How Is Hepatitis Diagnosed
The first step in diagnosing a hepatitis infection is to receive a medical exam from your doctor. The doctor will perform a physical to look for signs of the illness. All the varieties of hepatitis present with a very similar set of symptoms, which includes:
- Abdominal pain
You may also experience jaundice or a yellowing of the skin and eyes and bowel movements that appear gray. Michael says, Fortunately, most patients are asymptomatic. If you have hepatitis B and its an active condition, meaning youre sick from it, your skin and eyes are going to have a yellow tint.
The doctor will look for these telltale signs and then order blood work to spot the viral load for the type of hepatitis and whether the infection is dormant or active. If the virus is active, you are contagious. The blood test can also determine if the infection is acute or chronic .
If the blood test confirms hepatitis, the doctor may also order an ultrasound of the liver to see if it is inflamed. The ultrasound should also show if the liver is scarred with cirrhosis. You may also have a CT or MRI to look more closely at the liver or signs of liver cancer. This is especially important if you have a family history of the disease.
Finally, in the unusual event that the imaging tests arent shedding light on the situation, the clinician may order a liver biopsy.
Hepatitis C: Who Is At Risk
People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.
Three Types Of Hepatitis And What To Do About Them
Contact our practice at 410-224-4887 if you suspect you or a loved one has any form of hepatitis.
Hepatitis describes inflammation of your liver, the most common types being caused by one of several viruses. Hepatitis symptoms can make you sick for the short term or cause long-term, chronic liver problems.
When you have a form of hepatitis, it affects your livers ability to function. If your body cant clear the virus from your system, you may face long-term liver damage, liver failure, or liver cancer.
At Digestive Disorders Associates in Annapolis, Maryland, the expert team of board-certified gastroenterologists can help you recover from an acute form of hepatitis or manage your long-term infection.
Heres more about the most common forms of viral hepatitis and what you can do to heal.
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Hepatitis And Cirrhosis Similarities And Differences
Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
Hepatitis and cirrhosis are both diseases that affect the liver. Since hepatitis and cirrhosis are in many ways on a continuum of disease, the symptoms may be very similar. However, there are a number of important differences between the two.
In general, hepatitis may or may not be reversible , whereas cirrhosis refers to permanent scarring of the liver, often as the result of chronic hepatitis. While some forms of hepatitis may come on very rapidly, cirrhosis also tends to develop more gradually.
Let’s take a look at the symptoms that may occur with both diseases, review the basics of each disease, and then outline some of their main similarities and differences.
How Long Does It Last
Hepatitis A can last from a few weeks to several months.
Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6%10% of older children and adults who get infected develop chronic hepatitis B.
Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C.
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Hepatitis C: The Silent Killer
The hepatitis C virus causes both acute and chronic liver disease. Prior to its identification in 1989, large numbers of hepatitis victims were found to be negative for both hepatitis A and B. The unknown disease was known as non-A, non-B hepatitis before being named hepatitis C.
Researchers quickly discovered that hepatitis C accounted for large numbers of hepatitis cases, and it has been identified as a modern pandemic. An estimated three percent of the world’s population is chronically infected with hepatitis C, including four million people in the United States, making it one of the greatest public health threats of this century. Unlike other types of hepatitis, more than 80 percent of hepatitis C infections become chronic and lead to liver disease. Hepatitis C, in combination with hepatitis B, now accounts for 75 percent of all cases of liver disease around the world. Liver failure due to hepatitis C is the leading cause of liver transplants in the United States. Chronic hepatitis C is a major cause of cirrhosis and liver cancer, which most often lead to liver transplantation.
How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- From mother to child: Pregnant women can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
- Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who are living with HIV.
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What To Do About Hepatitis
If you have hepatitis A or B, in most cases youll get better with a doctors care and supportive treatment without specific anti-viral treatments.
Hepatitis C and other chronic forms will probably affect your life more profoundly, but you can do a lot to manage the condition and keep it under control.
If someone in your home has hepatitis, it is also important to take appropriate precautions to avoid spreading the disease.
For hepatitis A, handwashing is extremely important. For hepatitis B and C, care should be taken to avoid contact with the blood of the infected individual, even the microscopic amounts that hide in toothbrushes and on razors, so never share these items.
Treatment can suppress or even eradicate hepatitis C. Older treatments for hepatitis C are combination antiviral therapy with pegylated interferon and ribavirin.
