What are the differences between the types of hepatitis?
Some forms of hepatitis are mild while others are serious. Some can be short-lived (acute) while others can last a long time, even a lifetime (chronic). Vaccinations can protect you from some forms of viral hepatitis.
The symptoms of hepatitis are generally mild and non-specific. The symptoms are similar whatever the underlying cause of the hepatitis. Chronic hepatitis is defined as liver inflammation lasting for more than 6 months, and symptoms may not be evident until the liver is severely damaged.
Acute hepatitis symptoms come on quickly and can include:
- Pale coloured stools
- Dark urine
- Yellow eyes and skin
- Unexplained weight loss
- