The liver performs many essential functions such as removing toxins from the blood, producing biochemicals needed for digestion, and storing vitamins and minerals. Hepatitis is inflammation of the liver that can be caused by viruses, alcohol, medications, or genetic disorders. There are several types of hepatitis viruses (A, B, C, D, E) that can cause liver damage if not addressed. Hepatitis C is a major concern as it can lead to serious complications like cirrhosis and liver cancer if left untreated.

2. What is the Liver?
What is the Liver?
• Makes chemicals that
your body needs to
stay healthy
• Removes waste
products and other
harmful substances
from your blood
• Guards against
infection

3. The Liver is a Factory
The Liver is a Factory
• Builds and converts proteins and
sugars
• Stores vitamins, sugars, fats and other
nutrients
• Releases chemicals and nutrients into
the body when needed

4. • Stores vitamins A, D, K and B12 (also stores minerals)
• The production of biochemicals needed for digestion, such
as bile
• Maintains proper levels of glucose in the blood
• Produces 80% of your body's cholesterol (cholesterol is
vital)
• The storage glycogen (also converts glucose to glycogen)
• Decomposing red blood cells
• The production of hormones
• Produces urea (the main substance of urine).

5. What is Hepatitis?
What is Hepatitis?
• “Hepatitis” means inflammation of the liver
• Can be caused by:
– Genetic diseases
– Medications (including over-the-counter)
– Alcohol
– Hepatitis viruses (A,B,C,D,E)

6. • Hepatitis can heal on its own with no significant
consequence, or it can progress to scarring of the
liver. Acute hepatitis lasts under six months, while
chronic hepatitis lasts longer.
• Most liver damage is caused by 3 hepatitis viruses,
called hepatitis A, B and C. However, hepatitis
can also be caused by alcohol and some other
toxins and infections, as well as from our own
autoimmune process (the body attacks itself).

7. • Not all forms of hepatitis are infectious. Alcohol,
medicines, and chemical may be bad for the liver
and cause inflammation. A person may have a
genetic problem, a metabolic disorder, or an
immune related injury. Obesity can be a cause of
liver damage which can lead to inflammation.
These are known as non-infectious, because they
cannot spread form person-to-person.

8. What Are Liver Enzymes?
What Are Liver Enzymes?
• Enzymes are proteins found in your body that
speed up certain chemical reactions. Liver
enzymes perform these jobs within the liver.
• Healthy liver:
– the level of enzymes in your blood is normal
• Unhealthy liver:
– the level of enzymes can be higher than normal

9. Types of hepatitis
Types of hepatitis
• There are five main types of hepatitis that are
caused by a virus, A, B, C, D, and E - plus types X
and G.

12. Hepatitis A
Hepatitis A
• Virus HAV
• Spread through
contaminated food and
water
• Anal-oral sex
• Vaccine available to
prevent hepatitis A
• full recovery - it does not
lead to chronic disease.

13. Hepatitis B
Hepatitis B
• virus HBV
• Spread through blood-
blood contact
• Also transmitted through
sex, unsterilized needles,
toothbrush or razor,
• mother's milk
• Vaccine available to
prevent hepatitis B
• Being bitten by someone who
is infected.

14. Hepatitis C
Hepatitis C
• Identified in 1989
• Blood test became available
in 1992
• Used to be known as “non-
A, non-B” hepatitis
• Spread through blood-to-
blood contact
• liver cancer risk is only
increased in people with
cirrhosis
• No vaccine available to
prevent hepatitis C

15. • Misuse of anesthesia can result in the transmission of h
, -RESEARCH

16. Hepatitis C
Hepatitis C
• About 3 million
Americans infected
• About 170 million
infected worldwide
• Many do not
experience symptoms

17. Hepatitis D
Hepatitis D
• virus HDV (Hepatitis D Virus).
• Only a person who is already infected with
hepatitis B

18. Hepatitis E
Hepatitis E
• A person can become infected by drinking water
that contains HEV (hepatitis E virus).
• Infection is also possible through anal-oral sex.

19. Hepatitis X
Hepatitis X
• If a hepatitis cannot be attributed to the viruses of
hepatitis A, B, C, D, or E, it is called hepatitis X.
In other words, hepatitis of an unknown virus.

20. Hepatitis G
Hepatitis G
• This is a type of hepatitis caused by the hepatitis G
virus (HGV). Usually there are no symptoms.
When there are symptoms, they are very mild.

21. PREVENTION OF
PREVENTION OF
HEPATITIS
HEPATITIS
• How to prevent hepatitis A?
• Wash your hands with soap after going to the toilet
• Only consume food that has just been cooked
• Only drink commercially bottled water, or boiled water if
you're unsure of local sanitation
• Only eat fruits that you can peel if you are somewhere
where sanitation is unreliable
• Only eat raw vegetables if you are sure they have been
cleaned/disinfected thoroughly
• Get a vaccine for hepatitis A if you travel to places where
hepatitis may be endemic.

