The first time I heard of hepatitis I was probably around age 15. What I remember is my mother taking us to a private hospital after church to get an injection. And then we had to go back two more times to get two more injections to complete the Hepatitis B vaccination. So of course even though I had very little idea what hepatitis was, I didn’t like it very much.
Now as a doctor I’m fully aware of Hepatitis and it’s different types and all the possible things it could lead to, so now I’m thankful for those injections I had to take many years ago.
The term ‘hepatitis’ simply means inflammation of the liver. This may be caused by a variety of viruses or other infections, medications, or even a toxin such as alcohol (yes alcohol is actually considered a toxin by your body).
Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV).
The hepatitis B virus. The virus is primarily found in the liver but is also present in the blood and certain body fluids.
The hepatitis B virus reproduces in liver cells, but the virus itself is not the direct cause of damage to the liver. What happens is that, the presence of the virus triggers an immune response from the body as the body tries to eliminate the virus and recover from the infection. This immune response causes inflammation and may seriously injure liver cells. Therefore, there is a balance between the protective and destructive effects of the immune response to the hepatitis B virus.
Hepatitis B is spread mainly by exposure to infected blood or body secretions. In infected individuals, the virus can be found in the blood, semen, vaginal discharge, breast milk, and saliva. Hepatitis B is not spread through food, water, or by casual contact.
In the United States, sexual contact is the most common means of transmission, followed by using contaminated needles for injecting illicit drugs, tattooing, body piercing, or acupuncture. Also hepatitis B can be transmitted through sharing toothbrushes and razors contaminated with infected fluids or blood, therefore it’s generally advised to not share such personal items.
Hepatitis B also may be spread from infected mothers to their babies at birth (this is called ‘vertical’ transmission). This is the most prevalent means of transmission in regions of the world where hepatitis B rates are high, (Sub saharan Africa has the highest prevalence rates presently) and almost all infected infants will develop chronic hepatitis B. Fortunately, transmission can be significantly reduced through vaccination. This also emphasizes the need for proper antenatal care as pregnant women are routinely tested for hepatitis B so that proper prophylaxis can be given to prevent transmission to the baby.
In some cases, hepatitis B can be transmitted through transfused blood products, donated livers and other organs. Therefore it is very very important to ensure that any blood product to be transfused must be screened for Hepatitis B (and other viruses) to prevent this type of transmission.
When a person first gets hepatitis B, they are said to have an ‘acute’ infection. Most people are able to eliminate the virus and are cured of the infection. Some are not able to clear the virus and have ‘chronic’ infection with hepatitis B that is usually life-long
Acute hepatitis B
This is the period of illness that occurs during the first one to four months after acquiring the virus. Many times is may not present with any symptoms. Only 30% to 50% of adults develop significant symptoms during acute infection. Early symptoms may be non-specific, including fever, a flu-like illness, and joint pains. Other symptoms of may include:
- fatigue,
- loss of appetite,
- nausea,
- jaundice (yellowing of the skin and eyes), and
- pain in the upper right abdomen (due to the inflamed liver).
Most infants and children who acquire acute hepatitis B viral infection have no symptoms. In these individuals, the immune system fails to mount a vigorous response to the virus. Consequently, the risk of an infected infant developing chronic hepatitis B is approximately 90%. In contrast, only 6% to 10% of people older than 5 years who have acute hepatitis B develop chronic hepatitis B.
Chronic Hepatitis B
Inflammation from chronic hepatitis B can progress to cirrhosis (severe scarring) of the liver. Significant amounts of scarring and cirrhosis lead to liver dysfunction.
Symptoms may include:
- weakness,
- fatigue,
- loss of appetite,
- weight loss,
- breast enlargement in men,
- a rash on the palms,
- difficulty with blood clotting, and
- spider-like blood vessels on the skin.
Some complications that may occur in advanced cirrhosis:
The liver may be unable to detoxify certain toxic substances and this may lead to a state of confusion/ delirium and even coma.
- Increased pressure in the blood vessels of the liver (portal hypertension) causes fluid to build up in the abdominal cavity (ascites) and may result in engorged veins in the throat (esophageal varices) that tear easily and may cause massive bleeding.
- Portal hypertension can also cause kidney failure or an enlarged spleen and since the kidney and spleen are both involved in production of blood cells this can result in a decrease of blood cells and the development of anemia, increased risk of infection and bleeding.
- In advanced cirrhosis, liver failure also results in decreased production of clotting factors. This causes abnormalities in blood clotting and sometimes spontaneous bleeding.
- Patients with advanced cirrhosis often develop jaundice because the damaged liver is unable to eliminate a compound, called bilirubin which causes yellowness of the eyes and skin.
There are other things to note regarding Hepatitis B such as how to prevent it and also how to treat and all that will be discussed in the following post.
