Five viruses designated hepatitis A, B, C, D and E infect the liver and produce hepatitis as their primary clinical manifestation.
Hepatitis G virus has been identified more recently, but its role in causing liver disease is not clearly defined.
Other viruses, such as Epstein-Barr (EBV) and cytomegalovirus (CMV), may cause hepatitis as part of their clinical presentation but the liver is usually not the primary target organ.
The hepatitis A virus (HAV) is a 27nm-diameter, non-enveloped, RNA virus.
It belongs to the family Picornaviridae, the genus Hepatovirus, and has characteristics of the enteroviruses.
Viral transmission occurs in a fecal-oral fashion.
Viral replication and assembly occur in the hepatocyte cytoplasm of humans and nonhuman primates, the exclusive natural hosts.
HEPATITIS A VIRUS DEFINITION
The virus is then secreted into the bile and serum.
The hepatitis A virus is found throughout the world.
The most common cause of symptomatic acute hepatitis in the United States (annual incidence is 9.1 per 100,000) occurring largely as sporadic, rather than epidemic cases.
The virus is more prevalent in areas with poor sanitary conditions.
The most common source of hepatitis A is direct person-to-person exposure and, to a lesser extent, direct fecal contamination of food or water.
Consumption of raw or partially cooked shellfish raised in contaminated waterways is an uncommon but possible source of hepatitis A.
Vertical transmission from mother to fetus and transmission from blood or blood products have been described on rare occasions.
High-risk groups for acquiring hepatitis A include travelers to developing nations, children in day-care centers, sewage workers, cleaning personnel, male homosexuals, intravenous drug users, hemophiliacs given plasma products, and persons in institutions.
The hepatitis A virus (HAV) is not directly cytopathic to the hepatocyte.
Injury to the liver is secondary to the host's immune response.
Replication of HAV occurs exclusively within the cytoplasm of the hepatocyte.
Human leukocyte antigen (HLA)-restricted, HAV-specific CD8+ T lymphocytes and natural killer cells mediate hepatocellular damage and destruction of infected hepatocytes.
Interferon gamma appears to have a central role in promoting clearance of infected hepatocytes.
The incubation period of the hepatitis A virus ranges from 15 to 49 days (mean = 25 days).
The prodromal phase is characterized by non-specific symptoms, such as fatigue, weakness, anorexia, nausea, vomiting, abdominal pain, and, less commonly, fever.
Headache, arthralgias, myalgias, rash and/or diarrhea may follow.
Jaundice begins within 1 to 2 weeks from the onset of the prodrome.
SIGNS AND SYMPTOMS
It occurs in 70% of adults infected with hepatitis A, with or without pruritus, and in a far smaller proportion of children.
Mild hepatomegaly, splenomegaly and cervical lymphadenopathy are found in 85%, 15% and 14% of infected patients respectively.
The host is infective from 14 to 21 days before the onset of jaundice to 7 to 8 days after jaundice has resolved.
Host serum and saliva are not nearly as infectious as stool, and urine does not transmit the virus.
Anti-HAV antibody (immunoglobulin M [IgM] followed by immunoglobulin G [IgG]) appears shortly before the onset of symptoms and rises to high titers 3 to 4 months after exposure.
IgM-specific anti-HAV persists for 4 to 12 months, and IgG-specific anti-HAV persists for life.
Extrahepatic manifestations are uncommon and include a leukocytoclastic vasculitis, glomerulonephritis, arthritis, immune complex disease, toxic epidermal necrolysis, myocarditis, optic neuritis, transverse myelitis, polyneuritis, thrombocytopenia, aplastic anemia and red cell aplasia.
Detecting IgM anti-HAV in the serum of a patient with the clinical and biochemical features of acute hepatitis usually makes the diagnosis of acute hepatitis A.
Outlines the immune response to Hepatitis A infection.
HAV antigen can be detected in the stool or body fluids but there is no commercially available assay.
Detecting viral RNA is highly specific but expensive and rarely used to confirm the diagnosis.
Liver biopsy is not indicated.
Testing for anti-HAV IgG is not helpful in diagnosis but is a means of assessing immunity to hepatitis A.
Acute hepatitis A is usually a self-limited infection.
Complete recovery is seen in most and chronic disease does not occur.
In rare cases infection is complicated by fulminant disease and fatalities occur.
Treatment is mainly supportive.
Attempts should be made to prevent transmission of the virus within the household and to close contacts.
THERAPY AND PREVENTION
Boiling contaminated water for 20 minutes or exposing the virus to chlorine, formalin or ultraviolet light reduces the risk of infection.
