Hepatitis (Viral Hepatitis, A, B, C, D, E, G)

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Viral hepatitis facts

 

  • Many illnesses and conditions can cause inflammation of the liver (hepatitis), but certain viruses cause about half of all hepatitis in people.
  • Viruses that primarily attack the liver are called hepatitis viruses. There are several types of hepatitis viruses including types A, B, C, D, E, and possibly G. Types A, B, and C are the most common.
  • All hepatitis viruses can cause acute hepatitis.
  • Viral hepatitis types B and C can cause chronic hepatitis.
  • Symptoms of acute viral hepatitis include fatigue, flu-like symptoms, dark urine, light-colored stools, fever, and jaundice; however, acute viral hepatitis may occur with minimal symptoms that go unrecognized. Rarely, acute viral hepatitis causes fulminant hepatic failure.
  • The symptoms of chronic viral hepatitis often are mild and nonspecific, and the diagnosis of chronic hepatitis often is delayed.
  • Chronic viral hepatitis often requires treatment in order to prevent progressive liver damage, cirrhosis, liver failure, and liver cancer.
  • Hepatitis infections can be prevented by avoiding exposure to viruses, and through injectable immunoglobulins or by vaccines; however, vaccines are available for only hepatitis A and B.
  • Those at risk for viral hepatitis B and C include workers in the health care profession, people with multiple sexual partners, intravenous drug abusers, and people with hemophilia. Blood transfusion is a rare cause of viral hepatitis.

Viral hepatitis definition and overview

Hepatitis means hepatitis. Many diseases and conditions can cause hepatitis, for example, drugs, alcohol, chemicals, autoimmune diseases. Many viruses, for example, a virus that causes white blood cells and cytomegalovirus can inflame the liver. Most viruses, however, do not primarily attack the liver. The liver is just one of several devices that affect viruses. When most doctors talk about viral hepatitis, they use a definition that means hepatitis caused by some specific viruses that attack the liver in the first place, responsible for about half of all human hepatitis. There are several hepatitis viruses. Types A, B, C, D, E, F (uncertain) have been named, and G. As we learned from growing hepatitis viruses, this alphabetical list is likely to be longer. The most common viruses are hepatitis A, B and C. Hepatitis viruses are often presented concisely (eg, Hav, HPV, hepatitis A, B, C, respectively). Viruses that cause the majority of human viral hepatitis.

Hepatitis viruses multiply mainly in liver cells. This can lead to liver failure to function. The following is a list of the main functions of the liver:

  • The liver helps purify the blood by changing harmful chemicals into harmless ones. The source of these chemicals can be external, such as medications or alcohol, or internal, such as ammonia or bilirubin. Typically, these harmful chemicals are broken down into smaller chemicals or attached to other chemicals that then are eliminated from the body in the urine or stool.
  • The liver produces many important substances, especially proteins that are necessary for good health. For example, it produces albumin, the protein building block of the body, as well as the proteins that cause blood to clot properly.
  • The liver stores many sugars, fats and vitamins until they are needed elsewhere in the body.
  • The liver builds smaller chemicals into larger, more complicated chemicals that are needed elsewhere in the body. Examples of this type of function are the manufacture of a fat, cholesterol, and the protein bilirubin.

eindama multahiba alkubd, fa’iinah the ‘ada’ hadhih almahami bishakl jyd, waladhi yajlib aledyd min al’aerad walealamati, walmashakil almurtabitat bi’ayi nawe min ailtihab alkubd. likuli nawe min ‘anwae ailtihab alkabid alfirusiyi (A-F) ealaa hadi swa’ min almaqalat walkutub alty tasif tafasil al’iisabat mae hdha alfayrus meyn. tama tasmim hadhih almuqalat li’iieta ‘alqari lamhat eamat ean alfayrusat alssayidat alty tasabab ailtihab alkabid alfirusi, wa’aeradihim, waltashkhisu, waleilaji, wayajib’ an tusaeid alqari aikhtiar mawdue (q) li’akthar fi eumq almaelumati.
When the liver is inflamed, it performs these tasks well, which brings many symptoms and signs, and problems associated with any type of hepatitis. Each type of viral hepatitis (A-F) has both articles and books that describe the details of the infection with this particular virus. This article is designed to provide the reader with an overview of the prevalent viruses that cause viral hepatitis, its symptoms, diagnosis and treatment, and should help the reader to select the topic (s) to obtain more detailed information.

What are the common types of viral hepatitis?