22. How to prevent hepatitis B?
How to prevent hepatitis B?
• Tell the partner if you are a carrier or try to find
out whether he/she is a carrier
• Practice safe sex
• Only use clean syringes that have not been used
by anyone else
• Do not share toothbrushes, razors, or manicure
instruments
• Have a hepatitis B series of shots if you are at risk
• Only allow well sterilized skin perforating
equipment (tattoo, acupuncture, etc.).

23. How to prevent hepatitis C?
How to prevent hepatitis C?
• Is not preventables but ceratin measures are taken
to get relief from it
• Later discussion detail

24. How to prevent hepatitis D?
How to prevent hepatitis D?
• Use the same guidelines as for hepatitis B. Only a
person who is infected with hepatitis B can
become infected with hepatitis D.

25. How to prevent hepatitis E?
How to prevent hepatitis E?
• Do the same as you would to protect yourself from
hepatitis A infection.

26. How to prevent alcoholic
How to prevent alcoholic
hepatitis?
hepatitis?
• Go easy on the alcohol, or abstain from
consuming alcohol.

27. How to prevent toxic/drug
How to prevent toxic/drug
induced hepatitis?
induced hepatitis?
• Make sure you know about the lethal contents of
all chemicals
• e.g inj diclofenac sodium ,acitaminophen, or anal
gesics for longer duration or
• Epidural analgesia

28. Who Should Be Tested for
Who Should Be Tested for
Hepatitis C?
Hepatitis C?
• People with risk factors for hepatitis C
• Those who wish to be tested

29. How Do People Become
How Do People Become
Infected With Hepatitis C?
Infected With Hepatitis C?
• Blood products
– Blood transfusions before 1992
– Other blood products before 1987
– Current transfusions no longer a major risk factor
• Injection (IV) drug use – 60% of all new
infections
High Risk:

30. How Do People Become
How Do People Become
Infected With Hepatitis C?
Infected With Hepatitis C?
• Snorting cocaine or other drugs
• Occupational exposure
• Body piercing & acupuncture with
unsterilized needle
• Tattooing
Lower Risk:

31. How Do People Become
How Do People Become
Infected With Hepatitis C?
Infected With Hepatitis C?
• From pregnant mother to child
• Non-sexual household contacts (rare)
– Sharing razors and/or toothbrushes
• Sexual transmission
• Unknown
Lower Risk:

32. What About Sex?
What About Sex?
• Sexual transmission is not very likely, BUT it
is still possible
• If you have more than one sex partner, use
latex condoms
• If you have one long-term sex partner, you do
not necessarily need to change your sex
habits

33. Hepatitis C is NOT
Hepatitis C is NOT
Spread By:
Spread By:
• Sneezing
• Coughing
• Food or water
• Sharing drinking
glasses or eating
utensils
• Handshakes
• Holding hands
• Hugging
• Kissing on the cheek
• Playing with children
• Donating blood

34. How Can You Prevent the
How Can You Prevent the
Spread of Hepatitis C?
Spread of Hepatitis C?
• Cover open wounds
• Tell people not to touch your blood
• Clean blood spills yourself or inform others to
use latex gloves
• Dispose of needles/materials properly
• Do not inject drugs

35. How Can You Prevent the
How Can You Prevent the
Spread of Hepatitis C?
Spread of Hepatitis C?
• Avoid sharing contaminated articles
– Razors, toothbrushes, or other personal care
items
• Inform healthcare professionals/others
• Do not donate blood, body organs, tissues or
semen
• Practice safe sex

36. How Will You Know if You
How Will You Know if You
Have Hepatitis C?
Have Hepatitis C?
• Many people have no symptoms of the virus
• If you do have symptoms:
• The only way to know if you have hepatitis c
is to have a blood test
• Fatigue • Discomfort in the liver area
• Loss of appetite • Aching joints
• Trouble sleeping • Depression

37. How is Hepatitis C
How is Hepatitis C
Diagnosed?
Diagnosed?
• Blood testing
1. Hepatitis C antibody
test
2. Hepatitis C PCR
test to find virus in
blood
• Liver function tests

38. What is Your Hepatitis C
What is Your Hepatitis C
Genotype?
Genotype?
• Like different breeds of dog
• Genotype 1:
– Most common in U.S.
• Genotypes 2 & 3:
– Less common
6 different genotypes of hepatitis C

39. Why Should You Be Concerned
Why Should You Be Concerned
About Hepatitis C?
About Hepatitis C?
• Hepatitis C causes serious problems in some
patients
• Fibrosis
• Cirrhosis
• Advanced liver disease
• Hepatocellular carcinoma (liver cancer)

40. Fibrosis
Fibrosis
• The beginning of scarring
• Caused by infection, inflammation, or injury
• Can prevent the liver from working well
• Can lead to permanent scarring (cirrhosis)

41. Cirrhosis
Cirrhosis
• Pronounced “sir-o-sis”
• Means “scarring of the liver”
• At risk for liver failure and liver cancer
• Requires close medical follow-up
Healthy Liver Liver with Cirrhosis

42. Advanced Liver Disease
Advanced Liver Disease
• Fatigue
• Difficulty thinking clearly or concentrating
• Yellow jaundice
• Swelling
• Fluid in the abdomen
• Gastrointestinal bleeding
• Poor blood clotting

