Abnormalities In Heme Metabolism And Excretion
One way to understand jaundice pathophysiology is to organize it into disorders that cause increased bilirubin production or decreased bilirubin excretion .
Prehepatic pathophysiology
Prehepatic jaundice is attributed to a pathological increase in bilirubin production. The pathophysiology is quite simple an increased rate of erythrocyte hemolysis increased bilirubin production increased deposition of bilirubin in mucosal tissue appearance of yellow hue.
Hepatic pathophysiology
Hepatic jaundice is due to significant damage to liver function hepatic cell death and necrosis occur impaired bilirubin transport across hepatocytes. Bilirubin transport across may be impaired at any point between hepatocellular uptake of unconjugated bilirubin and hepatocellular transport of conjugated bilirubin into the gallbladder. In addition, subsequent cellular due to inflammation causes mechanical obstruction of intrahepatic biliary tract. Most commonly, interferences in all three major steps of bilirubin metabolism uptake, conjugation, and excretion usually occur in hepatocellular jaundice. Thus, an abnormal rise in both unconjugated and conjugated bilirubin will be present. Because excretion is usually impaired to the greatest extent, conjugated hyperbilirubinemia predominates.
Posthepatic pathophysiology
| Present | Present |
Laboratory findings depend on the cause of jaundice:
What Are The Signs & Symptoms Of Hbv Infection
HBV can cause a wide range of symptoms, from a mild illness and general feeling of being unwell to more serious chronic liver disease that can lead to liver cancer. Someone with hepatitis B may have symptoms similar to those caused by other viral infections, like the flu. The person might:
- be extra tired
- feel like throwing up or actually throw up
- not feel like eating
- have a mild fever
HBV also can cause darker than usual pee, jaundice , and belly pain.
People exposed to hepatitis B may start to have symptoms from 1 to 6 months later. Symptoms can last for weeks to months.
In some people, hepatitis B causes few or no symptoms. But even someone who doesn’t have any symptoms can still spread the disease to others.
Can Hepatitis B Be Controlled By Eating Right And Exercising
It is important that people with liver disease follow a healthy, nutritious diet as outlined by Health Canada in Eating Well with Canadas Food Guide.
Alcohol can also damage the liver so it is best that people with hepatitis B do not drink. Following a healthy lifestyle may also prevent fatty liver disease, another liver disease highly prevalent in Canada.
However, hepatitis B cannot be controlled by healthy eating and exercise alone. Hepatitis B can only be controlled by currently available treatment as prescribed by your doctor. Your doctor will need to do regular blood tests to know how much of the active virus is in your blood . The viral load test is used to monitor and manage hepatitis B patients. Viral load can tell your doctor if you need treatment for hepatitis B and how well you are responding to treatment.
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How Is Hepatitis B Prevented
Testing & Vaccination
- The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine over the course of 6 months. Protection lasts for 20 years to life.
- The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. .
- The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common .
- If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
- immune to hepatitis B or
- susceptible to hepatitis B and need vaccination or
- infected with hepatitis B and need further evaluation by a physician
Perinatal Hepatitis
- California law requires testing of all pregnant women for hepatitis B infection
- If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
- Giving the infant HBIG and HBV vaccine right away will reliably prevent infection of the infant
- Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune
Healthy Habits
After Exposure to Hepatitis B
What Are The Common Types Of Viral Hepatitis
Although the most common types of viral hepatitis are HAV, HBV, and HCV, some clinicians had previously considered the acute and chronic phases of hepatic infections as “types” of viral hepatitis. HAV was considered to be acute viral hepatitis because the HAV infections seldom caused permanent liver damage that led to hepatic failure. HBV and HCV produced chronic viral hepatitis. However, these terms are outdated and not currently used as frequently because all of the viruses that cause hepatitis may have acute phase symptoms . Prevention techniques and vaccinations have markedly reduced the current incidence of common viral hepatitis infections however, there remains a population of about 1 to 2 million people in the U.S. with chronic HBV, and about 3.5 million with chronic HCV according to the CDC. Statistics are incomplete for determining how many new infections occur each year the CDC documented infections but then goes on to estimate the actual numbers by further estimating the number of unreported infections .
Hepatitis A
Hepatitis B
Hepatitis C
Types D, E, and G Hepatitis
Individuals who already have chronic HBV infection can acquire HDV infection at the same time as they acquire the HBV infection, or at a later time. Those with chronic hepatitis due to HBV and HDV develop cirrhosis rapidly. Moreover, the combination of HDV and HBV virus infection is very difficult to treat.
- HIV patients
- People with hemophilia who receive blood clotting factors
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How Do I Know If I Have Hbv
A rapid point-of-care test after a finger prick or a simple blood test can tell if you are infected with the hepatitis B virus.
