people develop hepatitis B . Globally, the number is 1,000,000 in the case of hepatitis A and 350,000,000 in the case of hepatitis B. Hepatitis C is unique and virtually chronic in nature. There are over 4,000,000 people in the United States infected by hepatitis C. The worldwide prevalence of chronic hepatitis C is around 150,000,000 to 170,000,000 . The incidents of childhood occurrence of hepatitis are uncommon as 90 percent of the children show asymptomatic infections. The rate of occurrence of hepatitis is higher in the non-Hispanic blacks. The prevalence of chronic hepatitis is also higher among non-Hispanic blacks and Asian Pacific Islanders. The countries of China, United States and Russia have the highest populations of hepatitis .
African Americans have poorer prognostic factors than Caucasians; hence, they have a higher prevalence of hepatitis. In African Americans, especially males have the higher chances of progression of hepatitis. Gender differences in hepatitis relate to the effects of sex hormones on the liver. In the case of women, about 80 percent of the hepatitis cases occur in young women with a mean age of forty years, but it is also common in older women . Women affected by hepatitis have 5 percent chances of progressing to cirrhosis, which is 20-30 percent in men. The estrogen hormone in women delays the progression of hepatitis and enhances the response to the treatment therapies . However, chronic hepatitis B is dangerous to women, especially pregnant women infected with hepatitis transmit the infection to the fetus and 80 percent of the fetuses have chances of developing chronic infection.
Similar to any serious illness, hepatitis adversely affects a person’s mental health. Patients suffering from hepatitis experience psychological stress and are at higher risks of developing a chronic mental illness. Grief and loss are the common emotional responses showed by hepatitis patients, especially women. In such patients, complications arise in the management and treatment of hepatitis patients. Improper medical care leads to higher chances of mortality and morbidity. Hepatitis results in various psychological symptoms, such as anxiety, depression, irritability and neurovegetative symptoms . Hepatitis also exacerbates an existing psychological disorder. Social factors of hepatitis vary depending upon a variety of issues, such as socio-economic status, perception of illness, level of education, coping style support from friends and family, and access to health care.
The diagnosis of hepatitis occurs in several ways. In some cases, abnormalities in the liver function test determine the possibility of hepatitis, while in other cases, an elevated level of ALT’s determine the onset of hepatitis . However, to diagnose hepatitis in an accurate way, abdominal sonogram is one of the alternatives. Evaluation of the damage done to the liver is possible through liver function test and hepatitis-specific blood tests. The treatment of acute hepatitis involves the administration of a healthy, low-fat diet with plenty of water. Unnecessary medication and herbs are not necessary. In the case of chronic hepatitis, the treatment involves alcohol abstinence, tobacco avoidance and lifestyle modifications. On the other hand, treatment of fulminant hepatitis involves the close monitoring of the patients in intensive care units under the administration of fluids and medications .
It is important to integrate the prevention of hepatitis into public health programs in order to assist the people suffering from the risk of infection. The public health professionals must make the use of substance abuse treatment programs, counseling and public health settings to create an impact on the patients suffering from hepatitis . Creating awareness about the hepatitis vaccination is another step towards the success of preventing the occurrence of hepatitis. Public health professionals must ensure to incorporate hepatitis control activities into the existing healthcare systems for the betterment of public health. National organizations, agencies and public health providers must take the responsibility of advocating hepatitis prevention services to reduce the risk factors visible in the hepatitis patients during the treatment . Public health professional must ensure the availability of low-cost hepatitis vaccines to eliminate the risks of the disease.
References
Buggs, Adrienne M. "Viral Hepatitis." 23 08 2012. Medscape. 26 11 2014 <http://emedicine.medscape.com/article/775507-overview#a0156>.
Koff, Raymond S. Hepatitis Essentials. Jones & Bartlett Publishers, 2011.
Moore, Elaine A. Hepatitis: Causes, Treatments and Resources. McFarland, 2006.
