Hepatitis B

DESCRIPTION Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection.
 
SIGNS & SYMPTOMS About 30% of persons have no signs or symptoms.
Signs and symptoms are less common in children than adults. 
jaundice
fatigue
abdominal pain
 loss of appetite
nausea, vomiting 
joint pain
 
CAUSE Hepatitis B virus (HBV)
 
TRANSMISSION Occurs when blood from an infected person enters the body of a person who is not infected.

HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission), by sharing drugs, needles, or "works" when injecting drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.
Persons at risk for HBV infection might also be at risk for infection with hepatitis C virus (HCV) or HIV.
 
RISK GROUPS
 
 Persons with multiple sex partners or diagnosis of a sexually transmitted disease
Men who have sex with men
Sex contacts of infected persons
Injection-drug users
Household contacts of chronically infected persons
 Infants born to infected mothers
Infants/children of immigrants from areas with high rates of HBV infection (country listing)
Health-care and public safety workers with exposure to blood
(View current post-exposure prophylaxis recommendations)
Hemodialysis patients
 
PREVENTION Hepatitis B vaccine is the best protection.
If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission.
If you are pregnant, you should get a blood test for hepatitis B. Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.
Do not shoot drugs; if you shoot drugs, stop and get into a treatment program; if you can't stop, never share drugs, needles, syringes, water, or "works", and get vaccinated against hepatitis A and B.
Do not share personal care items that might have blood on them (razors, toothbrushes).
Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.
If you have or had hepatitis B, do not donate blood, organs, or tissue.
If you are a health-care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps (view current post-exposure prophylaxis recommendations).
 
VACCINE RECOMMENDATIONS Hepatitis B vaccine has been available since 1982.
Routine vaccination of 0-18 year olds
Vaccination of risk groups of all ages
 
LONG-TERM EFFECTS WITHOUT VACCINATION Chronic infection occurs in:
90% of infants infected at birth
30% of children infected at age 1–5 years 
6% of persons infected after age 5 years 
Death from chronic liver disease occurs in:

15%–25% of chronically infected persons
 
CONTRAINDICATIONS TO VACCINE A serious allergic reaction to a prior dose of hepatitis B vaccine or a vaccine component is a contraindication to further doses of hepatitis B vaccine. The recombinant vaccines that are licensed for use in the United States are synthesized by Saccharomyces cerevisiae (common bakers' yeast), into which a plasmid containing the gene for HBsAg has been inserted. Purified HBsAg is obtained by lysing the yeast cells and separating HBsAg from the yeast components by biochemical and biophysical techniques. Persons allergic to yeast should not be vaccinated with vaccines containing yeast.
 
TREATMENT & MEDICAL MANAGEMENT  HBV infected persons should be evaluated by their doctor for liver disease.
Adefovir dipivoxil, interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, entecavir, and telbivudine are six drugs used for the treatment of persons with chronic hepatitis B.
These drugs should not be used by pregnant women.
Drinking alcohol can make your liver disease worse.
 
TRENDS & STATISTICS
 

 
 Number of new infections per year has declined from an average of 260,000 in the 1980s to about 60,000 in 2004.
Highest rate of disease occurs in 20-49-year-olds.
Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination. 
Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood.

am sure, its not where i contacted it,  the doc said its my intake

something i had eaten, that is very bad to my system and my liver couldnt digest,

am so scared, arghhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

Types of hepatitis
Please see the respective articles for more detailed information.
See also: Infectious canine hepatitis

[edit] Viral
Most cases of acute hepatitis are due to viral infections:

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis B with D
Hepatitis E
Hepatitis F virus (existence unknown)
Hepatitis G, or GBV-C

In addition to the hepatitis viruses (please note that the hepatitis viruses are not all related). Other viruses can also cause hepatitis, including cytomegalovirus, Epstein-Barr virus, yellow fever, etc.

Hepatitis A
Hepatitis A or infectious jaundice is caused by a picornavirus transmitted by the Fecal-oral route, often associated with ingestion of contaminated food or with anal/oral sex.

It causes an acute form of hepatitis and does not have a chronic stage. The patient's immune system makes antibodies against hepatitis A that confer immunity against future infection. People with hepatitis A are advised to rest, stay hydrated and avoid alcohol. A vaccine is available that will prevent infection from hepatitis A for life. Hepatitis A can be spread through personal contact, consumption of raw sea food or drinking contaminated water. This occurs primarily in third world countries.