These tests can also help your doctor determine whether you are currently ill with hepatitis B, or if you are a chronic carrier. Although there is no treatment for the disease, bed rest and a good diet are important. Alcohol and medications should be restricted. Follow-up blood tests are necessary to tell if the disease has gone.
What You Should Know About Hepatitis B
Hepatitis B is an infectious hepatitis caused by the hepatitis B virus . This infection has two possible phases 1) acute and 2) chronic.
Most infected adults are able to fight off the virus so their infection is cured. A low percentage of adults infected with HBV go on to develop chronic infection. Children are at much higher risk for chronic infection. A majority of infected young children will fail to clear the virus from their bodies and go on to develop chronic infection.
About 2/3 of people with chronic HBV infection are chronic carriers. These people do not develop symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third develop “active” hepatitis, a disease of the liver that can be very serious.
Hepatitis B is the most common serious liver infection in the world.
In the United States, hepatitis B is largely a disease of young adults aged 20-50 years.
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Can Hepatitis B Be Prevented
The hepatitis B vaccine is one of the best ways to control the disease. It is safe, effective and widely available. More than one billion doses of the vaccine have been administered globally since 1982. The World Health Organization says the vaccine is 98-100% effective in guarding against the virus. Newborns should be vaccinated.
The disease has also been more widely prevented thanks to:
- Widespread global adoption of safe blood-handling practices. WHO says 97% of the blood donated around the world is now screened for HBV and other diseases.
- Safer blood injection practices, using clean needles.
- Safe-sex practices.
You can help prevent hepatitis B infections by:
- Practicing safe sex .
- Never sharing personal care items like toothbrushes or razors.
- Getting tattoos or piercings only at shops that employ safe hygiene practices.
- Not sharing needles to use drugs.
- Asking your healthcare provider for blood tests to determine if you have HBV or if you are immune.
What Are The Symptoms
- Symptoms can take 2 to 6 months to appear.
- Many people who are infected with hepatitis B have either no symptoms or only mild symptoms.
- Symptoms of acute hepatitis B can include fatigue, loss of appetite, joint pain, abdominal pain, nausea, vomiting, fever, and dark urine. A small number of people will develop jaundice .
- Some people develop chronic hepatitis B and most remain contagious for the rest of their lives. Chronic infection may lead to cirrhosis and/or liver cancer. Most people with chronic hepatitis B are unaware of their infection.
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How Is Hepatitis B Spread
You can become infected with hepatitis B through exposure to blood, semen and other bodily fluids of an infected person. You can get the infection by:
- Having unprotected sex.
- Sharing or using dirty needles for drug use, tattoos or piercing.
- Sharing everyday items that may contain body fluids, including razors, toothbrushes, jewelry for piercings and nail clippers.
- Being treated medically by someone who does not use sterile instruments.
- Being bitten by someone with the infection.
- Being born to a pregnant woman with the infection.
Hepatitis B is not spread by:
- Kissing on the cheek or lips.
- Coughing or sneezing.
- Hugging, shaking hands or holding hands.
- Eating food that someone with the infection has prepared.
- Breastfeeding.
Reduce Your Chance Of Infection
You can reduce your chance of hepatitis B infection by
- not sharing drug needles or other drug materials
- wearing gloves if you have to touch another persons blood or open sores
- making sure your tattoo artist or body piercer uses sterile tools
- not sharing personal items, such as toothbrushes, razors, or nail clippers
- using a latex or polyurethane condom during sex
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How Common Is Hepatitis B
The number of people who get this disease is down, the CDC says. Rates have dropped from an average of 200,000 per year in the 1980s to around 20,000 in 2016. People between the ages of 20 and 49 are most likely to get it.
About 90% of infants and 25-50% of children between the ages of 1-5 will become chronically infected. In adults, approximately 95% will recover completely and will not go on to have a chronic infection.
As many as 1.2 million people in the U.S. are carriers of the virus.
What Are The Symptoms Of Hepatitis B
Half of all people infected with the hepatitis B virus have no symptoms and may never realize that they have been infected. Adults are more likely to develop symptoms than children. For those who do get sick, symptoms usually develop within 1 to 4 months after exposure to the virus. The initial symptoms are often similar to the flu.
Common symptoms of hepatitis B include:
- Appetite loss
- Nausea and vomiting
- Itching all over the body
- Pain over the location of the liver
- Jaundice
- Dark urine
- Pale-colored stools
Other types of acute viral hepatitis such as hepatitis A and hepatitis C have symptoms that are indistinguishable from hepatitis B.
