Hepatitis

Definition

Hepatitis refers to inflammation of the liver, commonly caused by a viral infection, but can also be caused by alcohol abuse, toxins, and drugs.

There are five main viruses that cause Hepatitis, referred to as types A, B, C, D, and E.

The Liver

The liver is the largest internal organ in the human body, weighing approximately 1.36 kg. It is reddish brown in colour and is divided into four lobes of different sizes and lengths, and forms part of the digestive system.

Functions of the Liver

  • Production of bile, which facilitates fat break down in the small intestines during digestion.
  • The liver breaks downs proteins from food to be used by the body.
  • Production of cholesterol and special proteins to help carry fats through the body.
  • Storage of excess sugar (as glycogen) for future use by the body
  • Regulation of blood levels of amino acids, which form the building blocks of proteins
  • Storage of iron for the production of blood cells
  • Conversion of poisonous ammonia into nonpoisonous urea for excretion in urine
  • Detoxification-Clearing the blood of drugs, alcohol and other poisonous substances.
  • Regulating blood clotting
  • Performs defence functions by producing immune factors that fight bacterial infections
  • Storage of Vitamins.

Regeneration

The liver has the unique ability to regenerate parts that have been removed or destroyed so that it can continue to function in the body.

Up to 80% of liver function can be maintained even after a large part of the liver has been removed.

The regeneration process continues over several months until the missing liver tissue is replaced depending on the person’s age, nutrition and extent of damage or part removed.

The disease process

Hepatitis A

This is a viral liver disease caused by the Hepatitis A virus.

The disease is closely associated with contaminated drinking water and food, inadequate sanitation and poor personal hygiene.  Infection by Hepatitis A virus does not cause chronic liver disease and is rarely fatal, but it can cause acute liver failure (fulminant Hepatitis)

Hepatitis A viruses persist in the environment and can resist food-production processes routinely used to inactivate and/or control bacteria.

Transmission

The Hepatitis A virus is transmitted primarily by the faecal-oral route. This is when a healthy person (not infected by the virus) ingests food or water that has been contaminated with the faeces from an infected person.

Waterborne outbreaks, though not frequent, are usually associated with sewage-contaminated or inadequately treated water. The virus can also be transmitted by contaminated hands put in the mouth as commonly experienced in children.

Symptoms

  • Fever
  • Malaise or fatigue
  • Loss of appetite
  • Diarrhoea
  • Nausea, vomiting and abdominal discomfort
  • Dark-coloured urine
  • Jaundice (yellow colouration of the skin and eyes).

Who is at risk of Hepatitis A Infection?

Anyone who has not been vaccinated or previously infected can contract Hepatitis A.

Risk factors include:

  • Poor sanitation
  • Lack of safe water
  • Injecting drugs, in drug abuse
  • Living in a household with an infected person
  • Sexual relations with someone in acute Hepatitis A infection
  • Travelling to areas of high endemicity without being immunized

Treatment

There is no specific treatment for Hepatitis A. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Prevention

Improved sanitation, food safety, and immunization are the most effective ways to combat Hepatitis A.

The spread of Hepatitis A can be reduced by:

  • Adequate supplies of safe drinking water
  • Proper disposal of sewage within communities
  • Personal hygiene practices such as regular hand-washing with safe water

Hepatitis B

Hepatitis B is a potentially life-threatening liver infection caused by the Hepatitis B virus. It is a major global health problem and the most serious type of viral Hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver with possibilities of liver cancer.

Transmission

Hepatitis B virus is transmitted to people by direct blood contact, semen and vaginal fluid of an infected person. Modes of transmission are the same as those for the human immunodeficiency virus (HIV), but the Hepatitis B virus is 50 to 100 times more infectious.

Common modes of transmission are:

  • Birth (spread from an infected mother to her baby during birth)
  • Unprotected sex with an infected partner.
  • Sharing needles, syringes, or other drug-injection equipment.
  • Sharing items such as razors or toothbrushes with an infected person.
  • Direct contact with the blood or open sores of an infected person.
  • Exposure to blood from needle sticks or other sharp instruments.

Symptoms of Hepatitis B

  • Yellow colouration of the skin and eyes (jaundice)
  • Dark urine
  • Extreme fatigue
  • Nausea, vomiting and abdominal pain.

Complications of Hepatitis B

In some people, the Hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.

Treatment

There is no specific treatment for acute Hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Prevention

The Hepatitis B vaccine is the main mode of Hepatitis B prevention. The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. Protection lasts at least 20 years and is possibly lifelong. People in high-risk groups should also be vaccinated.