Although the most common types of viral hepatitis are HAV, HPV, and HCC, some doctors have previously considered the acute and chronic stages of hepatitis as “types” of viral hepatitis. Hev was considered an acute viral hepatitis because Haf infections rarely cause permanent liver damage or lead to liver failure. The hepatitis C virus and HCV produced chronic viral hepatitis. However, these terms are obsolete and are not frequently used because all the viruses that cause hepatitis can present acute symptoms in the stadium (see symptoms below). Prevention and vaccination techniques have resulted in a significant reduction in the current rate of viral hepatitis virus infection. However, there is still a population of approximately 800,000 to 1.4 million people in the United States with chronic hepatitis, and around 2.9 to 3.7 million with chronic hepatitis viruses according to the CDC. The statistics are incomplete to determine the number of new infections that occur each year, the CDC documented the infection and continued estimating the actual figures when estimating the number of undeclared victims (see sections and reference 1).


Hepatitis A (HAV)


It is estimated that there are 1,781 new infections per year according to the latest CDC data. Hepatitis induced hepatitis is a serious disease (acute viral hepatitis) that has not become chronic. At one time, hepatitis A was called “hepatitis” because it can spread easily from person to person, like other viral infections. Infection with the hepatitis A virus can be transmitted by eating food or water, especially when unhealthy conditions allow water or food to contaminate human waste containing hepatitis A (method of transmission of oral stools). Hepatitis A is usually spread among family members, and close contact is maintained through oral secretions (or close kisses) or stool (hand washing). It is also common to spread to customers in restaurants, children and daycare workers if you do not notice Wash your hands and take health precautions.


Hepatitis B (HPV)

 

There were more than 19,000 new cases of hepatitis C infection estimated by the CDC in 2013 and more than 1,800 people die each year from the consequences of chronic hepatitis B infection in the United States, according to the CDC. Hepatitis was simultaneously called “hepatitis” because it was thought to be the only method that could be spread by HPV through blood or serum (the liquid part of the blood) that contains the virus. It is now known that the hepatitis C virus can spread through sexual contact, blood or serum transfusion through needles common to drug users, occasional needle sticks with blood-infected needles, blood transfusions, dialysis and infected mothers. newly born. The infection can also be spread by tattooing, piercing the body, sharing razor blades and toothbrush (if there is contamination with infected blood). About 6% to 10% of patients with hepatitis have a chronic infection with the hepatitis C virus (the infection lasts at least six months, often from years to decades) and can infect others while they are infected. Patients with chronic infection with hepatitis B virus are also at risk of developing cirrhosis, liver failure and liver cancer. It is estimated that there are 2.2 million people in the United States and 2 billion people worldwide who suffer chronic hepatitis B infections.


Hepatitis C (HCC)


The CDC reported that there were approximately 16,500 new cases reported annually (no more than 13.4 times reported) of hepatitis C. Viral hepatitis was previously referred to as “not A, not hepatitis B”. Because the causative virus was not identified, it was known neither virus nor HPV. Hepatitis is commonly spread by needles common among drug users, blood transfusions, dialysis and needles. Almost 90% of blood transfusions related to hepatitis is caused by hemorrhage. Sexually transmitted transmission has been reported, but is rarely considered. It is estimated that between 50% and 70% of patients with acute HCCV infection develop chronic infection. Patients with chronic HCCV infection can continue to infect others. Patients with chronic viral hepatitis are at risk of cirrhosis, liver failure and liver cancer. It is estimated that there are approximately 3.2 million people suffering from a chronic infection with the hepatitis virus in the United States.

 

Types D, E and G Hepatitis


There are also types of viral hepatitis D, E and G. The most important of these is the hepatitis D virus (AIM), also known as delta virus or agent. A small virus that requires the infection associated with the hepatitis B virus to survive. The target can survive on its own because it requires a protein that produces HPV (a protein from the envelope, also called a surface antigen) to allow it to infect the cells of the liver. The ways in which HIV spreads are common needles among drug addicts, contaminated blood and sexual contact, basically the same methods as hepatitis.

People who already have a chronic infection with the hepatitis B virus can get hepatitis C infection at the same time they get the hepatitis C virus or later. Those who suffer from chronic hepatitis due to HPV and the goal of developing liver cirrhosis (acute liver scarring) quickly. In addition, the combination of HPV infection and target virus is very difficult to treat.

Hepatitis E virus (HEV) is similar to heme in terms of disease, and occurs mainly in Asia, where it is transmitted by contaminated water.

Hepatitis G virus (also known as GC) was recently discovered and resembles hepatitis C virus, but up close, flavirus, the virus and its effects are being investigated and its role in human disease is not Clear.

 

Who is at risk for viral hepatitis?