Fulminate hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated right away. Fortunately, fulminate hepatitis is rare. The symptoms of fulminate hepatitis develop very suddenly and may include:
Prolonged nausea and vomiting can cause dehydration. Individuals with dehydration may notice these symptoms:
- Extreme weakness
Symptoms of liver damage may include the following:
- Fluid retention causing swelling of the belly and sometimes the legs
- Weight gain due to ascites
- Persistent jaundice
- Loss of appetite, weight loss, wasting
- Vomiting with blood in the vomit
- Bleeding from the nose, mouth, or rectum or blood in the stool
- Hepatic encephalopathy
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How Is It Spread
Hepatitis A is spread when a person ingests fecal mattereven in microscopic amountsfrom contact with objects, food, or drinks contaminated by feces or stool from an infected person.
Hepatitis B is primarily spread when blood, semen, or certain other body fluids- even in microscopic amounts from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus can also be transmitted from:
- Birth to an infected mother
- Sex with an infected person
- Sharing equipment that has been contaminated with blood from an infected person, such as needles, syringes, and even medical equipment, such as glucose monitors
- Sharing personal items such as toothbrushes or razors
- Poor infection control has resulted in outbreaks in health care facilities
Hepatitis C is spread when blood from a person infected with the Hepatitis C virus even in microscopic amounts enters the body of someone who is not infected. The hepatitis C virus can also be transmitted from:
- Sharing equipment that has been contaminated with blood from an infected person, such as needles and syringes
- Receiving a blood transfusion or organ transplant before 1992
- Poor infection control has resulted in outbreaks in health care facilities
- Birth to an infected mother
If I Have No Symptoms How Would I Know If I Have Hepatitis B
To confirm whether or not you have hepatitis B, you will need blood tests.
If you have at least one risk factor , you should ask your health care provider to be tested for hepatitis B. Also, you should be tested for hepatitis B if:
- you were born in a region where hepatitis B is more common, including Asia, Africa, southern and eastern Europe, the Pacific Islands, the Middle East, and the Arctic
- one or both of your parents immigrated from a region where hepatitis B is more common
- you live or travel to regions where hepatitis B is more common
- you have a family history of liver disease or liver cancer
- you have been in prison
- you are pregnant
- you have ever used injection drugs, even just once
- you have unexplained abnormal liver enzymes or if
- you receive medicines that suppress the immune system.
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How Can I Pay For My Medication
Private health insurance or drug plansIf you have private health insurance or a drug plan at work, you may be able to have the medication paid through your plan. Please consult your private health insurance or drug plan provider to see if your drug is covered.
Publicly funded drug plansEach province and territory has their own rules. Some provincial drug plans provide coverage for individuals 65 and older, or those on social assistance. Some provinces provide special support to low-income individuals. Please call your Provincial Ministry or Department of Health to get more information about the terms of the publicly funded drug plan in your province.
Quebec public drug programIn Quebec, everyone must be covered by prescription drug insurance either through private or publicly funded plans.
Each provincial and territorial government offers a drug benefit plan for eligible groups. Some are income-based universal programs. Most have specific programs for population groups that may require more enhanced coverage for high drug costs. These groups include seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs. For more details, please contact your provincial or territorial health care ministry, or click on the appropriate link below.
Yukon
Available Patient Assistance Program for Hepatitis B treatment VEMLIDY
Symptoms Of Hepatitis B Virus
Symptoms for acute hepatitis B virus typically appear about 1 to 4 months after exposure and may resemble the flu. Most people with acute hepatitis B develop no symptoms. Symptoms may include:
- fatigue
Symptoms from liver involvement can include:
- dark urine
- clay-colored stools
- yellow-colored skin or eye sclera
Chronic hepatitis B is a lifelong infection and occurs in about 5% of patients who contract the virus. Infants and children are more likely to develop a chronic hepatitis B infection, but symptoms may not appear as frequently.
Up to 25% of people who develop chronic infection will develop serious liver conditions, such as cirrhosis , liver failure, or liver cancer.
Those with chronic hepatitis B do not typically have symptoms or feel ill, and can remain symptom free for 30 years or more. If symptoms appear, they are similar to the symptoms of acute infection listed above, but can be at a more advanced stage of liver impairment.
Acquiring hepatitis B during international travel is a possibility in certain regions, so review the CDC guidelines and talk to your doctor for recommendations before travel. If you know you have been exposed to hepatitis B, contact your doctor immediately within 24 hours as you may be able to receive a preventive treatment
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How Does Hepatitis B Spread
The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood. Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth.
- Direct contact with blood may occur through the use of dirty needles during illicit drug use, inadvertent needle sticks experienced by healthcare workers or contact with blood through other means. Semen, which contains small amounts of blood, and saliva that is contaminated with blood also carry the virus.
- The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane of an uninfected person.
People who are at an increased risk of being infected with the hepatitis B virus include the following:
In some cases, the source of transmission is never known.
You cannot get hepatitis B from the following activities:
- Having someone sneeze or cough on you
- Hugging someone
- Eating food or drinking water
- Casual contact