Viral Hepatitis A, B, C, D & E: Causes, Symptoms and Treatment

What Is Hepatitis?

Hepatitis is the condition characterized by inflammation of the liver. Hepatitis in some cases can progress to severe liver damage and liver cancer. Though alcohol abuse, certain medications, autoimmune diseases can lead to hepatitis, a viral infection is the most common cause. Viral hepatitis is one of the most common causes of morbidity and mortality worldwide.

What Are Various Types of Viral Hepatitis?

There are various types of viral hepatitis, namely A, B, C, D and E. 

Hepatitis A: Hepatitis A virus (HAV) is the causative agent for hepatitis A infection. It results in mild to severe sickness. This condition is self-limiting. The most common mode of transmission includes contaminated food or water, inadequate personal hygiene and oral-anal sex. Though vaccines are also available to afford protection against HAV, safe water and food strategies are considered to be sufficient to prevent it. 

Hepatitis B: Hepatitis B virus (HBV) is the causative agent for hepatitis B infection. In India, it is estimated that 40 million are infected with HBV.  The infection causes both acute and chronic liver disease. The most common mode of transmission includes exposure to infected blood, semen and other body fluids. There is a very effective vaccine available for HBV

Hepatitis C: Hepatitis C virus (HCV) is the causative agent for hepatitis C infection. It transmits through exposure to infected body fluids that may be due to unsafe injection, transfusing blood without screening, or sexual contact. There is no vaccine for HCV.

Hepatitis D: Hepatitis D virus (HDV) causes hepatitis D infection and can infect only those infected by HBV. It spreads when a healthy person is directly exposed to infected blood. HBV can afford protection against HDV. 

Hepatitis E: Hepatitis E virus (HEV) causes hepatitis E infection. It is transmitted through contaminated food and water and very common in developing nations with poor sanitary conditions.  

How Common Is Viral Hepatitis in India?

Viral hepatitis is a public health problem in India. According to the reports published by the World Health Organization, approx. 52 million people are estimated to be living with Hepatitis B and C in India.  The diagnosis rate of HBV and HCV is only about 8% and 18% respectively globally. Hence, the theme of the current campaign is finding the missing millions. Another major challenge is increasing the HBV vaccine coverage as it is not a part of a universal vaccination program. One report suggests that only 55% of health workers were vaccinated against HBV. 

What Are the Symptoms of Hepatitis?

Many patients with hepatitis infection do not experience symptoms. Symptoms of acute hepatitis include:

  • Abdominal pain

  • Loss of appetite

  • Fatigue

  • Nausea and Vomiting

  • Weight loss

  • Yellowing of skin and eyes

  • Itching

  • Joint pain

  • Swelling in ankles and legs

  • Easy bruising and bleeding

  • Dark urine

  • Pale stool

What Are the Causes of Non-Viral Hepatitis?

Following are the causes of non-viral hepatitis:

Alcoholic hepatitis: Excessive intake of alcohol may result in liver inflammation. The disease may progress to cause severe damage to the liver tissues causing cirrhosis or liver cancer.

Exposure to chemicals: Exposure to various toxins, including industrial chemicals, and certain medicines may cause hepatitis.  

Autoimmune disease: The immune system of the body attacks healthy liver cells and causes inflammation in the liver. This condition is known as autoimmune hepatitis. 

Genetic hepatitis: Various genetic diseases such as hemochromatosis, alpha-1-antitrypsin deficiency, and Wilson's disease results in liver inflammation.

Ischemic hepatitis: Reduction or blockage in blood flow to the liver lead to liver inflammation. Venous insufficiency, shock, and heart failure may result in ischemic hepatitis. 

What Are the Complications of Hepatitis?

In many cases, untreated hepatitis may progress to cause the following complications:

  • Acute liver failure

  • Cirrhosis of the liver

  • Liver cancer

  • Portal hypertension

  • Hepatic encephalopathy affecting the brain

  • Bleeding disorders

  • Blood vessel inflammation and kidney disease

What Are the Diagnostic Procedures for Hepatitis?

Following techniques are used to diagnose hepatitis:

Physical examination: The doctor will perform a thorough physical evaluation of the patient to look for any sign of hepatitis. The doctor will check the eye and skin colour for jaundice. He may also look for any enlarged liver or abdominal swelling. 

Liver function tests: The doctor may also recommend for liver function tests. These tests determine the functioning of the liver. Abnormal findings in the liver function tests may indicate stress or damaged liver. 

Imaging techniques: Various imaging techniques such as Magnetic Resonance Imaging (MRI), Ultrasound, Transient elastography, and Computed Tomography (CT) diagnose hepatitis infection.  Imaging technique determines the extent of liver damage, the presence of fluid in the abdomen, and tumours in the liver.

Liver biopsy: The doctor may advise a liver biopsy to evaluate the damage in the liver or to analyze the tumour for malignancy.

What Are the Treatment Options for Hepatitis?

The treatment depends upon the type of hepatitis. In general, the doctor will recommend to take enough rest, eat smaller meals, nutritious diet, avoiding oily food, alcohol and unnecessary medications, take adequate fluids and maintain adequate hygiene. 

Hepatitis A: Hepatitis A is generally mild and does not require treatment. 

Hepatitis B: In chronic infection, treatment includes interferon injections, antiviral medications, and liver transplant. 

Hepatitis C: The treatment options for hepatitis C includes antiviral medications and liver transplant. 

Hepatitis D: There is no drug or vaccine for HAD. As the hepatitis D virus requires the hepatitis B virus for replication, vaccination for hepatitis B prevents infection from the hepatitis D virus. 

Hepatitis E: The disease is generally self-limiting and, thus, no specific treatment is required. Taking good care and avoiding unnecessary medications are usually recommended. 

 

Frequently Asked Questions about Hepatitis

1. How do you get Type A Hepatitis?

Hepatitis A spreads when a healthy and non-vaccinated (not vaccinated for hepatitis A) person consumes food or water contaminated with faeces of an infected person.

2. What are the symptoms of hepatitis A, B, and C?

Symptoms of hepatitis A, B, and C are:

  • Fatigue

  • Weakness

  • Nausea and vomiting

  • Yellowing of skin and eyes

  • Itching

  • Loss of appetite

  • Weight loss

3. What is the most common form of hepatitis?

Hepatitis A, Hepatitis B, and Hepatitis C are the most common hepatitis. 90% of hepatitis patients suffer from these forms.

4. Which hepatitis is not curable?

Hepatitis B infection is treatable, but there is no complete cure for this infection. However, it is preventable through vaccination.

5. Which is the most severe hepatitis?

Hepatitis C is the most severe hepatitis because of its high risk of progression to cirrhosis and liver cancer. Hepatitis C in approximately 5-20% of patients progresses to cirrhosis.

 

Dr. Goutham Kumar Mehta 

Consultant - Hepatobiliary Surgery, Liver Transplantation Surgery

Manipal Hospitals Bangalore – Old Airport Road

 

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