Monday, April 9, 2012

Hepatitis


What is it?
Hepatitis is a viral inflammation of the liver that can lead to damage or destruction of its cells. It may be short-lived (acute) and long-lasting (chronic). In some cases, acute hepatitis becomes chronic condition, but chronic hepatitis can also develop independently.

Causes of Disease
Most cases of hepatitis caused by viruses that attack the liver, and marked with the letters A through G. It should be noted that sometimes causes hepatitis can not be explained, suggesting that some viruses have not yet discovered.
Hepatitis A, formerly called infectious hepatitis, is always acute and never becomes chronic. The virus is excreted in feces and transmitted by contaminated food and water. Eating shellfish from sewage-contaminated water is a common way of infection with hepatitis A. It can also be obtained by close contact with persons infected with the virus.
The hepatitis B virus, formerly called serum hepatitis, is in semen, blood and saliva. It is usually spread by blood transfusion, contaminated needles and sexual contact. Controls were blood transfusions reduce the risk of infection. The virus does not destroy cells directly, but it seems to activate immune cells that cause inflammation and scarring of the liver. Exceed 5% of the chronic form.
Hepatitis D virus can only reproduce when attached to the hepatitis B virus, hepatitis D so that it can not exist if not present hepatitis B. In 1-10% of patients with hepatitis B subsequently develop chronic hepatitis, and hepatitis B can become chronic without an acute phase
Virus hepatitis CSE can also transfer blood transfusions, infected needles, and sexual contact. Thanks to the control of blood, the risk of infection by blood transfusion is now much smaller. It can be transmitted through skin injuries. About 10% to 60% of patients with acute hepatitis C develop a chronic form, which can occur without prior acute phase.

Who and how are diagnosed with hepatitis?
Hepatitis A hepatitis is that people often encounter when traveling in foreign countries. Water and food contaminated with feces are the main sources of infection, and infected people can transmit it to others if not the strictest hygiene measures. The risk is low if good hygiene measures are applied, especially when changing diapers, child care and sick people ..
Hepatitis B can be transmitted through sexual activity. Pregnant women with hepatitis B virus can be transmitted to the child. It is more likely that children will become chronic carriers of the virus than adults. The virus can enter through cuts, scratches and other skin injuries. The risk exists for the hospital staff exposed to human blood and blood products, police officers, firefighters, employees of the institutions for the mentally ill, prisoners, and immigrants from areas where the rate of infection is high. It is also known to transmit the virus contaminated medical instruments, particularly those used in more than one person. People at high risk are intravenous drug users and homosexuals.
Hepatitis D occurs only in people with hepatitis B.
People at high risk of acquiring hepatitis C include intravenous drug users, intranasal cocaine addicts, people who undergo body-piercing-in, and recipients of transplanted organs. It seems that promiscuity and long-term sexual relationship with an infected partner increases the risk. The risk increases with the frequency of sexual activity and intimate behavior, such as using a common toothbrush. Unless infection in pregnant women with this virus is not strong, is not likely to pass it on to a child. Even with these risk factors, is still 40% of patients do not know how this form of hepatitis infection.

Symptoms
Symptoms of acute viral hepatitis can occur suddenly or gradually. They can be so mild that it is replaced with flu patients. Almost all patients experience some fatigue and often have a mild fever. Indigestion is very common, including nausea and vomiting, general feeling of discomfort in the abdomen or a sharper pain that may be localized in the upper right quadrant. This can lead to loss of appetite, weight loss and dehydration. After about two weeks, dark urine and jaundice (yellowish skin and mucous membranes) develops in some but not all patients.About half of all patients with hepatitis have light colored stools, muscle pain, feeling drowsiness, irritability and itching (usually mild). Diarrhea and joint aches occur in about a quarter of patients. The liver may be enlarged and painful and most patients have mild anemia. About 10% of patients, the spleen is enlarged.

Typical symptoms of acute hepatitis A
Symptoms of hepatitis A is usually mild, especially in children. They usually appear two to six weeks after exposure. In adult patients more likely the occurrence of fever, jaundice and itching that can last from one to several months.

Typical symptoms of acute hepatitis B
Symptoms of hepatitis B occur long after initial infection - usually after 50 to 150 days. Many patients feel no symptoms, or symptoms are mild and flu-like. About 10% to 20% of patients have fever and rash. Nausea is common. Patients with hepatitis B may have a pain in the joints.

Typical symptoms of acute hepatitis C
If it does occur, symptoms can develop over a month or two after a person infected with hepatitis C. They are usually milder than with hepatitis B. About 75% of patients showing no signs of jaundice, and most do not feel any symptoms.

Symptoms of chronic hepatitis
Hepatitis B and hepatitis C can pass into the chronic hepatitis are usually no early acute symptoms. Progressing symptoms of chronic viral hepatitis may be very slight and not stronger than a mild prolongation of acute symptoms during the six months or more. In fact, chronic hepatitis C may be present up to 20 years without causing any apparent difficulty. In some patients develop pain in small joints (eg hands) which may result in an almost indistinguishable from the symptoms of rheumatoid arthritis. In other patients, hepatitis B or C can lead to long-term disability or liver failure before you feel any symptoms.