People in high-risk groups include:

  • People with high-risk sexual behaviour
  • Partners and household contacts of infected people
  • Injecting drug abusers
  • People who frequently require blood or blood products
  • Recipients of solid organ transplantation
  • People at occupational risk of Hepatitis B virus infection, including health workers
  • Travellers to countries with high rates of Hepatitis B.
  • The vaccine has an outstanding record of safety and effectiveness.

Hepatitis C

Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

Transmission

The Hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through:

Receipt of contaminated blood transfusions, blood products, and organ transplants

Injections given with contaminated syringes and needle pricks in health-care settings

Injection drug use.

Being born to a Hepatitis C-infected mother.

Hepatitis C may be transmitted through sex with an infected person.

Symptoms

Approximately 80% of people do not exhibit any symptoms.

Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain, and jaundice

Complications of Hepatitis C

  • Chronic liver disease.
  • Cirrhosis.
  • Liver cancer; in 25% of liver cancer patients, the underlying cause is Hepatitis C.

Treatment

Hepatitis C does not always require treatment.

Combination antiviral therapy has been the mainstay of Hepatitis C treatment.

Prevention

There is no vaccine for Hepatitis C. The risk of infection can be reduced by avoiding:

  • Unnecessary and unsafe injections
  • Unsafe sharps waste collection and disposal
  • Use of illicit drugs and sharing of injection equipment
  • Unprotected sex with Hepatitis C-infected people
  • Sharing of sharp personal items that may be contaminated with infected blood
  • Tattoos, piercings and acupuncture performed with contaminated equipment.

For people infected with the Hepatitis C virus, the below recommends are approved by the World Health Organization (WHO):

  • Education and counselling on options for care and treatment
  • Immunization with the Hepatitis A and B vaccines to prevent co-infection from these
  • Hepatitis viruses to protect their liver.otect their liver.
  • Regular monitoring for early diagnosis of chronic liver disease.

Hepatitis D

Hepatitis D virus (HDV) is found ONLY in people who carry the Hepatitis B virus.

HDV may follow a recent (acute) Hepatitis B infection or an existing long-term (chronic) Hepatitis B liver disease worse.

It can cause symptoms in people who carry the Hepatitis B virus but who never had symptoms.

Risk factors include:

  • Abusing intravenous (IV) or injection drugs.
  • Being infected while pregnant (the mother can pass the virus to the baby)
  • Carrying the Hepatitis B virus.
  • Intercourse through anal penetration.
  • Receiving many blood transfusions.

Symptoms

Hepatitis D may make the symptoms of Hepatitis B worse.

Symptoms may include:

  • Abdominal pain
  • Dark-coloured urine
  • Fatigue
  • Jaundice
  • Joint pain
  • Loss of appetite
  • Nausea
  • Vomiting

Treatment

Many of the medicines used to treat Hepatitis B are not helpful for treating Hepatitis D. A liver transplant for end-stage chronic Hepatitis B may be effective.

Prevention

Use the same guidelines as for Hepatitis B; only a person who is infected with Hepatitis B can become infected with Hepatitis D.

There is no vaccine for Hepatitis D, but it can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination.

Hepatitis E

Hepatitis E is a liver disease caused by the Hepatitis E virus. The Hepatitis E virus is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4–6 weeks. Occasionally, a fulminant form of Hepatitis develops (acute liver failure), which can lead to death.

Transmission

The Hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. The risk factors for Hepatitis E are related to poor sanitation.

Other transmission routes have been identified, which include:

  • Foodborne transmission from ingestion of products derived from infected animals
  • Transfusion of infected blood products;
  • Vertical transmission from a pregnant woman to her fetus.
  • The ingestion of raw or uncooked shellfish has also been identified as the source of sporadic cases in endemic areas.

Symptoms

  • Jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools)
  • Loss of appetite
  • An enlarged, tender liver
  • Abdominal pain and tenderness;
  • Nausea and vomiting;
  • Fever.

Treatment

There is no available treatment capable of altering the course of acute Hepatitis. As Hepatitis E is usually self-limiting, hospitalization is generally not required. However, hospitalization is required for people with fulminant Hepatitis and should also be considered for infected pregnant women.

Prevention

  • Maintaining hygienic practices such as hand washing with safe water, particularly before handling food
  • Avoiding drinking water and/or ice of unknown purity
  • Avoiding eating uncooked shellfish, and uncooked vegetables or fruits that are not peeled or properly washed.

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