An infected person may pass hepatitis A to others by not washing his or her hands (especially after going to the bathroom) before handling food that others are going to eat. Hepatitis A can also be picked up from contaminated water or by eating shellfish taken from contaminated waters. It is the most common cause of food-borne outbreaks of hepatitis.

Symptoms

Symptoms generally appear 2 to 6 weeks after infection with the virus. Hepatitis A is often so mild that there are no obvious symptoms, especially in children.

The disease usually begins with typical symptoms of a viral infection:

• loss of appetite
• fever
• general achiness
• fatigue.

Smokers may lose their taste for cigarettes.

Other symptoms may follow after several days:

• nausea and vomiting
• foul breath and bitter taste in the mouth
• dark urine
• yellowish skin and eyes (jaundice)
• pain just below the ribs on the right side, especially when pressure is applied
• pale-colored bowel movements that may be looser than normal.

Treatment

The usual treatment is bed rest, a balanced diet, and avoiding alcohol for at least 6 months. Hospitalization is required only for more serious cases. Antibiotics are not useful in treating hepatitis.

Recovery from hepatitis A usually takes 4 to 8 weeks. The disease rarely has lasting effects such as permanent liver damage.

Hepatitis that lasts more than 6 months usually isn't caused by hepatitis A infection.

What can be done to help prevent hepatitis A?

Hepatitis A can be spread only by people with active infections. It is usually contagious for 2 to 3 weeks before symptoms appear and for 2 to 3 weeks afterward. During this period, others can pick up the virus by touching anything contaminated with the blood, stool, saliva, and possibly other body fluids of an infected person.

An injection of immune (gamma) globulin is usually given right after you have been exposed to contaminated food, have had contact with an infected person, or before possible exposure to hepatitis A (such as before travel to an area where the disease is common). Immune globulin may not always prevent hepatitis A, but it may make it milder. The protection lasts only for a few weeks.

As of 1995 there is a vaccine for hepatitis A. The first shot is given before travel to an area of known risk for hepatitis A infection. A booster shot is recommended 6 to 12 months after the first injection.

Hepatitis B

Hepatitis B is the name of one of the viruses that cause hepatitis. When the liver is infected, it becomes inflamed and tender. It may also become swollen. Patches of liver tissue may be destroyed by the inflammation. Hepatitis B is a serious, sometimes severe and even fatal type of hepatitis.

Some people who have hepatitis B develop the chronic form of the disease. This means they continue to be infected with the virus for a long time and develop the complications of prolonged liver inflammation. The disease can eventually cause liver failure and death.

Transmission

Hepatitis B is extremely infectious. This type of hepatitis is commonly spread through sexual secretions (such as semen) and blood. It is also spread by the use of contaminated syringes and needles. If instruments such as the ones used in tattoo and piercing parlors are not completely sterilized between uses, they can spread hepatitis. The disease can be spread by people who do not know they carry the virus. In the U.S. there are between half a million and a million people who carry the virus but are not sick.

Mothers who are infected with hepatitis B or who are carriers can spread the disease to their babies.

Symptoms

Symptoms of hepatitis B may appear as long as 4 weeks to 6 months after a person is infected with the virus. Many people who develop the chronic form of the disease have only vague symptoms, even though the virus may be damaging their livers.

If symptoms occur, the disease usually begins with the typical symptoms of viral infection:

• loss of appetite
• fever
• general achiness
• fatigue.

Other possible early symptoms include:

• itching hives
• pain in certain joints
• in smokers, a loss of taste for cigarettes.

Symptoms that may follow several days later include:

• nausea and vomiting
• foul breath and bitter taste in the mouth
• dark brown urine
• yellowish skin and eyes (jaundice)
• pain just below the ribs on the right side, especially when pressure is applied
• pale-colored bowel movements that may be looser than normal.

Hepatitis can cause permanent liver damage. Some of the symptoms of serious liver damage are:

• pain on the left side of the upper abdomen from an enlarged spleen
• swelling of the stomach and legs
• reddening of the palms
• spiderlike blood vessels under the skin, or easy bruising
• bleeding from the esophagus or stomach.

The symptoms generally last several weeks and are usually followed by a slow but complete recovery. It may take 6 months before tests of your liver function are normal.

Up to 10% of people with hepatitis B develop chronic hepatitis. Chronic hepatitis can be mild, or it may cause severe, permanent liver damage. Prolonged infection with the hepatitis B virus is related to an increased risk of liver cancer.

Diagnosis

A careful medical history will help determines when you began having symptoms and how they have progressed, as well as possible sources of hepatitis virus infection. Your doctor needs to make sure that liver inflammation is not from the side effects of medications you are taking or from the abuse of drugs such as alcohol. Your doctor will examine your skin, eyes, and especially your abdomen for signs of hepatitis.

The diagnosis is confirmed by blood tests. When blood tests of liver function are abnormal, your doctor will conduct tests to determine if a particular type of hepatitis virus is causing the liver problems. Other viruses can also cause liver inflammation, such as the common infectious mononucleosis virus.

If your doctor thinks you may have chronic hepatitis and/or serious liver damage, or if the diagnosis is uncertain, he or she will order a liver biopsy. A biopsy is a procedure in which a needle is used to remove a small amount of tissue. This is done through the skin after a local anesthesia is injected. The sample of tissue is sent to a lab for tests.