43. Hepatocellular Carcinoma
Hepatocellular Carcinoma
• Most common type of liver cancer
• Chronic hepatitis C increases the risk
• Treated with surgery, medications or
liver transplant

44. Liver Transplant
Liver Transplant
• May be needed for patients who develop liver
failure or liver cancer
• About 50% of all U.S. liver transplants result
from liver damage caused by hepatitis C
• Most patients with hepatitis C will never need
a liver transplant

45. What Happens to People With
What Happens to People With
Hepatitis C Virus?
Hepatitis C Virus?
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Infected With Hepatitis C
100
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No Chronic Disease
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85
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Cirrhosis
17
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2
Liver Cancer

46. How Will You Know if You
How Will You Know if You
Have Problems from
Have Problems from
Hepatitis C?
Hepatitis C?
• Blood tests
– Can be normal even with liver
damage
• Liver biopsy
– Only way to determine the amount of
scarring
– Small risk of complications and very
few side effects
– Should be free of alcohol and street
drugs

47. What About Alcohol?
What About Alcohol?
Drinker Without Hepatitis C
Drinker With Hepatitis C
Hepatitis C Non-Drinker
Chance Of Getting
Cirrhosis
Non-Drinker

48. Effect of Alcohol on
Effect of Alcohol on
Liver Scarring
Liver Scarring
0
1
2
3
4
<10 15 25 35+
Cirrhosis
No Scarring
Years of Hepatitis C Infection
Heavy Drinker
Light or Non-Drinker

49. With Hepatitis C, You
With Hepatitis C, You
Should:
Should:
• Avoid all alcohol
• Be careful with all
medications, including over
the counter and herbal
medications
• Tell all health care
providers that you have
hepatitis C

50. Hepatitis C & HIV Co-Infection
Hepatitis C & HIV Co-Infection
HIV
• Spread through blood and
sexual contact
• Over time makes it hard for
your body to fight off
dangerous infections
• Can be treated BUT there is
no cure
Hepatitis C
• Spread through blood only
• Over time can cause
cirrhosis and liver cancer
• There is a cure BUT it’s not
effective in all patients
These viruses are spread in similar ways but are
very different diseases
All patients with hepatitis C should be tested for HIV
All patients with hepatitis C should be tested for HIV

51. Those With Hepatitis C
Those With Hepatitis C
Should
Should
• Take care not to spread hepatitis C to others
• Be vaccinated for hepatitis A and hepatitis B
• Discuss treatment options with a
knowledgeable medical professional

52. What Medications to Avoid?
What Medications to Avoid?
• acetaminophen (Tylenol®
and others): no more than four
extra strength or six regular strength tablets per day
• ibuprofen and other anti-inflammatory medications
(Motrin®
, Advil®
, Aleve®
, and others)
– Hepatitis C patients without cirrhosis may take the
recommended dose on bottle
– Hepatitis C patients with cirrhosis should NOT take
any

53. What About Vitamins and
What About Vitamins and
Herbs?
Herbs?
• Iron supplements not recommended
– They may increase the rate of liver scarring
• Milk thistle is safe, BUT not shown to
improve liver disease
• Talk with your medical care provider before
starting any new medication or supplement

54. Treatment of Chronic
Treatment of Chronic
Hepatitis C
Hepatitis C

55. Goals of Treatment
Goals of Treatment
• Clear all the hepatitis C virus from the body
(“sustained response”)
• Slow or stop damage to the liver
• Help decrease symptoms

56. What Treatment is
What Treatment is
Available?
Available?
• Interferon
– Given by shot, usually 3 times a week
• Pegylated interferon
– Long-acting, taken once a week
• Combination therapy
– Interferon (standard or pegylated) taken with
ribavirin
– Ribavirin is a pill taken twice daily

57. During Treatment
During Treatment
• Medications taken for either 6 or 12 months
• Blood testing required 2 to 3 times the first
month, then every 4 weeks
• Clinic visits every 1 month
• Interferon must be refrigerated

58. Side Effects of
Side Effects of
Interferon & Ribavirin
Interferon & Ribavirin
• Flu-like symptoms
– Headache
– Fatigue
– Muscle & joint aches
– Fever, chills
• Psychiatric symptoms
– Depression
– Difficulty sleeping
– Difficulty concentrating
– Irritability
Common Side Effects:

59. Side Effects of
Side Effects of
Interferon & Ribavirin
Interferon & Ribavirin
• May occur from the
beginning:
– Upset stomach,
diarrhea
– Decreased blood
counts
– Skin irritation from
shots
• May occur later in
treatment:
– Hair loss
– Weight loss
– Thyroid problems
Less Common Side Effects:

60. Disadvantages of Treatment
Disadvantages of Treatment
• Side effects
• Other medical conditions can be made worse
• Patients with severe mental health problems
cannot be safely treated
• Ribavirin can cause severe birth defects if
either parent is taking the medication
• Two forms of reliable birth control required

61. Complementary Therapies
Complementary Therapies
• Aromatherapy
• Massage therapy
• Meditation and visualization
• Yoga

62. Living With Hepatitis C
Living With Hepatitis C
Maintain a healthy life outlook.
Live your life!