The treatment came with difficult side effects, and was effective for only about 40 to 80 percent of patients, depending on the type of hepatitis C they carried.
Newer drugs approved by the FDA in 2013 and 2014 are more effective, curing the viral infection for 90 percent of patients or more. New antiviral medications to treat hepatitis C include simeprevir and sofosbuvir , and combination therapies include Harvoni and Viekira Pak.
Hepatitis B: How Does It Spread
You can get it through contact with the blood or body fluids of an infected person. In the U.S., it’s most often spread through unprotected sex. It’s also possible to get hepatitis B by sharing an infected person’s needles, razors, or toothbrush. And an infected mother can pass the virus to their baby during childbirth. Hepatitis B is not spread by hugging, sharing food, or coughing.
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The Impact Of Hiv On Hepatitis C
The interaction between HIV and hepatitis C affects the transmission and natural history of hepatitis C.13 People who do not receive HIV treatment are less likely to spontaneously clear their hepatitis infection, have higher hepatitis viral loads and experience more rapid hepatitis disease progression than HIV-negative people.
They may also belong to groups that are criminalised and stigmatised, meaning they are likely to experience barriers to accessing health services.14On the other hand, antiretroviral treatment taken to treat HIV helps keep hepatitis C under control. Hepatitis outcomes are better in people who receive HIV treatment. Whereas response to the older generation of hepatitis C treatments was poorer in people with HIV, this is not the case with modern therapies.
Differences Between Hepatitis And Cirrhosis
There are many important differences between hepatitis and cirrhosis, even when they may have the same cause.
- Reversibility. By definition, cirrhosis is irreversible, whereas hepatitis may be completely reversible depending on the cause.
- Blood tests.Liver enzymes are often very elevated with hepatitis, especially acute hepatitis. With cirrhosis, however, at least in the early stages, liver function tests may be only slightly abnormal.
- Conditions other than hepatitis can lead to cirrhosis. For example, hemochromatosis, alpha-1-antitrypsin deficiency, and more can lead to cirrhosis.
- Treatments. With hepatitis, the goal is usually to alleviate the diseasefor example, treat the infection, remove a drug causing drug-related hepatitis, or decrease weight and increase metabolism with NASH. With cirrhosis, the scarring is permanent and cannot be treated. Therefore, the goal is to treat symptoms related to cirrhosis and to prevent any further liver injury.
- Symptoms. Portal hypertension leading to esophageal varices, an enlarged spleen, a low platelet count, and a low protein level in the blood are more common with cirrhosis than with hepatitis.
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Three Main Types Of Hepatitis
There are several types of hepatitis, including alcoholic hepatitis caused by heavy alcohol use, toxic hepatitis caused by ingesting certain poisons or medicines, and autoimmune hepatitis. But viral versions of hepatitis are the most common.
Viral hepatitis can be classified as type A, B, C, D, and E with A, B, and C being the most prevalent in the United States.
Hepatitis C Treatment Guidelines
Guidelines issued by WHO in April 2016 recommend four preferred regimens, each including the drug sofosbuvir, in order to simplify treatment decisions for hepatitis C.36 Depending on the regimen, treatment may last 12 or 24 weeks.
When these guidelines were issued, the choice of drug regimen was dependent on which of the six genotypes the patient had. Different genotypes, each with its own genetic composition of the virus, are more common in different parts of the world. Each patient therefore required genotype testing before treatment could be provided.
In July 2018, WHO updated these treatment guidelines to reflect certain key developments. It recommended that the use of DAA regimens for all people with chronic hepatitis C infection, rather than reserving DAA treatment for people with more advanced disease as had previously been done. In part, this is linked to the continued substantial reduction in , which has enabled treatment to be rolled out rapidly in a number of low- and middle-income countries. In addition, as several new pangenotypic DAA medicines have now been approved, the need for genotyping to guide treatment decisions has been reduced.37
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How To Protect Yourself Against Hepatitis B
Dr. Fried emphasizes that hepatitis B infection can be prevented by avoiding risky behaviors involving sex and drugs and by getting vaccinated. The hepatitis B vaccination is required for infants at birth, and subsequent vaccinations for adults are also important. There are separate vaccines for hepatitis A and B, but there is also a combination A and B vaccine so you can take care of both types at once. In North Carolina, newborn vaccinations have been required since 1994. Anyone born before this year should talk to their health care provider about being vaccinated for hepatitis B.
