Acute and Chronic Hepatitis

What is Hepatitis?

Hepatitis refers to inflammation of the liver.

What causes hepatitis?

Many illnesses and conditions can cause hepatitis.

Drugs, alcohol, over-the-counter, herbal, and prescription medications, autoimmune diseases (where your body mistakenly attacks healthy liver cells for targets to destroy), and a number of different viruses such as Epstein-Barr Virus (EBV), cytomegalovirus (CMV), and hepatitis viruses can all inflame the liver.

Whereas most viruses do not primarily attack the liver, viral hepatitis does. Viral hepatitis is named for the virus that causes it, for example Hepatitis A, Hepatitis B, Hepatitis C, D or E. The three most common types of viral hepatitis are Hepatitis A, B, and C. These viruses multiply in your liver cells and affect your liver’s ability to perform its normal functions.

How is viral hepatitis transmitted?

Each type of hepatitis is transmitted differently.

  • Hepatitis A is transmitted primarily by the fecal-oral route (when an uninfected person ingests food or water contaminated with the feces of an infected person). It is transmitted through contaminated food and water sources.
  • Hepatitis B is transmitted when infected blood, semen, or other bodily fluids enter the body of a person who is not infected. An infected mother can transmit the virus to her newborn during childbirth.
  • Hepatitis C is a blood-borne pathogen transmitted through infected blood, unprotected sex, and contaminated or unsterile needles.
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How soon after being infected will I become sick?

It depends on the type of hepatitis you’ve contracted and your immune response.

  • All hepatitis viruses can cause acute hepatitis, meaning hepatitis that presents acutely and lasts less than 6 months.
  • Hepatitis B and C can cause chronic hepatitis, or hepatitis that lasts greater than 6 months. Many people who contract Hepatitis C will not know they have the virus until years down the road.
  • Chronic hepatitis can lead to progressive liver disease, liver failure, and even liver cancer, so being diagnosed, monitored for complications, and treated appropriately is paramount to having a good outcome.

What are the symptoms of Acute Viral Hepatitis?

It depends.

  • Symptoms of Acute hepatitis B infection can appear anywhere from 60-150 days after infection, with the average time for symptoms to develop being 90 days after exposure. Symptoms may include:
    • Loss of appetite, joint and muscle pain, low-grade fever, nausea, vomiting, jaundice or yellowing of the skin and eyes, itchy skin, abdominal pain (particularly in the right upper quadrant), and ascites (or fluid in the abdomen).
    • A rare, life-threatening condition called “fulminant hepatitis” can occur. People with fulminant hepatitis can go into sudden liver failure. This condition requires urgent medical intervention.
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  • Hepatitis C more commonly presents as a chronic condition but can present as acute hepatitis. Symptoms may include:
    • Fatigue, lack of appetite, flu-like symptoms, dark urine, light colored stools (or clay-colored stools), nausea, vomiting, abdominal pain, low-grade fever, jaundice, and ascites (or fluid in the abdomen).
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  • Symptoms of Acute Hepatitis A infection may include:
    • Jaundice, right upper abdominal pain, nausea, vomiting, clay colored stools, and lack of appetite possibly in the context of a known hepatitis outbreak or associated with travel to certain areas or consumption of contaminated food or water sources.

What are the symptoms of Chronic Viral Hepatitis?

It depends.

  • The symptoms of chronic viral hepatitis are often mild and nonspecific.
  • Many patients will be asymptomatic; however when signs and symptoms are present, they may include:
    • Jaundice or yellowing of the skin or eyes, itchy skin, fatigue, loss of appetite, nausea, joint or muscle pains, weight loss, fluid in the abdomen or lower extremities, easy bruising, excessive bleeding, and generalized malaise or not feeling well.

Chronic viral hepatitis can lead to progressive liver damage, cirrhosis of the liver, liver failure and even liver cancer, so early diagnosis, routine surveillance for disease progression and complications, and appropriate treatment is paramount to having a good outcome.

How can hepatitis be prevented?

Again, it depends on the virus.