People who are most at risk for developing viral hepatitis are:

  • Workers in the health care professions
  • Asians and Pacific Islanders
  • Sewage and water treatment workers
  • People with multiple sexual partners
  • Intravenous drug users
  • HIV patients
  • People with hemophilia who receive blood clotting factors

Blood transfusions, once a common way to spread viral hepatitis, and is now a rare cause of hepatitis. It is generally believed that viral hepatitis is more common ten times among individuals and social economists and less educated. About a third of all cases of hepatitis come from a source or of unknown identity. This means that a person should not be in a high-risk group in order to be infected with hepatitis. In countries with poor sanitary conditions, food and water pollution with HIV leads to an increased risk. Some day centers can be contaminated by the disease, so children in these centers are at risk of becoming infected with HIV.

 

What are the symptoms and signs of viral hepatitis?

The period of time between exposure to hepatitis and the onset of the illness is called the incubation period. The incubation period varies depending on the specific hepatitis virus. Hepatitis A virus has an incubation period of about 15 to 45 days; Hepatitis B virus from 45 to 160 days, and Hepatitis C virus from about 2 weeks to 6 months.

Many patients infected with HAV, HBV, and HCV have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Fever
  • Weakness
  • Tiredness
  • Aching in the abdomen

Less common symptoms include:

  • Dark urine
  • Light-colored stools
  • Fever
  • Jaundice (a yellow appearance to the skin and white portion of the eyes)

 

How is viral hepatitis diagnosed?


The diagnosis of viral hepatitis is based on the symptoms and physical results, as well as blood tests of liver enzymes, viral antibodies and viral genetic materials.
Symptoms and physical results

The diagnosis of acute viral hepatitis is often easy, but the diagnosis of chronic hepatitis can be difficult. When the patient declares symptoms of fatigue, nausea, abdominal pain, dark urine, and then develop jaundice, it is likely diagnosis of acute viral hepatitis can be confirmed by blood tests. On the other hand, patients with chronic hepatitis due to hepatitis C and HCV often have no symptoms or only mild symptoms not defined as chronic fatigue. In general, these patients do not have jaundice until the liver damage is very advanced. Therefore, these patients may remain undisciplined for years or decades.
Blood test

There are three types of blood tests to evaluate patients with hepatitis: liver enzymes, anti-hepatitis virus, viral proteins or genetic material (DNA or viral RNA).

Liver enzymes: Among the most sensitive blood tests widely used to evaluate patients with hepatitis are liver enzymes, called aminotransferases. They include aminotransferase aspartate (AST or Sgut), alanine aminotransferase (ALT or SGBT). These enzymes are usually found inside liver cells. If the liver is infected (as in viral hepatitis), the liver cells will emit enzymes into the blood, raise the levels of enzymes in the blood and indicate liver damage.

The normal range of AST values ​​is 5 to 40 units per liter of serum (the liquid part of the blood) while the normal range of values ​​is 7 to 56 units per liter of blood serum. (These normal levels may vary slightly depending on the laboratory). Patients with acute viral hepatitis (for example, haf or HPV) can develop very high levels and, sometimes, thousands of units per liter. These high levels are normal in several weeks or months in which patients recover completely from acute hepatitis. In contrast, patients with chronic viral hepatitis and HIV infection generally have only a slight increase in stalk levels, but these anomalies can last for years or decades. As the majority of patients with chronic hepatitis are asymptomatic (without jaundice or nausea), abnormal liver enzymes are routinely unexpectedly found in blood tests during routine physical exams or physical insurance.

High levels of AST and ALT only mean that the liver is inflamed, and can cause elevations by many factors other than hepatitis viruses, such as drugs, alcohol, bacteria, fungi and others in order to prove that the virus Hepatitis is responsible for the high, should blood for the antibody test Anti-hepatitis virus as well as genetic material.

Viral antibodies: antibodies are proteins produced by white blood cells that attack invaders, such as bacteria and viruses. It can detect antibodies against hepatitis A, virus B, C usually in the blood within weeks of infection, the antibodies remain detectable in the blood for decades afterwards. Blood tests of antibodies can be useful in diagnosing acute and chronic viral hepatitis.

In acute viral hepatitis, antibodies not only help to eliminate the virus, but also protect the patient from infection in the future by the same virus, that is, the patient develops immunity. In chronic hepatitis, however, the antibodies and the rest of the immune system can not eliminate the virus. Viruses continue to multiply and are released from liver cells into the blood, where their presence can be determined by measuring viral proteins and genetic material. Therefore, in chronic hepatitis, both viral and antiviral proteins and genetic material can be detected in the blood.