When should consult their doctor?
Contact your doctor when the first symptoms that could indicate hepatitis, a must if a jaundice (yellow skin color and the whites of the eyes), dark urine or light stools,

What results can I do?

Tests to diagnose the presence of hepatitis
For people that are suspected to have or transmit viral hepatitis, doctors will measure certain substances in the blood. One of the most important factors indicating the hepatitis is bilirubin, a red-yellow pigment that is normally processed in the liver and then excreted in urine. In patients with hepatitis, the liver can not process bilirubin, and bilirubin levels in the blood increases, causing jaundice. Doctors will also look for elevated blood levels of enzymes known as aminotransferases, which are released when the liver is damaged. They usually raise before they develop jaundice and decrease when it occurs.

Tests to determine the cause of hepatitis
In order to detect the virus that caused hepatitis, tests are performed from the blood. Some of these tests can detect antigen of hepatitis, such as certain parts of the virus. But more often reveal specific antibodies, which are molecules in the host immune system that attack specific antigens. The antibodies may not appear for weeks or months after hepatitis developed, so that if the tests are implemented too early, it may not detect antibodies even when the patient is infected. Antibodies are also still present after the patient recovers, so that a positive antibody test may indicate a previous infection, but can not always determine whether the infection is active.

Tests for hepatitis A
The first antibody generated against hepatitis A were IgM antibodies. They appear early in the course of the disease and can usually be detected as soon as symptoms appear. IgM antibodies disappear during recovery, but it retained IgG antibodies, indicating previous infection.

Tests for hepatitis B and D
Test for hepatitis B should be made quickly to identify the antigen, HBsAg, which is in the blood in the early stages, but disappears within four months unless the patient becomes a long-term holder. Antibodies to the antigen encountered during recovery and then can be detected, even if I antigen was not found earlier. In order to diagnose hepatitis D using a test for antibodies, hepatitis B must also be disclosed.

Testing for hepatitis C
Several tests, particularly one known as such. ELISA, are available for the detection of antibodies to hepatitis C.Antibody to hepatitis C need not occur for three to six months after the onset of disease, so the absence of antibodies does not exclude infection. If the doctor still firmly believes that the virus is present, you can spend another study, polymerase chain reaction (PCR). By PCR can detect genetic material.

Search for chronic hepatitis
Blood tests for chronic hepatitis measured the levels of aminotransferase, bilirubin, and the detection of blood clotting problems. We also carried out immunological tests to detect antibodies to the hepatitis virus. If the patient feels the symptoms of chronic active hepatitis six months or longer, a virus can not be detected, then the usual suspects in autoimmune hepatitis. In order to confirm this condition, test results may show high levels of immune factors called serum globulins and specific antibodies to proteins of the liver. It can do a liver biopsy in patients with acute viral hepatitis caught in a late stage, or in severe cases of chronic hepatitis. Some experts now recommend biopsy of all patients with chronic hepatitis C, regardless of the severity of the disease, the risk of liver damage and possible development of cirrhosis even in patients without symptoms. A biopsy helps determine treatment options, the degree of damage and prognosis.

Treatment - self help + GP

Treatment of acute viral hepatitis
In mild cases of viral hepatitis, there is no need drug treatment or other treatment No diet and taking vitamins are not proven to be particularly useful, although it is recommended to lighter food with less fat. Taking several small meals throughout the day, so you are more abundant in the morning can help prevent you from losing weight and reduce nausea. The liver processes many types of drugs, so that as soon as hepatitis is diagnosed, the patient should stop taking any medicines, including medicines obtained without a prescription, except those specifically prescribed by a doctor or recommended. In some cases, your doctor may prescribe drugs that have very little effect on the liver to relieve symptoms of hepatitis, such as nausea or severe itching. All patients should refrain from alcohol and sexual contacts during the acute phase. Although most patients with hepatitis feels tired and need more rest than usual, be physically active as they wish, and that it does not affect recovery. In fact, patients should be encouraged to be active as much as possible. Depression is common, especially in people who are accustomed to an active life. In most cases of hepatitis recovery is complete. Cases of acute hepatitis, requires periodic visits to the doctor for repeated blood tests and their frequency depends on how the patient feels. If symptoms occur even after three months, and laboratory findings and further indicate the presence of the virus, tests should be performed every month. If symptoms are still present after 6 months, a biopsy may be needed to determine possible liver damage.

Treatment - specialist
Hospital treatment is necessary only in patients at high risk of complications, such as pregnant women, the elderly, patients with other chronic illnesses, or who have severe nausea and vomiting, so they need to give fluids intravenously. The main goals of treatment of acute viral hepatitis are the provision of adequate nutrition, to prevent further liver damage, and prevent transmission to others.