  1. For Hepatitis A and B: Vaccination. There is no vaccination available for Hepatitis C.
  2. Hepatitis A is mostly spread through infected food and water via the fecal-oral route. Therefore, proper hand-washing after using the bathroom and before eating, ensuring that food is fully cooked and appropriately stored, drinking only bottled water when traveling, and avoiding or peeling fruits and vegetables that may have been washed or grown in contaminated water can all help to prevent the spread of the infection.
  3. Avoiding infected blood and bodily fluids can help prevent Hepatitis B and C. Practice safe sex, avoid unsterile or contaminated needles, avoid sharing toothbrushes, razors, and manicure/pedicure instruments, and confirm that tattoo, piercing, and acupuncture equipment is sterile.

Who is at risk for hepatitis?

  1. Individuals at risk for Hepatitis A include anyone exposed to the virus during an outbreak, anyone who has consumed an infected food or water source, individuals who have traveled to areas known to have an outbreak of the infection, and individuals with other immune disorders such as HIV and Hepatitis B.
  2. Individuals at risk for Hepatitis B and C include health care workers, IV drug abusers, people with multiple sexual partners or a known infected sex partner, and people with hemophilia. A history of blood transfusions and tattoos today are rare causes of viral hepatitis.

What are the basic differences between Hepatitis A, B and C?

Hepatitis A

  • Is transmitted via the fecal-oral route through contaminated food and water.
  • A vaccine is available and recommended for people with hepatitis B
  • Symptoms include: jaundice, abdominal pain, nausea, vomiting, low appetite
  • Most people make a full recovery in a few weeks with supportive care. After that, they have immunity to the virus.
  • No drug treatment is needed.

Hepatitis B

  • Is transmitted through infected blood and bodily fluids
  • Symptoms include: Loss of appetite, joint and muscle pain, low-grade fever, aausea, vomiting, jaundice or yellowing of the skin and eyes, itchy skin, abdominal pain, and ascites (or fluid in the abdomen).
  • Chronic infection may occur in 90% of infants exposed to Hepatitis B infection.
  • Long-term complications, like liver cancer and cirrhosis, affect 15-25% of people with chronic hepatitis B.
  • Hepatitis B is the primary cause of liver cancer worldwide.
  • It is the 2nd leading cause of cancer deaths worldwide.
  • A vaccine is available
  • Treatment options: There is no cure for Hepatitis B infection; however there are treatment options available for certain patients. These options include immunomodulators that help your immune system clear your body of the virus, and antiviral drugs that stop or slow down the virus from replicating. Not everyone with chronic hepatitis B infection will need to be treated or benefit from treatment.
  • Surveillance: Whether you are a candidate for treatment or not the most important thing for your liver health is routine medical surveillance, as Hepatitis B is the primary cause of liver cancer worldwide. It’s typically advised that you see a specialist every 6 months for surveillance labs and imaging studies such as ultrasound.

Hepatitis C

  • Is a blood-borne pathogen transmitted through infected blood, unprotected sex, and contaminated or unsterile needles.
  • Chronic infection occurs in 55–85% of infected adults.
  • Hepatitis C is the leading cause of liver transplants in the United States!>
  • There is no vaccine available; however depending on the strain of the virus you’ve been diagnosed with there are many available treatment options today.
  • Treatment options: Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. Different strains of the virus are treated with different antiviral medications. The goal of treatment is to have NO hepatitis C virus detected in your body at least 12 weeks after you complete your treatment course.

Why should I get treated for Hepatitis C if I’m not symptomatic?

  1. Hepatitis C is the leading cause of liver transplants in the United States! Getting treated can help to lower your chances of disease progression and developing cirrhosis of the liver and liver cancer.
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  2. To clear the Hepatitis C virus from your bloodstream
  3. To slow down the progression of inflammation and scarring in your liver
  4. Today, depending on the genotype or strain of Hepatitis C that you have, cure is possible!
  5. Compared with older medications, side effect profiles of today’s antiviral drugs are much more tolerable.
  6. Treatment courses are much shorter, easier, and more effective than years ago.

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