Examples of viral antibody tests include:

  • anti-HAV (hepatitis A antibody)
  • antibody to hepatitis B core, an antibody directed against the inner core material of the virus (core antigen)
  • antibody to hepatitis B surface, an antibody directed against the outer surface envelope of the virus (surface antigen)
  • antibody to hepatitis B e, an antibody directed against the genetic material of the virus (e antigen)
  • hepatitis C antibody, the antibody against the C virus

Viral proteins and genetic material: Examples of tests for viral proteins and genetic material are:

  • hepatitis B surface antigen
  • hepatitis B DNA
  • hepatitis B e antigen
  • hepatitis C RNA

Other tests: Obstruction of the bile ducts, from either gallstones or cancer, occasionally can mimic acute viral hepatitis. Ultrasound testing can be used to exclude the possibility of gallstones or cancer.

 

What is the treatment for viral hepatitis?

The treatment of acute viral hepatitis and chronic viral hepatitis are different. The treatment of acute viral hepatitis involves rest, relieve symptoms and maintain an adequate intake of fluids. The treatment of chronic viral hepatitis involves medications to eliminate the virus and take measures to prevent further damage to the liver.


Acute hepatitis

In patients with acute viral hepatitis, the initial therapy consists of alleviating the symptoms of nausea, vomiting and abdominal pain (supportive care). Special attention should be paid to medications or compounds, which may have adverse effects in patients with abnormal liver functions (eg, acetaminophen [Tylenol, etc.], alcohol, etc.). Only drugs that are necessary should be administered because the weak liver does not usually eliminate drugs and medications can accumulate in the blood and reach toxic levels. In addition, sedatives and sedatives are avoided because they can highlight the effects of liver failure in the brain and cause inactivity and coma. The patient should refrain from drinking alcohol, because alcohol is toxic to the liver. Sometimes it is necessary to administer fluids intravenously to avoid dehydration caused by vomiting. Patients with severe nausea and / or vomiting may need treatment for fluids and fluids intravenously.

HPV is not treated with acute antiviral medications. Acute hepatitis, although rarely diagnosed, can be treated with many medications used to treat chronic hepatitis. Treatment with Hecav is recommended mainly for 80% of patients who do not eradicate the virus early. The treatment results in the elimination of the virus in most patients.


Chronic hepatitis

The treatment of chronic infection with hepatitis B and hepatitis C usually involves medications or combinations of medications to eliminate the virus. Doctors believe that in patients who have been correctly selected, successful virus elimination can stop the gradual damage to the liver and prevent the development of liver cirrhosis, liver failure and liver cancer. Alcohol aggravates liver damage in chronic hepatitis and can cause a more rapid progression of liver cirrhosis. Therefore, patients with chronic hepatitis should stop drinking alcohol. Smoking cigarettes can also aggravate liver disease and should stop.

Chronic anti-hepatitis C medications include:

 

  • injectable alpha interferons (Pegasys).
  • oral ribavirin (Rebetol, Copegus).
  • oral boceprevir (Victrelis).
  • simeprevir (Olysio).
  • oral sofosbuvir (Sovaldi).
  • oral simeprevir (Olysio).
  • oral daclatasvir (Daklinza).
  • oral ledipasvir/sofosbuvir (Harvoni).
  • oral ombitasvir/paritaprevir/ritonavir (Technivie).
  • oral ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak).

Medications for chronic hepatitis B infection include:

  • injectable alpha interferons.
  • oral lamivudine (Epivir).
  • oral adefovir (Hepsera).
  • oral entecavir (Baraclude).
  • orak telbivudine (Tyzeka).
  • oral tenofovir (Viread).

Because of constantly ongoing research and development of new antiviral agents, the current list of medications for chronic hepatitis B and C infections is likely to change every year. Many of those drugs which are currently available are rarely used because of newer, safer, and more effective alternatives.

Decisions regarding treatment of chronic hepatitis can be complex, and should be directed by gastroenterologists, hepatologists (doctors specially trained in treating diseases of the liver), or infectious disease specialists for several reasons including::

 

1-The diagnosis of chronic viral hepatitis may not be obvious. Sometimes, a liver biopsy can be done to control liver damage. Physicians suffering from chronic liver disease should weigh the risk of a liver biopsy against the possible benefits of the biopsy.


2-  
Not all patients with chronic viral hepatitis are candidates for treatment. Some patients do not need treatment (because some patients with chronic hepatitis B and C do not develop progressive liver damage or liver cancer).


