Hepatitis A - E

Overview

Hepatitis is an inflammation of the liver.  It can be the result of infections, chemicals (like alcohol), some medications, and toxins.  Most infections that cause Hepatitis are due to viruses.  There are several known viruses that cause hepatitis and they are named with letters: including hepatitis A, B, C, D or E. Symptoms of viral hepatitis may be vague and are often similar to the flu.  Vaccines are available for hepatitis A and B and several treatment options are now available for patients with certain types of viral hepatitis.  In addition, researchers are exploring new ways to diagnose and treat all forms of these diseases.

Causes

Forms of viral hepatitis

Hepatitis is an inflammation of the liver. Inflammation usually produces swelling, tenderness and can sometimes cause permanent damage. Hepatitis is caused by a number of things including alcohol, drugs, chemicals and viral infections. If the inflammation of the liver continues at least six months or longer, it is called chronic hepatitis. Chronic hepatitis can lead to scarring, also called fibrosis. Further progression of the scarring is called cirrhosis, which can lead to liver failure. Currently there are at least five different viruses known to cause viral hepatitis:

Hepatitis A

Hepatitis A has also been called “infectious hepatitis”. It is spread by eating food or drinking water contaminated with human feces. This type of viral hepatitis is not frequently life threatening; and does not lead to chronic liver disease. It can be prevented by vaccination.

Hepatitis B

Hepatitis B used to be called “serum hepatitis,” It can be spread from mother to child at birth or soon after; and can also be spread through sexual contact, contaminated blood transfusions and needles. This form of viral hepatitis may lead to chronic infection, cirrhosis (scarring of the liver) and liver cancer. As with Hepatitis A, vaccinations are available. Currently there is no cure for Hepatitis B and treatments are aimed at suppressing the virus to prevent liver damage.

Hepatitis C

Formerly known as “non-A, non-B hepatitis,” Hepatitis C is the most common form of viral hepatitis. It can be spread through blood transfusions and contaminated needles; but the cause is unknown for a substantial number of patients. Hepatitis C causes chronic infection and inflammation more often than other causes of viral hepatitis and can lead to cirrhosis, or scarring, of the liver. Co-infection of hepatitis C in patients who are HIV positive is common; about one quarter of patients infected with HIV are also infected with hepatitis C. Fifty percent to 90 percent of those with HIV infection and a history of injection drug users are also infected with hepatitis C. Hepatitis C virus infection is more severe in patients with HIV. While there is no vaccine for Hepatitis C, as there is for Hepatitis A and B, treatments with the goal of curing the disease are available. 

Hepatitis D

This form of viral hepatitis is found most often in intravenous (IV) drug users who are also carriers of the hepatitis B virus. Hepatitis D is spread only in the presence of the hepatitis B virus and is transmitted the same way. Since Hepatitis D occurs in people who have viral hepatitis B, it is a serious health problem and may increase the severity of symptoms associated with hepatitis B. 

Hepatitis E

This form of viral hepatitis is similar to viral hepatitis A and is found most often in people who live in countries with poor sanitation. It is rare in North America and rarely life-threatening.

Differences between acute and chronic hepatitis

Acute viral hepatitis is the initial infection. Acute hepatitis may be mild or severe. The condition is called chronic hepatitis if the infection lasts for six months or longer. Hepatitis A and E do not cause chronic hepatitis. The hepatitis viruses B, C and D can produce both an acute and chronic episode of illness. Chronic hepatitis B and C are serious health problems.

Symptoms

Many cases of viral hepatitis are not diagnosed because the symptoms are vague and similar to a flu-like illness. Sometimes, there are no symptoms at all. Some individuals with viral hepatitis experience or develop:

  • Fatigue
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal discomfort
  • Muscle and joint aches
  • Changes in the color of urine and stools. Some people with viral hepatitis may develop jaundice, a condition in which the skin and whites of the eyes turn yellow. Itching of the skin may occur with jaundice.

Treatments

After the doctor has determined which type of hepatitis virus is present, treatment programs can be discussed. Currently, treatment is available for both Hepatitis B and Hepatitis C. However, not everyone with the infections will ever need treatment. Some helpful hints for people with chronic viral hepatitis are listed below:

  • Review your medical history thoroughly with your doctor.
  • Exercise will depend on the presence and degree of fatigue present. If there is no fatigue, there are no restrictions to the amount or type of exercise that can be performed.
  • During the acute phase of illness, all alcoholic beverages should be avoided, as should IV needle use and risky sexual behavior. For chronic forms of hepatitis, alcohol should also be avoided to prevent more rapid progression of liver scarring/fibrosis.
  • A nutritious, well-balanced diet is encouraged.
  • Discuss limits on medications, especially acetaminophen (Tylenol) with your doctor to avoid further liver injury.

FAQ

Call your doctor and schedule an urgent appointment.  Your doctor will take a history, do a physical examination and order blood tests to determine your diagnosis.

A carrier is a person who has hepatitis B, C or D virus in his or her blood. This person may not have any symptoms of the disease at all.Because the virus is in the blood, it can be transmitted to others through intravenous drug use, high-risk sexual behavior and blood transfusions.  Blood tests can determine if someone is a carrier.

Exercise will depend on the presence and degree of fatigue present. If there is no fatigue, there are no restrictions to the amount or type of exercise that can be performed. During the acute phase of illness, all alcoholic beverages should be avoided, as should IV needle use and risky sexual behavior.

People with hepatitis A or E should not prepare or handle food to be eaten by others until there is clear evidence that they are not infectious (as determined by your doctor).  Limitations on food handling are not necessary for people with hepatitis B, C or D.

Not always. Liver biopsy is a procedure by which a needle is used to remove a small piece of liver so that it can be analyzed under a microscope.  This procedure is done to determine the degree of damage the virus has caused and to help distinguish among other causes of hepatitis. A liver biopsy is usually not needed to determine the presence of viral hepatitis.

Usually hospitalization is not required. If a person cannot keep food or liquids down over a period of time, your doctor may decide that hospitalization is needed.

Resources

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