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Hepatitis

Hepatitis is a general term that refers to inflammation that occurs in the liver. Hepatitis is generally caused by a viral infection, although it can also be caused by other conditions. Some causes of hepatitis in addition to viral infections are the habit of drinking alcohol, autoimmune diseases, as well as toxic substances or certain drugs.

Hepatitis can interfere with various bodily functions, especially those related to metabolism, because the liver has many roles in the body's metabolism, such as:

  • Produces bile for fat digestion.
  • Decompose carbohydrates, fats and proteins.
  • Neutralize poisons that enter the body.
  • Activating various enzymes.
  • Dispose of bilirubin (a substance that can make the body yellow), cholesterol, hormones, and drugs.
  • Form proteins such as albumin and blood clotting factors.
  • Store carbohydrates (in the form of glycogen), vitamins and minerals.

 

Hepatitis that occurs can be acute or chronic. Someone who experiences acute hepatitis can provide a variety of manifestations and the course of the disease. Starting from asymptomatic, symptomatic and self-healing, it becomes chronic, and the most dangerous is developing into liver failure. When it develops into chronic hepatitis, it can cause cirrhosis and liver cancer (hepatocellular carcinoma) in the annual period. Hepatitis treatment itself varies according to the type of hepatitis suffered and symptoms that appear.

 Hepatitis : Cause, symptoms, treatment and prevention

Causes of Hepatitis

Hepatitis can be caused due to infection or not due to infection. The distribution of types of hepatitis caused by viral infections are as follows:

  • Hepatitis A. This disease is caused by the hepatitis A virus (HAV). Hepatitis A is usually transmitted through food or drinking water contaminated with feces from people with hepatitis A who contain the hepatitis A virus.
  • Hepatitis B. This disease is caused by the hepatitis B virus (HBV). Hepatitis B can be transmitted through body fluids infected with the hepatitis B virus. Body fluids that can be a means of transmission of hepatitis B are blood, vaginal fluids, and semen. Therefore, sharing syringes and having unprotected sex with people with hepatitis B can cause a person to contract the disease.
  • Hepatitis C. This disease is caused by the hepatitis C virus (HCV). Hepatitis C can be transmitted through bodily fluids, especially through sharing syringes and unprotected sexual intercourse.
  • Hepatitis D. This disease is caused by the hepatitis D virus (HDV). Hepatitis D is a rare, but serious, disease. The hepatitis D virus cannot reproduce in the human body without hepatitis B. Hepatitis D is transmitted through blood and other body fluids.
  • Hepatitis E. This disease is caused by the hepatitis E virus (HEV). Hepatitis E easily occurs in environments that do not have good sanitation, due to hepatitis E virus contamination in water sources.

 




Mothers who suffer from hepatitis B and C can also infect their babies through the birth canal.

Besides being caused by a virus, hepatitis can also occur due to damage to the liver by chemical compounds, especially alcohol. Excessive alcohol consumption will permanently damage liver cells and can develop into liver failure or cirrhosis. The use of drugs over dosages or exposure to toxins can also cause hepatitis.

In some cases, hepatitis occurs because of an autoimmune condition in the body. In autoimmune hepatitis, the body's immune system attacks and destroys the cells and tissues of the body itself, in this case liver cells, causing inflammation. Inflammation that occurs can vary from mild to severe. Autoimmune hepatitis is more common in women than men.

Common Symptoms of Hepatitis

Before the hepatitis virus causes symptoms in the patient, first this virus will pass the incubation period. The incubation time of each type of hepatitis virus varies. HAV requires an incubation time of around 15-45 days, HBV is around 45-160 days, and HCV is around 2 weeks to 6 months.

Some of the symptoms that commonly appear in hepatitis patients include:

  • Experience flu-like symptoms, such as nausea, vomiting, fever, and weakness.
  • Pale stool.
  • Eyes and skin turn yellow (jaundice).
  • Abdominal pain
  • Weight loss.
  • Urine darkens like tea.
  • Loss of appetite.

 

If you experience viral hepatitis that can turn into chronic, such as hepatitis B and C, you may not experience these symptoms at first, until the damage produced by the virus has an effect on liver function. So the diagnosis becomes late.

Risk Factors for Hepatitis

Risk factors that can increase a person to be more susceptible to hepatitis depend on the cause of hepatitis itself. Hepatitis that can be transmitted through food or drinks such as hepatitis A and hepatitis E, is more risky for water treatment workers or waste treatment. While non-infectious hepatitis, it is more risky for someone who is addicted to alcohol.

For hepatitis whose transmission through body fluids such as hepatitis B, C, and D is more at risk in:

  • Medical officer.
  • Drug users with syringes.
  • Changing sexual partners.
  • People who often receive blood transfusions.

 

But at this time it is rare for people to contract hepatitis through blood transfusions, because every blood donated first passes an examination for diseases that can be transmitted through blood.

Diagnosis of hepatitis

The first step in the diagnosis of hepatitis is to ask for a history of symptoms and look for risk factors from the sufferer. Then do a physical examination to find physical signs or abnormalities that appear in the patient, such as by pressing the abdomen to look for enlargement of the liver as a sign of hepatitis, and checking the skin and eyes to see changes in color to yellow.

