May is designated as worldwide Hepatitis Awareness Month.

This is an opportunity to brush up on the basics of hepatitis. The word hepatitis means inflammation of the liver. The hepat part of the word comes from the Greek for liver. The itis part simply refers to inflammation. If you think about other common words with itis, you will see a pattern. Tonsillitis means inflammation of the tonsils, appendicitis indicates inflammation of the appendix, arthritis signifies inflammation of the joints and so on.

Hepatitis is a general term and does not tell us about the cause of the inflammation. Alcohol, drugs, toxins, microorganisms, autoimmune and genetic factors can all cause hepatitis. Another type of hepatitis is related to a high fat diet or to being overweight. These controllable factors can lead to excess accumulation of fat around the liver, causing it to become inflamed.

Viruses cause the contagious forms of hepatitis. These viral diseases are labeled by letters of the alphabet. The most common are hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV). There are also hepatitides D, E, and G. (Hepatitises is also an acceptable plural.) For a while, there was a hepatitis F, but it was removed from the list. Hepatitis F may be non-existent or a mutation of one of the other viruses. Some experts believe that hepatitis F is still existent, but until more is known, F is left out of the alphabet soup. Although A, B, C, D, E, and G are all liver diseases caused by viruses, the differences between them are significant. Hepatitis A is no more like hepatitis C than a monkey is to a human. One can see the obvious similarities, but the differences are clear.

Similarities

Regardless of the cause, there are not necessarily symptoms for all the hepatitides. The liver is a non-complaining organ and might not let you know when there is a problem. However, when the liver does complain, the symptoms are similar. Fatigue is the most common. There may be nausea, loss of appetite, malaise (plain old not feeling well). Vomiting, diarrhea, stomach pain, and fever may occur. The skin and eyes may turn yellow, which is known as jaundice. Urine may be a dark tea-color while the stools may turn the color of pale clay. Your medical provider may feel an enlarged liver. Lab tests to measure liver enzymes may be abnormal.

Differences

Hepatitis A and E are transmitted by fecal-oral routes. Hepatitis E is found outside the United States and rarely seen in this country. Hepatitis A outbreaks commonly occur in families, day care centers, and from food. HAV prevention strategies include hand washing before eating and preparing food, after using the bathroom, and after changing diapers. Avoid raw or undercooked shellfish such as oysters and clams. When traveling in areas with a high risk of hepatitis E, do not drink any water that has not been properly treated. Avoid ice, raw or undercooked shellfish, and all uncooked fruits and vegetables that have not been peeled. Hepatitis A and E are not chronic diseases. This means that if you get them, eventually you will recover and you will not be infected again. Complications and death are uncommon in these two viruses except that about 20% of women in their third trimester of pregnancy die of complications from HEV. There is no specific treatment for HAV and HEV. There is a vaccine against hepatitis A. Everyone with chronic hepatitis B and C, who has never had HAV, should be immunized. Hepatitis B, C, D and G are transmitted via blood and body fluids. Prevention practices include avoidance of everything where there is even a remote chance of contact with blood or body fluid: Practice safer sex, do not share drugs or drug preparation tools, and make sure tattooing, piercing, and manicuring are performed safely. HBV is very contagious. It is more contagious than HCV or HIV. HBV is passed sexually, via contaminated drug utensils, and from mother to fetus. In the United States, many adults who contract HBV usually get over it without it turning into a chronic disease. They develop natural protection against re-infection. However, HBV may become chronic, leading to serious liver problems including cirrhosis, cancer, and death. Worldwide, HBV is a huge problem. Of the more than 2 billion people who have contracted HBV, 350 million have become chronic carriers, with over a half million deaths annually. There is treatment for HBV, although it is not always effective. The best way to avoid acquiring HBV is by immunization. Everyone with chronic hepatitis C who has not had HBV should be the vaccinated. HDV is unusual in that it does not appear on its own. It is found in the presence of HBV. HDV can be very serious and lead to death. There is no HDV vaccine, but in a sense, the HBV vaccine provides protection, since without HBV there can be no HDV. Regular HCV Advocate readers are virtual authorities on HCV, so I will only mention it briefly. HCV is chronic in about 80% of those who are infected. Treatment is effective about half of the time. Treatment that is initiated in the first 6 months of onset is almost 100% effective. Unlike HBV, HCV is not officially categorized as a sexually transmitted disease. Although the rate of sexual transmission is low, safer sexual practices is always a good idea. There is no vaccine against HCV. Not much is known about HGV. Blood transfusions are the common route for this virus. It has not been determined if HGV is anything to be concerned about. In certain cases, HGV may even provide beneficial effects. There is no HGV vaccine.

Hepatitis is often a preventable disease regardless if the cause is viral, toxic, substance, or lifestyle. It is easy to take the liver for granted since it doesnít complain much. If we abuse our stomachs or our backs, usually we change our habits. However, since the liver is quiet, we donít get immediate feedback if we are harming it. Donít wait until itís too late. Take care of your liver starting now.

Resources

American Liver Foundation
www.liverfoundation.org

Center for Disease Control
www.cdc.gov

HCV Advocate
www.hcvadvocate.org

Hepatitis Foundation International
www.hepfi.org

World Health Organization
www.who.int/en


Article Resource: Hepatitis Awareness by Lucinda K. Porter, RN as published in "Health Wise", HCV Advocate, May 2007 of the Hepatiais C Support Project