WORDS ABRAHAM MATHEW SAJI

Our liver is one of the major internal organs of our body that works nonstop to purify our blood as well as to produce and store essential micronutrients that are required by our body. When the liver is infected or sore, it fails to perform its functions and this results in the signs and symptoms manifested by hepatitis. The word hepatitis is a combination of hēpar or hēpat, which means liver in ancient Greek, and itis (the Greek word for inflammation). Thus, hepatitis simply means inflammation of the liver.

1. What Are The Causes Of Hepatitis?

Inflammation of the liver can be caused by various conditions, illnesses, some foods and drinks, certain medications and also viruses. Speaking about viruses, virus types A, B, C, D, E, F and G have been reported to cause infectious hepatitis. With medical advances and our quest for knowledge, the alphabetical list will only get longer. The most common are hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Of these, HBV and HCV can cause chronic hepatitis that can lead to conditions of liver cirrhosis and also liver cancer if left untreated.

Hepatitis A infections are often mild and can be treated easily compared to the others. Upon treatment and recovery, patients get immune to the virus. There is also a safe and effective vaccine available. This type is more common in places with poor hygiene and sanitation conditions.

Hepatitis B and hepatitis C infections can be caused by one or more of the following:

• Sharing needle with infected person
• Having unprotected sex with infected person
• Sharing personal items like toothbrush and razor blade with infected person
• Receiving a blood transfusion from an infected person
• Having a tattoo created using an unsterile or infected needl
• Bitten by an infected person
• Through lactation from an infected mother
• When the virus enter through a break in the skin.

Both HBV and HCV infections are treatable, depending on the severity of the infection. There is a safe and effective vaccine available to protect us from HBV. However, there is no vaccine yet against HCV. Ongoing research and medical advances may result in more effective prevention and treatment options soon.

2. What Are The Symptoms Of Hepatitis?

From the time when a person is infected with the virus to the development of symptoms is known as the incubation period. Each type of virus has varying incubation periods eg, 15–45 days for HAV, 45–160 days for HBV and 14–180 days for HCV. At the initial stages—also referred to as acute phase—some of the common symptoms are:

• mild-to-moderate fever
• loss of appetite
• fatigue muscle and joint aches
• nausea
• vomiting
• diarrhoea
• abdominal pain
• weight loss.

Symptoms of chronic hepatitis

 When the acute phase is left untreated, the disease progresses to the long-term (chronic) phase with the following symptoms:

• moderate-to-high fever
• jaundice
• abdominal swelling
• swelling of lower extremities of the body
• yellowness of skin, eyes and tongue (jaundice)
• blood in vomit or faeces
• itchy skin
• dark urine
• hives
• liver cirrhosis
• increase in liver enzymes and tumour markers
• liver cancer.

3. How Is Hepatitis Diagnosed?

As the symptoms of most infectious hepatitis are common, the diagnosis of the type and degree of infection can be done by thorough laboratory investigations like:

• Pathological blood tests that can detect the levels of enzymes, proteins and antibodies
• Pathological nucleic acid tests that can confirm the type of virus and its numbers
• Scans that can detect inflammation and any damage to surface of the liver
• Paracentesis, where a sample of the abdominal fluid is extracted and tested
• Liver biopsy that can detect cancer and extent of liver damage
• Elastography that measures stiffness of the liver
• Liver function tests that can help to identify liver disease.

4. What Are The Treatment Options For Hepatitis?

There is a wide array of treatment options available today and will depend on factors like:

• Type of infection
• Degree of infection
• Age and other underlying conditions of the person.

The treatment dose and duration may also be prolonged based on any or more of the above factors. Advances in research have seen treatment options moving from chemical-based medications to biotechnological interventions like monoclonal antibodies.

5. How Can We Prevent Hepatitis?

As the old adage goes, “An ounce of prevention is better than a pound of cure.” Some of the steps we can take to prevent being infected by hepatitis viruses are:

• Avoid injecting illegal substances into our body
• Avoid sharing of needles, toothbrushes, razors and other personal care items
• Practice safe sex
• Seek and share information with partner about any infection
• Wash hands properly with soap and water after using the toilet
• Consume safe drinking water
• Eat clean and fresh foods
• Ensure needles used in body piercing or tattoo have been sterilized
• Avoid or drink moderate amounts of alcohol
• Consult doctor for vaccination against HAV and HBV.

6. Love your Liver!

Here are some key steps we can take to ensure our liver stays healthy:

• Eat healthy and balanced meals
• Eat small portions of meals that can be easily digested
• Exercise regularly
• Maintain a healthy weight
• Avoid or drink moderate amounts of alcohol
• Consult doctor to ensure the medications we take don’t harm our liver
• Consult doctor before taking supplements

7. Is Recovery Possible?

Complete recovery from infectious hepatitis can be considered when:

• The causative virus has been completely removed from the bloodstream and liver
• Antibodies have been detected in the blood pointing to immunity
• The associated symptoms, which occurred during the infectious state have improved.

8. What Is The Situation In Malaysia?

In 2017, there was an estimated 1 million people who were chronically infected with HBV and an approximate 800,000 were positive for antibody to HCV. An effective nationwide vaccine coverage and the availability of affordable and effective treatment, which has been made possible by the Ministry of Health have been the reasons for these numbers being under control. Based on the newborn vaccination schedule, every newborn would have been immunized against HBV by the age of 6 months, with progressive doses at 1, 2 and 6 months. HT

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