After that, patients will be advised to undergo several additional examinations, such as:

Liver function tests. This test is done by taking a blood sample from the patient to check the performance of the liver. In liver function tests, the content of liver enzymes in the blood, namely the enzyme aspartate aminotransferase and alanine aminotransferase (AST / SGOT and ALT / SGPT), will be measured. Under normal conditions, both enzymes are present in the liver. If the liver is damaged by inflammation, the two enzymes will spread in the blood so that the levels rise. However, keep in mind that liver function tests are not specific to determine the cause of hepatitis.

Viral hepatitis antibody test. This test serves to determine the presence of antibodies that are specific to HAV, HBV, and HCV viruses. When someone is exposed to acute hepatitis, the body will form specific antibodies to destroy the virus that attacks the body. Antibodies can form several weeks after a person has hepatitis virus infection. Antibodies that can be detected in patients with acute hepatitis include:

  • Antibodies against hepatitis A (anti HAV).
  • Antibodies to the core material of the hepatitis B virus (anti HBc).
  • Antibodies to the surface material of the hepatitis B virus (anti HBs).
  • Antibodies to the genetic material of the hepatitis B virus (anti HBe).
  • Antibodies to the hepatitis C virus (anti HCV).

 

Protein tests and viral genetic material. In patients with chronic hepatitis, antibodies and the body's immune system cannot destroy the virus so that the virus continues to develop and escape from the liver cells into the blood. The presence of viruses in the blood can be detected by specific antigen tests and viral genetic material, including:

  • Antigen surface material for hepatitis B virus (HBsAg).
  • Antigen in the genetic material of the hepatitis B virus (HBeAg).
  • Hepatitis B virus DNA (HBV DNA).
  • Hepatitis C virus RNA (HCV RNA).

 

Abdominal ultrasound. With the help of sound waves, ultrasound of the stomach can detect abnormalities in the liver and its surroundings, such as liver damage, liver enlargement, or liver tumors. In addition, through abdominal ultrasound can also detect the presence of fluid in the abdominal cavity and abnormalities in the gall bladder.

Liver biopsy. In this method, liver tissue samples will be taken and then observed using a microscope. Through a liver biopsy, the doctor can determine the cause of the damage that occurs in the liver.

Hepatitis treatment

Treatment given to hepatitis patients depends on the cause. Monitoring the patient's physical condition during the period of healing hepatitis is very necessary so that the recovery process can run well. Tiring physical activity should be avoided during healing until symptoms subside.

Treatment of acute hepatitis A, B, and E generally does not require specific treatment, the treatment is focused on relieving the symptoms that arise, such as nausea vomiting and abdominal pain. Keep in mind in the case of acute hepatitis, administration of drugs must be considered carefully because the patient's liver function is being disrupted. Acute hepatitis patients must maintain body fluid intake, either by drinking water or by administering intravenous fluids, to avoid dehydration from frequent vomiting. Especially for acute hepatitis C, interferon drugs will be given.

Treatment of chronic hepatitis has a goal to inhibit the proliferation of viruses, and prevent further liver damage and develop into cirrhosis, liver cancer, or liver failure. Unlike chronic hepatitis B, chronic hepatitis C treatment also aims to destroy the virus from the body. Treatment of chronic hepatitis involves antiviral drugs such as ribavirin, simeprevir, lamivudine, and entecavir, as well as interferon injections. Chronic hepatitis patients are required to stop drinking alcohol and smoking to prevent severe liver damage.

Hepatitis D infection can occur together or after a hepatitis B infection. Treatment of hepatitis D infection has not been studied until now.

Treatment of autoimmune hepatitis generally involves immunosuppressant drugs, especially corticosteroid groups such as prednisone and budesonide. In addition, patients with autoimmune hepatitis can also be given azathioprine, mycophenolate, tacrolimus, and cyclosporin.

Complications of Hepatitis

People with acute hepatitis can experience fulminant hepatitis which leads to liver failure due to severe inflammation of the liver. Symptoms of fulminant hepatitis sufferers include chaotic speech and decreased consciousness to coma. Patients can also experience bruising and bleeding due to the lack of blood clotting factor proteins produced by the liver. Fulminant hepatitis patients can die within a few weeks if not treated immediately.

In addition to fulminant hepatitis, people with hepatitis B and C can also experience chronic hepatitis. Chronic hepatitis is hepatitis that occurs in a person for more than 6 months. In chronic hepatitis, the virus will multiply in the liver cells and cannot be destroyed by the immune system. Viruses that reproduce chronically in a patient's liver will cause chronic inflammation and can cause cirrhosis, liver cancer, or liver failure.

Hepatitis prevention

In order to avoid hepatitis, someone needs to adopt a clean and healthy lifestyle. For example by:

  • Maintain a clean water source so that it is not contaminated with the hepatitis virus.
  • Wash food to be consumed, especially shellfish and oysters, vegetables, and fruits.
  • Do not share toothbrushes, razors or syringes with other people.
  • Do not touch the blood spill without protective gloves.
  • Having safe sex, for example by using a condom, or not changing partners.
  • Reduce alcohol consumption.

 

Besides going through a clean and healthy lifestyle, hepatitis (especially A and B) can be effectively prevented through vaccination. Hepatitis C, D, and E vaccines are still under development. But in some countries, the hepatitis C vaccine is available and can be used.



References

References

World Health Organization (2018). What is Hepatitis?

Easterbook, et al. (2017). Diagnosis of Viral Hepatitis. Current Opinion on HIV and AIDS.

Samji, et. al. Medscape (2017). Viral Hepatitis.


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Is a health and wellness enthusiast. In him free time, she loves to travel and taste different types of teas.

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