Treatment

The usual treatment for hepatitis B is bed rest, a balanced diet, and avoidance of alcohol and certain medications for at least 6 months. Antibiotics are not useful in treating hepatitis. Except for more serious cases, hospitalization is usually not necessary. If you become severely dehydrated, you may need to be hospitalized to receive fluids intravenously.

If you have chronic hepatitis B, you may need steroids or you may be a candidate for injections of interferon, an antiviral drug. You should discuss these possibilities with your doctor.

Prevention

Hepatitis B is highly contagious for 4 to 6 weeks before symptoms appear and continues to be contagious for some time afterward. After you begin your treatment, your doctor will want to see you for a follow-up. He or she will test your blood to see if you are still contagious. Some people who get hepatitis B become chronic carriers. A blood test can determine whether you are a chronic carrier of the virus.

To avoid spreading the disease to others:

• Be careful about cleanliness and personal hygiene. Bathe frequently. Take special care to wash your hands thoroughly with soap and very warm water, especially after you use the bathroom and before you eat or prepare food.
• Clean any blood stains with a disinfectant.
• Don't share needles, razor blades, or toothbrushes with others.
• Don't have sexual intercourse until you are no longer contagious.
• Don't donate blood.

Immunizations to prevent hepatitis B have been developed. High-risk individuals, such as hospital staff, sexual partners of people who carry the disease, and male homosexuals, should be vaccinated against hepatitis.

In addition, the American Academy of Pediatrics and the American Academy of Family Physicians now recommend immunizing all infants against hepatitis B. As the cost of the vaccine decreases, more people are being encouraged to get the immunization to prevent sexually transmitted hepatitis B. Ask your doctor or local health department about whether you should be immunized against hepatitis B.

Hepatitis C

Previously, viral hepatitis that was not caused by the type A or type B virus was called "non-A, non-B hepatitis." Recently three more viruses have been identified that cause some of these non-A, non-B infections. These new viruses are hepatitis C, D, or delta, and E. The hepatitis C virus (HCV) is thought to cause 95% of non-A, non-B hepatitis infections in people who have had blood transfusions. In addition, hepatitis C probably causes 50% of cases of sporadic non-A, non-B hepatitis.

The most important feature of hepatitis C is the frequency with which people develop chronic (ongoing) liver disease. Even mild cases tend to get worse over time, often resulting in cirrhosis of the liver. Research continues to determine whether hepatitis C has the same risk of liver cancer as hepatitis B.

Transmission

Hepatitis C is usually spread through blood transfusions. How sporadic cases occur, which are not associated with transfusions, is unclear. Sexual transmission is suspected. Hepatitis C can be spread by people who do not have an active infection. They are called asymptomatic carriers.

Symptoms

The symptoms of hepatitis C are similar to the symptoms of other forms of viral hepatitis. Symptoms may appear 2 weeks to 6 months after you are infected. Some people develop a chronic form of the disease without any obvious symptoms, even though damage to the liver may be occurring. See the above symptoms of Hepatitis B.

Symptoms may last from 1 to 6 weeks and are usually followed by complete recovery. Relapse is common, however, and can be triggered by drinking too much alcohol or exerting yourself before you are fully recovered. It may also be caused by another infection. Relapses are usually milder than the initial infection and respond well to rest.

After having viral hepatitis, a third to half of patients develop chronic hepatitis. As many as 35% develop chronic liver disease, including cirrhosis. The doctor may check your blood regularly for signs of chronic liver disease.

Diagnosis

Your medical history including onset and progression of symptoms is the important first step in diagnosis. Especially important is your history of hepatitis risk factors such as transfusions.

On physical exam, the doctor may find that the liver is enlarged and tender when pressed. He or she may use the following lab tests:

• blood tests
• analysis of a urine specimen
• analysis of a stool specimen.

Or your exam may be entirely normal with hepatitis C.

If hepatitis C is suspected it can now be identified by blood test. Hepatitis C is often found incidentally at routine screening when liver function tests are abnormal.

To diagnose chronic hepatitis, the doctor may order a liver biopsy, a procedure in which a small amount of tissue is removed for examination. This is done through the skin after local anesthesia is injected.

Treatment

The doctor will recommend getting rest, eating a nutritious diet, and avoiding alcohol and certain medications for at least 6 months. Hospitalization isn't usually necessary. In more serious cases (for instance, if you become severely dehydrated), you may need to be hospitalized.

Alpha interferon can be used to treat chronic hepatitis C. It is usually used in combination with another antiviral agent called Ribavirin. Other antiviral agents are being explored, including long acting interferon. Adequate nourishment and avoiding overexertion and alcohol are also important in treating chronic hepatitis. To reduce inflammation, the doctor may prescribe steroids.

Prevention

At this time there is no immunization for hepatitis C, so prevention is key. Important prevention tips include:

• Use good health habits. Bathe frequently and take special care to wash your hands thoroughly with soap and very warm water after using the bathroom and before eating or preparing food.
• Clean bloodstains with a disinfectant.
• Avoid sharing needles, razor blades, and toothbrushes with others.
• Avoid sexual activity until the disease is no longer contagious.
• Avoid donating blood if you have hepatitis or may be a carrier.

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Please note: We do not answer questions regarding individual medical problems on this website. We advise you to contact your physician for your specific health related concerns.

©2007 Syracuse Gastroenterological Associates, P.C.

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