Strict personal hygiene and the avoidance of raw and unpeeled foods can help prevent an infection. Infected people excrete the hepatitis A virus with their faeces two weeks before and one week after the appearance of jaundice. The time between the infection and the start of the illness averages 28 days (ranging from 15 to 50 days),[7] and most recover fully within 2 months although approximately 15% of sufferers may experience continuous or relapsing symptoms from six months to a year following initial diagnosis.[8]


Hepatitis B
Hepatitis B is caused by a hepadnavirus, which can cause both acute and chronic hepatitis. Chronic hepatitis develops in the 15% of patients who are unable to eliminate the virus after an initial infection. Identified methods of transmission include blood (blood transfusion, now rare), tattoos (both amateur and professionally done), sexually (through sexual intercourse or through contact with blood or bodily fluids), or via mother to child by breast feeding (minimal evidence of transplacental crossing). However, in about half of cases the source of infection cannot be determined.

Blood contact can occur by sharing syringes in intravenous drug use, shaving accessories such as razor blades, or touching wounds on infected persons. Needle-exchange programmes have been created in many countries as a form of prevention. Patients with chronic hepatitis B have antibodies against hepatitis B, but these antibodies are not enough to clear the infection that establishes itself in the DNA of the affected liver cells. The continued production of virus combined with antibodies is a likely cause of immune complex disease seen in these patients.

A vaccine is available that will prevent infection from hepatitis B for life. Hepatitis B infections result in 500,000 to 1,200,000 deaths per year worldwide due to the complications of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hepatitis B is endemic in a number of (mainly South-East Asian) countries, making cirrhosis and hepatocellular carcinoma big killers. There are six FDA-approved treatment options available for persons with a chronic hepatitis B infection: alpha-interferon, pegylated interferon adefovir, entecavir, telbivudine and lamivudine. About 65% of persons on treatment achieve a sustained response.


Hepatitis C
Hepatitis C (originally "non-A non-B hepatitis") is caused by a virus with an RNA genome that is a member of the Flaviviridae family. It can be transmitted through contact with blood (including through sexual contact where the two parties' blood is mixed) and can also cross the placenta. Hepatitis C may lead to a chronic form of hepatitis, culminating in cirrhosis. It can remain asymptomatic for 10-20 years. Patients with hepatitis C are susceptible to severe hepatitis if they contract either hepatitis A or B, so all hepatitis C patients should be immunized against hepatitis A and hepatitis B if they are not already immune, and avoid alcohol. The virus can cause cirrhosis of the liver. HCV viral levels can be reduced to undetectable levels by a combination of interferon and the antiviral drug ribavirin. The genotype of the virus determines the rate of response to this treatment regimen. Genotype 1 is more resistant to interferon therapy than other HCV genotypes.


Hepatitis D
Hepatitis D is caused by hepatitis delta agent, which is considered a subviral satellite as it can only propagate in the presence of the Hepatitis B virus.


Hepatitis E
Hepatitis E produces symptoms similar to hepatitis A, although it can take a fulminant course in some patients, particularly pregnant women; it is more prevalent in the Indian subcontinent.
[edit] Hepatitis F virus
Hepatitis F virus is a hypothetical virus linked to hepatitis. Several hepatitis F virus candidates emerged in the 1990s; none of these reports have been substantiated.


Hepatitis G, or GBV-C
Another potential viral cause of hepatitis, hepatitis G virus, has been identified,[9] and is probably spread by blood and sexual contact.[10] There is, however, doubt about whether it causes hepatitis, or is just associated with hepatitis, as it does not appear to replicate primarily in the liver.[11] It is now classified as GBV-C[2].


Other viral causes of hepatitis
Other viral infections can cause hepatitis (inflammation of the liver):

Mumps virus
Rubella virus
Cytomegalovirus
Epstein-Barr virus
Other herpes viruses

Alcoholic hepatitis

Main article: Alcoholic hepatitis
Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset.

Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis b.y itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C.. The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis in Western countries. It is known to occur a lot in Mexico.


Drug induced hepatitis
A large number of drugs can cause hepatitis. The anti-diabetic drug troglitazone was withdrawn in 2000 for causing hepatitis. Other drugs associated with hepatitis:[12]

Allopurinol
Amitriptyline (antidepressant)
Amiodarone (antiarrhythmic)
Azathioprine[13][14]
Halothane (a specific type of anesthetic gas)
Hormonal contraceptives
Ibuprofen and indomethacin (NSAIDs)
Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics)
Ketoconazole (antifungal)
Methyldopa (antihypertensive)
Minocycline (tetracycline antibiotic)
Nifedipine (antihypertensive)
Nitrofurantoin (antibiotic)
Phenytoin and valproic acid (antiepileptics)
Zidovudine (antiretroviral i.e. against HIV)
Some herbs and nutritional supplements
The clinical course of drug-induced hepatitis is quite variable, depending on the drug and the patient's tendency to react to the drug. For example, halothane hepatitis can range from mild to fatal as can INH-induced hepatitis. Hormonal contraception can cause structural changes in the liver. Amiodarone hepatitis can be untreatable since the long half life of the drug (up to 60 days) means that there is no effective way to stop exposure to the drug. Statins can cause elevations of liver function blood tests normally without indicating an underlying hepatitis. Lastly, human variability is such that any drug can be a cause of hepatitis.