Treatment of acute fulminant hepatitis
In patients who develop fulminant hepatitis, ie. liver failure, treatment is directed to the affected organs and systems. No medications, including corticosteroids, have no effect on the status itself. Liver transplantation is currently the only treatment is life saving in fulminant hepatitis and a survival rate to 60%. Without a liver transplant, the probability of survival was only 20%. The goal of treatment of all forms of chronic hepatitis is relieve symptoms, prevent the development of cirrhosis, reducing the level of the virus and facilitate survival.Kroničkog treatment of viral hepatitis is very different from the treatment of chronic autoimmune hepatitis, so that the correct diagnosis is extremely important.

Forecast

Forecast of acute viral hepatitis
In most cases of acute viral hepatitis, the recovery is complete and the liver returns to normal within two to eight weeks. In a few cases of hepatitis B or C, this could be extended to recovery and is out for any one year. In a small number of patients may develop chronic hepatitis. In rare cases, fulminant hepatitis develops. People who are infected with hepatitis continue to produce antibodies to that specific virus. This means that they can not re-infected by the same virus hepatitis. Unfortunately, not protected against other virus types.

Prognosis of chronic hepatitis
Patients with chronic hepatitis who have few symptoms generally have a good prognosis, with little risk of developing cirrhosis. However, in chronic active hepatitis, a liver biopsy often reveals scars suggestive of cirrhosis and liver cell damage. A damaged liver affects almost all bodily processes including digestive, hormonal and circulatory system. Without the treatment eventually may develop a disorder of consciousness, bleeding in the stomach and intestines, or kidney failure with the consequences that result in life in danger.

Prevention
The periods of greatest contamination
Hepatitis A is contagious two to four weeks before symptoms develop and a few days later. People with hepatitis B or C may become carriers of the virus after recovery, even if they do not develop chronic disease and the symptoms are not present.

Life as a preventive measure
Everyday precautions
Patients with viral hepatitis should abstain from sexual activity or take strict precautions if you do not. Hot water and thoroughly cleaning items used by the patients it is important to prevent the spread of infection. Because hepatitis A is usually transmitted through contaminated food, people infected with hepatitis A should not participate in preparing food for others, unfortunately, people are most infectious before symptoms appear.Limitations in food preparation are not required with other types of hepatitis. With all the objects contaminated with the blood of patients with hepatitis B or C must be handled with special care.

Travel to countries with a high risk of hepatitis
Travelers should be vaccinated against hepatitis A if you are traveling for a long time in countries where outbreaks occur. They need to peel yourself and follow all the fresh fruits and vegetables. The diet should avoid crabs and shellfish. Even ice cubes can cause infection, and should only be used in packaged water bottles for brushing teeth and drinking. If you can not buy water, tap water should be boiled for ten minutes.

Vaccinations and preventive measures for certain viruses

Prevention of Hepatitis A
The standard preventive measures against hepatitis A were immunoglobulin injections. Although it is not routinely given to children under two years of age, the vaccine is proven safe for children. People need to be vaccinated are those who live in communities where outbreaks occur, people with chronic liver diseases, health care workers exposed to the virus, and travelers to developing countries. Passengers should also receive immune globulin if you are visiting high risk areas within four weeks after vaccination. Side effects are few, although there may be an allergic reaction.

Prevention of Hepatitis B and D
All blood for transfusions is now tested for viruses hepatitis B and C, which significantly reduces the risk of infection from this source. Several vaccine can prevent hepatitis B, and are effective and safe, including infants and children. It also showed that vaccination programs reduce the risk of liver cancer. Others who should be vaccinated are people who have had sexual contact with an infected health care workers who may come into contact with infected blood or body fluids, and those who travel frequently or are retained for a long time in countries with high incidence of this disease. Three doses applied during the six months are usually required in adults. Alcoholics, who often have a weaker response, must be protected from high doses. A small percentage of people do not develop immunity even when the vaccine is given repeatedly. The vaccine loses its effect after five years with about a third of people who received it, but the value of the additional dose is safe. Preventing hepatitis B also prevents hepatitis D. It seems that testing pregnant women for hepatitis B and then the treatment of children infected mothers immediately after birth is very effective prevention strategy for infants. Treated with immunoglobulin and vaccination series at birth, one and six months of life.

Prevention of Hepatitis C
Although blood transfusion examines the hepatitis viruses B and C, those who have previously received a transfusion - even decades ago - may be at risk. These persons are encouraged to be tested. Avoiding exposure or prevention of transmission, however, is still very important for carriers of hepatitis and for those who are in contact with them. Infected patients should use condoms, perhaps even in relationships that last for years.Partners of persons infected with hepatitis B and C regardless of the duration of the connection, should avoid sharing personal items such as razors or toothbrushes, and to refrain from sexual activity during menstruation or infection caused by bleeding in the urinary or genital area. Injecting drug users should be using disposable needles and do not lend used needles and other drug equipment.

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