HEPATITIS

Hepatitis is a major public health problem. Approximately 400 million people have hepatitis B and 170 million have hepatitis C. Both cause chronic liver infection that can be fatal. Hepatitis B and C are implicated in 80% of cases of liver cancer, the fourth leading cause of cancer deaths in the world.

Hepatitis means inflammation of the liver from any cause. In plain terms, it means injury to the liver and it is characterized by the presence of inflammatory cells in the tissue of the liver. And the disease could be classified as acute or chronic

Clinically, the course of acute hepatitis varies widely from mild symptoms requiring no treatment to severe hepatic failure needing liver transplantation. Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after recovery stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks

Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include : malaise, fever, muscle and joint aches, nausea or vomiting, diarrhoea and headache.

More specific symptoms include profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort.

Physical findings are usually minimal, apart from jaundice (33%) and tender hepatomegaly (10%). There can be occasional lymphadenopathy (5%) or splenomegaly (5%)

Chronic Hepatitis

Abnormal blood tests being the only manifestation. Features may be related to the extent of liver damage or the cause of hepatitis. Many experience return of symptoms related to acute hepatitis. Jaundice can be a late feature and may indicate extensive damage..

Other features include abdominal fullness from enlarged liver or spleen, low grade fever and fluid retention (ascites). Extensive damage and scarring of liver (i.e., cirrhosis) leads to weight loss, easy bruising and bleeding tendencies.

 Acne,
abnormal

menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.

Findings on clinical examination are usually those of cirrhosis or are related to etiology

causes
The causes of hepatitis are many but those that are of clinical importance are as follows:

Alcoholic hepatitis Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis and Usually alcoholic hepatitis comes after a period of increased alcohol consumption

. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis may develop jaundice, prolonged prothrombin time and liver Cirrhotic liver failure.

There may be superimposed on fatty liver or on cirrhosis.

There is also inflammation and degeneration of hepatocytes.

picture of alcohol fatty liver

Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis

 Viral

Hepatitis When inflammation is due to a viral infection. It may present in acute (recent infection, relatively rapid onset) or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A Hepatitis B Hepatitis C Hepatitis D and Hepatitis E

Hepatitis B and C are the most feared ones because of there long term complications. Hepatitis B This is caused by infection with hepatitis B virus and it primarily infect the liver cells and also present in all body fluids. Identified methods of transmission include blood and blood product(blood transfusion, now rare),

tattoos , sexually - through sexual intercourse or through contact with blood or bodily fluids through kissing or oral sex . via mother to child by breast feeding (minimal evidence of transplacental crossing). However, in about half of cases the source of infection cannot be determined. Blood contact may come about by sharing syringes in intravenous drug use, shaving accessories such as razor blades, or touching wounds on infected persons

The virus is also present in Saliva sputum tears sweat vomitus and vagina secretions

 complications

of Hepatitis B are chronic hepatitis Cirrhosis and hepatocellular carcinoma. Hepatitis B is endemic in South-East Asia and a number of African countries, making cirrhosis and hepatocellular carcinoma big killers

Normal liver Hepatocellular Carcinoma

Normal and cirrhotic liver

Hepatitis C This is also important cause of hepatitis and it resembles hepatitis B in terms of: Clinical presentation Mode of transmission And complications

macro nodular cirrhosis

Management
Prevention of the disease through vaccination is the best management option for hepatitis. Treatment of the disease after infection is possible but it must be stressed that at a particular viral titre level , the disease is INCURABLE.

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