A safe and effective hepatitis A vaccine is available and is recommended for patients at high risk of acquiring hepatitis A.
Patients with chronic liver disease are more likely to develop severe or fulminant liver disease when infected with hepatitis A and should be vaccinated.
Two formulations of the HAV vaccine are available; both consist of inactivated hepatitis A antigen purified from cell culture.
Havrix is recommended as two injections 6 to 12 months apart in an adult dose of 1440 enzyme-linked immunosorbent assay (ELISA) units (1.0 mL) and a pediatric dose (ages 2 to 18 years) of 720 units (0.5 mL).
Travelers to high-risk areas should receive the first dose of vaccine at least 4 weeks prior to anticipated exposure.
VAQTA is recommended as 2 injections at least 6 months apart in an adult dose of 50 units (1.0 mL) and a pediatric dose (2-17 years) of 25 units (0.5 mL).
Protection lasts for approximately 15 years.
Hepatitis A vaccines have an excellent safety record, with serious complications in less than 0.1% of recipients.
Sero-conversion rates after the HAV vaccine are greater than 90%, but are lower in patients with chronic liver disease (possibly as low as 50%).
At least half the patients who are vaccinated post transplantation have titers below the protective level 2 years after receiving the vaccination.
Patients with liver disease should therefore be vaccinated as early on in their illness as possible.
Follow-up testing for anti-HAV antibody and booster inoculations are not currently recommended.
Pooled human immune globulin, 2 mL in adults and 0.02 mL/kg in children, given intramuscularly, is recommended for post-exposure prophylaxis.
The course of hepatitis A infection is benign in the majority of those infected.
It occasionally may be severe, or fulminant, in adults, particularly in those with chronic liver disease.
Jaundice usually resolves in less than 2 weeks and full recovery usually occurs in 2 months.
The illness occasionally may persist for several weeks or months, but never leads to a chronic infection, chronic hepatitis, or cirrhosis.
A chronic relapsing hepatitis has been noted to last for as long as a year.
Hepatitis A may cause a cholestatic hepatitis which usually responds to a short course of prednisolone 30 mg daily.
Pregnancy does not affect the severity or outcome of acute hepatitis A infection.
In the rare case of fulminant hepatitis, patients should be evaluated early for possible liver transplantation.
H E P A T I T I S B V I R U S H B V
A virus disease with a long incubation period (usually 50 to 160 days), caused by hepatitis B virus, a DNA virus and member of the family Hepadnoviridae, usually transmitted by injection of infected blood or blood derivatives or by use of contaminated needles, lancets, or other instruments; clinically and pathologically similar to viral hepatitis type A, but there is no cross-protective immunity; HBsAg is found in the serum and the hepatitis delta virus occurs in some patients.
VIRAL HEPATITIS TYPE B
Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV).
For some people, the infection becomes chronic, leading to liver failure, liver cancer or cirrhosis — a condition that causes permanent scarring of the liver.
The hepatitis B virus is transmitted through contact with the blood and body fluids of someone who is infected — the same way the human immunodeficiency virus (HIV), the virus that causes AIDS, spreads. Yet hepatitis B is nearly 100 times as infectious as HIV.
At risk if an intravenous (IV) drug user who shares needles or other paraphernalia, have unprotected sexual contact with an infected partner, or were born in or travel to parts of the world where hepatitis B is widespread.
In addition, women with HBV can pass the infection to their babies during childbirth.
Most people infected as adults recover fully from hepatitis B, even if their signs and symptoms are severe.
Infants and children are much more likely to develop a chronic infection.
Although no cure exists for hepatitis B, a vaccine can prevent the disease.
Hepatitis B can damage the liver and spread to other people.
Most infants and children with hepatitis B never develop signs and symptoms.
The same is true for many adults. Signs and symptoms usually appear four to six weeks infection and can range from mild to severe.
They may include some or all of the following:
SIGNS AND SYMPTOMS
Loss of appetite
Nausea and vomiting
Weakness and fatigue
Abdominal pain, especially around the liver
Yellowing of the skin and the whites of the eyes (jaundice)
Liver is located on the right side of the abdomen, just beneath the lower ribs.
It performs more than 500 functions, including processing most of the nutrients absorbed from intestines, removing drugs, alcohol and other harmful substances from bloodstream, and manufacturing bile — the greenish fluid stored in gallbladder that helps digest fats.
Liver also produces cholesterol, blood-clotting factors and certain other proteins.
Because of the complexity of the liver and its exposure to so many potentially toxic substances, it would seem especially vulnerable to disease.
But the liver has an amazing capacity for regeneration — it can heal itself by replacing or repairing injured tissue.
In addition, healthy cells take over the function of damaged cells, either indefinitely or until the damage has been repaired.
Yet in spite of this, liver is prone to number of diseases that can cause serious or irreversible damage, including hepatitis B.
Hepatitis B infection may be either acute — lasting less than six months — or chronic, lasting six months or longer.
If the disease is acute, immune system is able to clear the virus from the body and should recover completely within a few months.
When immune system can't fight off the virus, HBV infection may become lifelong, leading to serious illnesses such as cirrhosis and liver cancer.
ACUTE VS. CHRONIC HEPATITIS B
Most people who acquire hepatitis B as adults have an acute infection.
But the outlook isn't nearly as hopeful for infants and children.
Most infants infected with HBV at birth and many children infected between 1 and 5 years of age become chronically infected.
Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.
Hepatitis B is one of six currently identified strains of viral hepatitis — the others are A, C, D, E and G.
Each strain is unique, differing from the others in severity and in the way it spreads.
In industrialized countries:
Transmission through needle sharing.
Transmission through accidental needle sticks.
Transmission from mother to child.
Major Ways of Transmission Occurs
To become infected with HBV, infected blood, semen, vaginal secretions or saliva must enter the body.
Can not become infected through casual contact — hugging, dancing or shaking hands — with someone who has hepatitis B.
Can not be infected in any of the following ways:
Coming into contact with the sweat or tears of someone with HBV
Sharing a swimming pool, telephone or toilet seat with someone who has the virus
The liver is located in the upper right portion of the abdomen, beneath the diaphragm and above the stomach.
Weighing between 3 and 4 pounds, the liver is the largest internal organ in the body.
Unprotected sex with more than one partner – risk – heterosexual, homosexual or bisexual. Unprotected sex means having sex without using a new latex or polyurethane condom every time.
Have unprotected sex with someone who's infected with HBV.
Have a sexually transmitted disease such as gonorrhea or chlamydia.
RISK FACTORS Anyone of any age, race, nationality, sex or sexual orientation can be infected with HBV.
Share needles during intravenous (IV) drug use.
Share a household with someone who has a chronic HBV infection.
Jobs that exposes to human blood.
Received a blood transfusion or blood products before 1970 — the date the blood supply began to be tested for HBV. Today, the risk of contracting HBV per unit of donated blood is low.
Receive hemodialysis for end-stage kidney (renal) disease.
Travel to regions with high infection rates of HBV, such as sub-Saharan Africa, Southeast Asia, the Amazon Basin, the Pacific Islands and the Middle East.
Newborns whose mothers are infected with HBV also are at high risk.
The same is true of infants and children whose parents were born in areas where HBV infection is widespread.
In many developing countries, the most common method of transmission of the virus is between mother and child or among children living in the same household.
Most children now receive HBV vaccine along with other routine shots. But some children — especially those who don't have access to regular medical care or whose parents are from countries with high infection rates — may be overlooked.
When to seek medical advice
Tests done in other countries may not always be as reliable.
To best meet the special needs of adopted children, doctors usually make testing for HBV part of a comprehensive health evaluation.
Tests done at clinic, hospital or public health clinic. Many public clinics offer free testing for HBV and other sexually transmitted diseases.
Testing is important to protect and to prevent transmission of the virus to others.
Because many people with hepatitis B don't have signs and symptoms, diagnosis the disease on the basis of one or more blood tests. These tests include: DIAGNOSIS BASED ON TESTS
Hepatitis B surface antigen (HBsAg).
Hepatitis B surface antigen is the outer surface of the virus.
Testing positive for this antigen means pass the virus to others.
A negative test means not infected.
Antibody to hepatitis B surface antigen (anti-HBs).
A positive result on this test means have antibodies to HBV.
This may be due to a prior HBV infection.
Antibody to hepatitis B core antigen (anti-HBc).
Although this test identifies people who have a chronic infection, the results can sometimes be ambiguous.
If test is positive for hepatitis B core antibodies, may have a chronic infection can transmit to others.
But also may be recovering from an acute infection or have a slight immunity to HBV that can't otherwise be detected.
How this test is interpreted often depends on the results of the other two tests.
E-antigen test . This blood test looks for the presence of a protein secreted by HBV-infected cells. A positive result means have high levels of the virus in the blood and can easily infect others. If the test is negative, have lower blood levels of HBV and are less likely to spread the infection.