3-  
Medications for chronic infection with hepatitis B and hepatitis C are not always effective. Prolonged treatment (from 6 months to years) is often necessary. Even with prolonged treatment, successful treatment rates (defined as total and permanent eradication of the virus) are often low (generally less than 80%, often around 50%).


4-   
Most medications such as interferon and ribavirin can have serious side effects and doses may be reduced.


5-  
There are several different strains of the hepatitis C virus with different sensitivity to drugs. For example, hepatitis C type 3 is more likely to respond to injections of interferon and rivafirin type 1. Some strains of hepatitis B are resistant to lamifudin but respond to adevir or anticoafir.

In addition, recent research has shown that the combination of some antiviral drugs leads to a cure (viral elimination) in many patients with chronic hepatitis C. Other studies have pending FDA approval.

 

Fulminant hepatitis

Treatment of acute fulminant hepatitis should be done in centers that can perform liver transplantation since acute fulminant hepatitis has a high mortality (about 80%) without liver transplantation.

How is viral hepatitis prevented?

The prevention of hepatitis involves measures to avoid exposure to viruses, the use of immunosuppression in the case of exposure and vaccines. The management of immunoglobulin is called negative protection because antibodies from patients with viral hepatitis are administered to the patient. Vaccination is called active protection because the viruses that have been killed or the non-infectious components of the viruses are administered to stimulate the body to produce its own antibodies.
Avoid exposure to viruses

The prevention of viral hepatitis, like any other disease, is preferred to rely on treatment. Taking precautions to prevent another person from being exposed (dirty needles), unprotected sex, physical excretion and other waste (feces and vomiting) will help prevent the spread of all these viruses.
Use Immune

Immunoglobulin serum (ISG) is a human serum that contains antibodies against hepatitis A. Inhalation can be administered to prevent infection in individuals who have been exposed to hepatitis A. It acts immediately as an administration, and the duration of protection It is several months. Generally, Lax is administered to travelers in areas of the world where there are high rates of hepatitis A and close or in-home contacts for patients with hepatitis A. Hepatitis A is safe with some side effects.

Hepatitis B is a human serum that contains antibodies against hepatitis B. Hepig is made from a plasma (blood product) that is known to contain a high concentration of antibodies against hepatitis B. If administered in plasma, within 10 days of exposure to the virus, Hippig is almost almost successful in preventing infection. However, even if it is given a little later, Hbig can reduce the severity of infection with the hepatitis B virus. Protection against hepatitis B lasts approximately three weeks after giving Hbig. Hibig is also administered at the time of birth to babies born to mothers known to have hepatitis B. In addition, HEPEG is administered to people exposed to HPV due to sexual contact or health workers mistakenly mistaken for a needle that is known It is contaminated with blood from an infected person.

 

What is the prognosis of viral hepatitis?

 

The prognosis of viral hepatitis for most patients is good; however, this prognosis varies somewhat depending on the infecting virus. For example, those patients who develop chronic hepatitis have a worse prognosis because of the potential to develop cirrhosis, liver failure, liver cancer (hepatocellular carcinoma), and occasionally death. Symptoms of viral hepatitis such as fatigue, poor appetite, nausea, and jaundice usually subside in several weeks to months, without any specific treatment. In fact, virtually all patients with acute infection with HAV and most adults (greater than 95%) with acute HBV recover completely. Complete recovery from viral hepatitis means that:

  • the hepatitis virus has been completely eliminated from the liver by the body’s immune system,
  • the inflammation in the liver subsides,
  • the patient develops immunity to future infection with the same virus, and
  • the patient cannot transmit the infection to others.

Unfortunately, not all patients with viral hepatitis recover completely. Five percent of patients with acute HBV infection and about 60% of patients with acute HCV infection develop chronic hepatitis. Patients (about 0.5% to 1%) that develop fulminant hepatitis have about an 80% fatality rate. Chronic HCV infections are the leading cause for liver transplants.

Because the liver works to detoxify substances, this task is compromised during acute and chronic viral hepatitis infections. Consequently, avoiding items that may stress the compromised livers function (for example, alcohol, smoking, taking drugs that require liver processing) should be strongly considered by the patient to improve their prognosis.

 

REFERENCES:

CDC. Viral Hepatitis.

CDC. Hepatitis C FAQs for the Public.

CDC. Surveillance for Viral Hepatitis – United States, 2012.

Medscape. Hepatitis B Medication.

Medscape. Hepatitis C Medication.

Medscape. Viral Hepatitis.

UpToDate. GB virus C (hepatitis G) infection.

WHO. Hepatitis B: Are you at risk?

WHO. Hepatitis B.

 

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