VIRAL HEPATITIS

It is liver inflammation due to viral infection. It may be present in acute, fulminant or chronic forms.

WHAT CAUSES IT?
The five unrelated hepatotropic viruses — hepatitis A, B, C, D and E.

COMMON TYPES
Infectious jaundice is caused by hepatitis A virus. Infection with hepatitis A virus can happen through consumption of contaminated food or water. Hepatitis A is generally spread among family members and friends/relatives through the passage of oral secretions or stool (unclean hands). People with hepatitis A are advised to rest, stay hydrated and avoid alcohol. A vaccine is available that will prevent HAV infection for up to 10 years.

Hepatitis B is caused by a virus that can cause both acute, fulminate and chronic hepatitis. Hepatitis B is blood-borne infection transmitted through blood transfusion, tattoos, sexual intercourse or contact with body fluids.  Blood contact can transmit the virus. Sharing syringes or shaving accessories can be the reason. Patients can recover from the infection completely. A small proportion becomes the carrier of this virus and may develop after about 15 to 20 years and end up in liver disease. Vaccine can prevent infection from hepatitis B.

 Hepatitis C virus (HCV) usually spreads by shared needles among drug abusers, blood transfusion, hemodialysis, and needle sticks. Patients with chronic hepatitis C infection are at risk of developing cirrhosis and liver cancer after a silent phase of 15 to 20 years.

SYMPTOMS
Many patients infected with hepatitis A, B and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu-like symptoms, which include:
    Loss of appetite
    Nausea
    Vomiting
    Fever
    Weakness
    Tiredness
    Abdomen ache
    Rare common symptoms
     Dark-coloured urine
    Light-coloured stools
    Fever
    Jaundice (yellow appearance to the skin and white portion of the eyes)

DIAGNOSIS
When a patient reports symptoms of fever, fatigue, nausea, abdominal pain, darkening of urine, and then develops jaundice, the diagnosis of acute viral hepatitis is likely and can be confirmed by blood tests.
On the other hand, patients with chronic hepatitis due to hepatitis B and hepatitis C often have no symptoms or only mild non-specific symptoms. Typically, these patients do not have jaundice until the liver damage is advanced. Therefore, these patients can remain undiagnosed for years to decades. Quite a few times chronic hepatitis is diagnosed when blood tests are done for other reasons.

TREATMENT
Treatment of acute viral hepatitis involves relieving symptoms and maintaining adequate intake of fluids. Supportive care is the main modality for acute hepatitis.  Fulminant hepatitis is life threatening which carries a high mortality if liver transplant is not available immediately. Fortunately, the rate of cases is really low.  Treatment of chronic viral hepatitis involves medications to destroy the virus and taking measures to prevent further liver damage.  Patients who develop progressive liver damage/ cancer or significant complications from liver dysfunction, transplant is the best option.

Patients with chronic hepatitis B or C have predisposition to develop liver cancer and should be monitored. Liver resection to remove cancer is the best way. If it is not possible, other options such as radiofrequency ablation, transarterial chemoembolization, radioactive embolization are available.

Source: ToI