Liver enzymes . These blood tests check for elevated levels of liver enzymes such as alanine aminotransferase and aspartate aminotransferase, which leak into the bloodstream when liver cells are injured.
Alpha-fetoprotein (AFP) test . High blood levels of this protein may sometimes be a sign of liver cancer.
Liver ultrasound or computerized tomography (CT) scan . These tests look at the liver for complications such as liver scarring (cirrhosis) or liver cancer.
Liver biopsy . In this procedure, a small sample of liver tissue is removed for microscopic analysis. A biopsy can accurately show the extent of any liver damage and may help determine the best treatment.
Having a chronic HBV infection eventually may lead to serious liver diseases such as cirrhosis and liver cancer.
Having had HBV infection as an infant or child gives greater chance of developing these illnesses as an adult.
In addition, hepatitis B puts at risk of acute liver failure — a condition in which all the vital functions of the liver shut down.
When that occurs, a liver transplant is necessary to sustain life.
Anyone chronically infected with HBV is also susceptible to infection with another strain of viral hepatitis — hepatitis D.
Formerly known as delta virus, the hepatitis D virus needs the outside coat of HBV in order to infect cells.
Hepatitis D can't be infected, unless already infected with HBV.
Injection drug users with hepatitis B are most at risk, but contract hepatitis D if unprotected sexual contact with an infected partner or live with someone infected with hepatitis D.
Having both hepatitis B and hepatitis D makes it more likely develop cirrhosis or liver cancer.
Receiving an injection of hepatitis B immune globulin within 24 hours of coming in contact with the virus may help protect from developing hepatitis B.
And also should receive the first in a series of three shots of the hepatitis B vaccine.
Once developed chronic hepatitis B, few treatment options exist. In some cases — especially if don't have signs and symptoms or liver damage – doctor may suggest monitoring, rather than treating.
In other cases, doctor may recommend treatment with antiviral medications.
When liver damage is severe, liver transplantation may be the only option.
Liver transplantation is a newer and very successful form of therapy for people with a badly damaged liver.
In those patients with chronic hepatitis B, the new liver usually becomes infected with the virus, but most transplant medical centers are dealing with this effectively.
There are new drugs for chronic hepatitis B now under investigation.
However, at the present time the best defense against HBV is prevention.
A hepatitis B vaccine (Engerix-B) has been available since 1981.
It is given in a series of three immunizations and provides more than 90 percent protection for both adults and children.
The vaccine generally protects against HBV for at least 15 years.
The HBV antigen used in the vaccine is produced in a laboratory and not derived from the blood of people infected with the virus. Can not get hepatitis B from the vaccine.
Almost anyone can receive the vaccine, including infants, older adults and those with compromised immune systems.
Infants often receive the vaccine in the first year of life — typically at two, four and nine months of age.
Side effects tend to be mild and may include weakness, fatigue, headache, nausea, and soreness or swelling at the injection site. Although concerns have been raised that the HBV vaccine may increase the risk of autoimmune disease and, in babies, of sudden infant death syndrome (SIDS), studies have found no connection.
Vaccination is the best way to protect from hepatitis B, the measures listed below also can help keep safe.
Knowing the HBV status of any sexual partner.
Using a new latex or polyurethane condom every time while having sex.
Using a sterile needle.
Talking to the doctor if traveling internationally.
Being cautious about blood products in certain countries.
Don't share needles or syringes.
Don't donate blood or organs.
Don't share razor blades or toothbrushes.
Alcohol speeds the progression of liver disease – no alcohol.
Avoid medications that may cause liver damage. It's especially important to avoid using acetaminophen (Tylenol, others), which can cause liver damage even in healthy people.
Healthiest diet. Fresh fruits and vegetables, whole grains and lean protein.
Regular exercise – helps increase strength and energy levels.
Interferon . Protect against invading organisms such as viruses.
Lamivudine (Epivir-HBV). This antiviral medication helps prevent HBV from replicating in the cells.
Adefovir dipivoxil (Hepsera). Helps prevent HBV from replicating in the cells.
Entecavir (Baraclude) . This antiviral medication.
Herbs that help Liver Function
YOGA IS BALANCE (SAMATVAM)
I A Y T CORRECTS IMBALANCES
RELIEF OF PAIN
General considerations : It again depends on the degree and kind of problem. Mild liver diseases do not limit the choice of practices, whereas severe and/or acute problems do.
Contraindications : Excessive physical strain and the practices which shake or move the liver area violently.
Recommendations : The liver can be compared to the chemical factory of the body, that is why harmful substances, such as alcohol, should be strictly avoided.