Other toxins that cause hepatitis

Toxins and drugs can cause hepatitis:

Amatoxin-containing mushrooms, including the Death Cap (Amanita phalloides), the Destroying Angel (Amanita ocreata), and some species of Galerina. A portion of a single mushroom can be enough to be lethal (10 mg or less of α-amanitin).
White phosphorus, an industrial toxin.
Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage can be limited by prompt administration of acetylcysteine.
Carbon tetrachloride ("tetra", a dry cleaning agent), chloroform, and trichloroethylene, all chlorinated hydrocarbons, cause steatohepatitis (hepatitis with fatty liver).
Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria.

Metabolic disorders
Some metabolic disorders cause different forms of hepatitis. Hemochromatosis (due to iron accumulation) and Wilson's disease (copper accumulation) can cause liver inflammation and necrosis.

See below for non-alcoholic steatohepatitis (NASH), effectively a consequence of metabolic syndrome.


Obstructive
"Obstructive jaundice" is the term used to describe jaundice due to obstruction of the bile duct (by gallstones or external obstruction by cancer). If longstanding it leads to destruction and inflammation of liver tissue.


Autoimmune
Anomalous presentation of human leukocyte antigen (HLA) class II on the surface of hepatocytes—possibly due to genetic predisposition or acute liver infection—causes a cell-mediated immune response against the body's own liver, resulting in autoimmune hepatitis.

Autoimmune hepatitis has an incidence of 1-2 per 100,000 per year, and a prevalence of 15-20/100,000. As with most other autoimmune diseases, it affects women much more often than men (8:1). Liver enzymes are elevated, as is bilirubin. Autoimmune hepatitis can progress to cirrhosis. Treatment is with steroids and disease-modifying antirheumatic drugs (DMARDs).

The diagnosis of autoimmune hepatitis is best achieved with a combination of clinical and laboratory findings. A number of specific antibodies found in the blood (antinuclear antibody (ANA), smooth muscle antibody (SMA), Liver/kidney microsomal antibody (LKM-1) and anti-mitochondrial antibody (AMA)) are of use, as is finding an increased Immunoglobulin G level. However, the diagnosis of autoimmune hepatitis always requires a liver biopsy. In complex cases a scoring system can be used to help determine if a patient has autoimmune hepatitis, which combines clinical and laboratory features of a given case.

Four subtypes are recognised, but the clinical utility of distinguishing subtypes is limited.

Positive ANA and SMA, raised immunoglobulin G (classic form, responds well to low dose steroids)
Positive LKM-1 (typically female children and teenagers; disease can be severe)
All antibodies negative, positive antibodies against soluble liver antigen (SLA)(now designated SLP/LP). This group behaves like group 1.
No autoantibodies detected (~13%)

Alpha 1-antitrypsin deficiency
In severe cases of alpha 1-antitrypsin deficiency (A1AD), the accumulated protein in the endoplasmic reticulum causes liver cell damage and inflammation.

Nonalcoholic steatohepatitis
Non-alcoholic steatohepatitis (NASH) is a type of hepatitis which resembles alcoholic hepatitis on liver biopsy (fat droplets, inflammatory cells, but usually no Mallory's hyaline) but occurs in patients who have no known history of alcohol abuse. NASH is more common in women and the most common cause is obesity or the metabolic syndrome. A related but less serious condition is called "fatty liver" (steatosis hepatis), which occurs in up to 80% of all clinically obese people. A liver biopsy for fatty liver shows fat droplets throughout the liver, but no signs of inflammation or Mallory's hyalin.

The diagnosis depends on history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty infiltration of the liver is radiologic imaging including ultrasound, computed tomographic imaging, or magnetic resonance imaging. However, radiologic imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with follow -up blood tests and a repeat liver biopsy are required.

NASH is becoming recognized as the most important cause of liver disease second only to Hepatitis C in numbers of patients going on to cirrhosis.

Ischemic hepatitis
See also: Ischemic hepatitis
Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure (or shock) leading to the equivalent term "shock liver". Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 You/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis.