Viral hepatitis

What is it?

This describes a viral infection of the liver. There are at least seven distinct hepatitis viruses that may cause infection. The symptoms of infection are similar for the different viruses. But there are distinct routes of infection, as well as complications and prognosis, and the main diagnostic categories are described as viral hepatitis A, B, or C (see discussions for each specific type).

The infection can be spread by ingestion of contaminated food or water, and anal sexual practices. Occasionally, infection is spread in contaminated blood; health care workers are at high risk to infection from accidental needle pricks. Often, simultaneous infection occurs with multiple types of hepatitis viruses. In the US, acute viral hepatitis is commonly seen in American Indian reservations, in native Alaskan villages, and among international travelers. There are other endemic areas of viral hepatitis throughout the world.

How is it diagnosed?

History of hepatitis A is often of international travel, especially to areas with less stringent standards of water purification or food preparation; eating of seafood, especially shellfish; or anal sexual practices.

Spread of hepatitis B, C, D and G may be accomplished by exposure to contaminated blood, and during sexual intercourse with an infected person. The source of infection is often difficult to trace because of the extended (and variable) period between contraction of the virus and the appearance of disease symptoms.

Symptoms may occur suddenly or slowly. The initial symptoms are typically fatigue and weariness, followed by anorexia, nausea and upper abdominal pain. These early symptoms may be followed by headache, fever, influenza-like symptoms, arthralgia, rash, intermittent nausea or diarrhea. The duration of clinical symptoms varies between two to eight weeks.

Occasionally, acute viral hepatitis is marked by repeated relapses; this is especially true of hepatitis A or D infections. Acute viral hepatitis can progress to fulminant hepatitis in its most extreme form.

Physical exam may show jaundice and dark urine during the early phases of the illness, accompanied by lightening of the stools and generalized itching. Weight loss usually occurs, averaging five to fifteen pounds. The onset of fulminant hepatitis is marked by the appearance of abnormal behavior, drowsiness, confusion, sleepiness, and possibly coma. Deep jaundice, biochemical signs of liver failure and coagulation abnormalities are usually present.

Tests: Routine liver biochemical tests may be used to distinguish viral from nonviral hepatitis, but cannot discriminate between the different types of viral hepatitis. Antibodies to the various hepatitis viruses may be detected in the blood during active infection and for many subsequent months, even after liver enzyme levels return to normal. For hepatitis B and C viruses, the presence of specific antiviral antibodies in the blood is a diagnostic tool for monitoring the progression of the infection. In cases of fulminant or chronic hepatitis, a liver biopsy may be performed to evaluate the extent of liver disease.

How is it treated?

The best treatment for hepatitis is prevention. A vaccine exists for hepatitis types A and B. People at high-risk such as health care workers, individuals undergoing kidney dialysis, individuals who practice promiscuous sexual activity and persons traveling to areas where hepatitis infection rates are high, should be vaccinated. Sterile or disposable needles should be used for acupuncture, ear piercing or tattooing.

After hepatitis has been diagnosed, consumption of alcoholic beverages should be avoided. Rest should be taken as needed. Meals should be limited in caloric intake to minimize nausea and help overcome loss of appetite.

In severe cases, intravenous feeding may be required. Liver transplantation may be performed in some cases of fulminant hepatitis. There is no specific antiviral treatment for acute viral hepatitis. Hepatitis B gamma globulin may be given for passive protection in immunodeficient individuals who have contracted the B form of viral hepatitis. Chemical or biological compounds that nonspecifically stimulate antiviral immunity may help in infections that relapse or become chronic. Interferon may be included in treatment for hepatitis B and C.

Medications

Rebetol (Ribavirin), Reglan (Metoclopramide), Famvir (Famciclovir)

What might complicate it?

The severity of acute viral hepatitis is influenced primarily by the type of virus and the immune status of the individual. If the individual is older, pregnant, or immunodeficient, the disease tends to be more severe, to last longer, and has a higher probability of becoming a chronic infection; chronic disease may lead to cirrhosis, liver cancer, or liver failure. Simultaneous infection with multiple types of hepatitis viruses may complicate the infection and contribute to the development of more serious disease.

Predicted outcome

Symptoms of acute viral hepatitis resolve two to eight weeks. Damage to the liver may heal within three to six months after the cessation of active viral infection. There are no expected long-term effects of uncomplicated acute viral hepatitis. Liver cancer may occur in hepatitis B and C. Fulminant hepatitis may result in death, unless liver transplantation can be performed quickly. The long-term impact of the transplantation will depend upon the health of the individual. Older individuals and those suffering from immunodeficiencies may experience greater difficulty in recovering from the surgery.

Alternatives

A number of other infectious agents, including other viruses, bacteria and yeast can cause hepatitis but the biochemical profile of the disease is different than with the hepatitis viruses. The demonstration of antibodies to hepatitis virus proteins is also diagnostic of acute viral infection.

Appropriate specialists

Gastroenterologist and infectious disease specialist.

Last updated 25 June 2011