What is hepatitis?

The term "Hepatitis" refers to inflammation of the liver resulting from a virus, a disease, alcohol consumption or drugs. However, a viral hepatitis is the most prevalent cause of the disease. In fact, this disease can be severe and life-threatening, or mild and resolves on its own. Moreover, such disease can last less than 6 months "acute" leading to liver failure, or last longer than 6 months "chronic" causing liver damage.

Types of hepatitis:

Hepatitis viruses that infects humans are 7, named with letters from A to G. Also, this disease can result from a disease such as autoimmunity, or it results from alcohol consumption.

Hepatitis A:

To begin with, it's an RNA virus present in very high concentration in the feces/stool of individuals carrying the virus. Indeed, it's when the incubation period reaches its end, the peak of the viral load is met. You might obtain this viral infection by oral-fecal contact whether it's from contaminated water (drinking water, sea, river, lake...), food, or things. Besides, it's possible to acquire the infection from contact with a sick person. Additionally, living with a person who has the virus puts you at a 20% risk of getting infected.

Hepatitis B:

Basically, you can mostly detect this virus in vaginal mucus, semen, serum, tears and saliva. On the other hand, you might rarely find the virus in sweat, stool, or urine. Therefore, any contact with mucous membranes or bodily fluids of an infected person, leads to infection. For instance, it's easy to obtain the virus by blood transfusion, having multiple sex partners, contaminated intravenous drug needles and more. In addition, it's possible to trasmit the virus perinatally, and it often becomes a chronic infection.

Hepatitis C:

People often acquire this virus by using a contaminated needles which is common among drug users. You can also obtain the virus sexually or perinatally, but it's less common.

Hepatitis D:

If you have type D then you're having a coinfection with type B too. In fact, it has the same methods of transmission with the perinatal way being the most rare. 

Hepatitis E:

Just like type A, type E spreads among people via the fecal-oral route. Meanwhile, other ways of transmission such as person-person or maternal-neonatal are uncommon.

Hepatitis G:

This is not known as a virus that cause hepatitis itself. But it often comes in association with type B or C chronic infections. 

Other viruses:

There's a bunch of viruses that might cause this disease including:

• Varicella-zoster virus
• Cytomegalovirus
• Herpes simplex virus
• Epstein-Barr virus

Autoimmune hepatitis:

This occurs due to taking certain drugs, Epstein-Barr/hepatitis viral infections, or environmental triggers. For instance, such drugs include methyldopa, adalimumab, infliximab, minocycline, and nitrofurantoin.

Alcoholic hepatitis:

Indeed, among the many factors that cause such type are:

• Hepatocytes cell membrane damage by ethanol metabolytes (acetaldehyde) 
• Free redicals
• Abnormal retention of fat iniside cells or organs
• Oxidative stress and injury
• Over-stimulation of cytokines
• Malnutrition 

Symptoms:

The symptoms depend totally on the virus causing the disease. In short, some people might obtain chronic viral infections where they present no symptoms or mild ones. On the contrary, other patients might start having liver failure right after the disease onset. The most common symptoms are:

• Anorexia
• Vomiting and nausea
• Feeling uncomfortable
• Elevated rash or hives
• Itching
• Joint stiffness
• Tiredness and fatigue
• Dark urine color
• Pale stool color
• Pain in the upper abdominal area
• Jaundice

How to diagnose hepatitis?

Physical assessment: it iincludes checking for the previously mentioned symptoms and some signs for dehydration, tachycardia, dry mucousal membrane, and slow capillary re-input.

Laboratory tests: test results that indicate liver disease are:

• Elevation in bilirubin levels
• Prolongation in international normalized ration (INR) and prothrombin time (PT)
• Leukopenia
• Thrombocytopenia
• Reduction in hematocrit and hemoglobin levels
• Elevation in ammonia levels in serum 
• Presence of hepatitis virus antigen and antibodies

Biopsy: taking a biopsy from liver by using a needle that enters from your liver area skin can help analyze liver damage.

Ultrasound scan: this method scans your abdominal area and shows the liver size or any damage. 

How to prevent it?

Indeed, there's many precautions that proves handy avoiding hepatitis:

• Taking hepatitis A and B vaccines; as a matter of fact, newborns should take these vaccines during the first 6 months, but adults can have it too. In addition, healthcare and medical workers should get the vaccines since they are at a high risk. Finally, there's no hepatitis C, D and E vaccines, yet vaccinating against type B prevents type D.
• Avoid local water in endemic areas including undercooked food, raw vegetables and fruits, and ice. 
• Minimize contact with diseased individuals as much as possible. 
• Never use water, food or be exposed to body fluids from a sick person.
• Stop using contaminated needles or razors.
• Use condoms during sex. 
• Keep your own toothbrush.

Hepatitis treatment:

There's no cure to this disease. Fact is, you can reduce symptoms and cease any severe damage that's going to occur to your liver. For example, keeping up with a hydrating diet to overcome dehydration from diarrhea and vomiting. Besides, an acute form lasting less than 6 months, will resolve on its own. However, there's antiviral drugs that deal with both chronic and acute viral infections (hepatitis C). Also, there's medications that help with autoimmune hepatitis to stop the immune system from attacking the liver. For instance, corticosteroids such as prednisone, budesonide, tacrolimus, azathioprine and cyclosporine are effecient.

Complications:

• Liver necrosis
• Cirrhosis
• Liver failure
• Hepatocellular carcinoma
• Variceal bleed
• Spontaneous bacterial peritonitis
• Hepatic encephalopathy
• Coagulopathy
• Thrombocytopenia
• Extrahepatic complications including non-Hodgkin lymphoma, autoimmune thyroiditis...

References:

-Mehta P, Reddivari AKR. Hepatitis. [Updated 2021 Dec 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554549/#_NBK554549_pubdet_

-Healthline "Hepatitis: What is it?"

-John hopkins medicine "Hepatitis"

-CDC "What is viral hepatitis"

-Image credits: https://www.freepik.com/vectors/medical-man