If I Have Hepatitis How Can I Avoid Giving It To Someone Else
If you have hepatitis B and C, you need to find ways to keep others from making contact with your blood. Follow these tips:
- Cover your cuts or blisters.
- Carefully throw away used bandages, tissues, tampons, and sanitary napkins.
- Don’t share your razor, nail clippers, or toothbrush.
- If your blood gets on objects, clean them with household bleach and water.
- Don’t breastfeed if your nipples are cracked or bleeding.
- Don’t donate blood, organs, or sperm.
- If you inject drugs, don’t share needles or other equipment.
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General Symptoms Of Liver Diseases
Liver disease symptoms may be present with hepatitis, cirrhosis, or any other conditions that result in dysfunction of or damage to the liver. These may include:
More symptoms of acute hepatitis are possible, including bleeding gums, edema in your legs, sleep reversal and other sleep disorders, and loss of consciousness.
Signs And Symptoms Of Hepatitis
If you contract hepatitis, it may present in a way that is similar to a nasty bout of a flu, says Dr. Gulati. Common symptoms of hepatitis include:
- Joint pains
Other warning signs to look out for include dark urine, light, clay-colored stools, abdominal discomfort, and jaundice, the yellowing of the whites of the eyes or the skin due to an accumulation of bilirubin.
If you have hepatitis, a simple blood test will show elevated liver enzymes. Additional blood tests can help identify which virus, if any, is to blame.
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The Outlook For Hepatitis C And Hiv Coinfection
Hepatitis C treatment is currently provided in specialised centres by hepatologists. To expand access, treatment will need to be provided by non-specialists in primary-care clinics. Large numbers of healthcare workers will need training in the clinical management of hepatitis C.
Shifting to this public health approach is one of several ways in which simplified and standardised procedures could help bring hepatitis C treatment to scale provided the costs of drugs and monitoring is reduced.
There remains a long way to go before the world will be on track to reach the WHO target of eliminating hepatitis C as a major public health threat by 2030. Reaching this goal means diagnosing 90% of people living with hepatitis C and putting 80% on treatment, while drastically reducing new hepatitis C infections.58 For this to happen, efforts in each of these areas will need to be greatly accelerated. But until political and financial support for integrated hepatitis C, harm reduction and HIV diagnosis, treatment and care becomes a global health priority these targets may remain unreachable.
What Is The Outlook
Most people with hepatitis A recover without any complications. Once youve had hepatitis A, you cant get it again. Antibodies to the virus will protect you for life.
Some people may be at an increased risk for serious illness from hepatitis A. These include:
- older adults
acute hepatitis B infections in the United States in 2018.
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How Hepatitis Is Transmitted
Hepatitis A is usually spread from person to person or by ingesting food or water that is contaminated with the virus. In some cases, raw shellfish from polluted waters can also spread the disease.
Hepatitis B and C are usually spread through infected blood or other bodily fluids.
Doctors, dentists, and nurses, as well as staff and patients at blood banks, dialysis clinics, and pathology laboratories, are at a greater risk of developing these kinds of hepatitis due to accidental blood exposure.
Drug users who share needles are at high risk of contracting hepatitis B and C, as are those who have unprotected sex with an infected person.
Drugs Contraindicated For Hepatitis C Patients
The standard course of treatment these days involves the use of a class of drug called direct-acting antivirals . If you are prescribed one, your healthcare provider will be sure to inform you what to avoid. DAAs are very effectivesome of the newer ones have an efficacy rate upwards of 90 percent but its up to you to ensure that youre taking them properly and not hindering progress. As you go through treatment, make sure to get your practitioners OK before taking any new medications, supplements, or making dietary changes.
So what should you be avoiding? What follows is a quick breakdown of common drugs to steer clear of if you have hepatitis C.
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How Do You Treat Hepatitis B
Like hepatitis A, medical treatment for acute hepatitis B is focused on getting plenty of rest and fluids and eating a healthy diet, although sometimes antiviral drugs are recommended for severe cases to help prevent liver failure. Patients with chronic hepatitis B may be given an oral antiviral drug to control the viral infection and minimize liver damage. These drugs are effective, but they rarely cure chronic hepatitis B. Therefore, these medications often have to be taken for life.
Acute Hepatitis B Symptoms
There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Dark urine and light stool color
During the icteric phase:
- Jaundice develops
- Anorexia, nausea and vomiting may worsen
- Irritated skin lesions may develop
- Other symptoms may subside
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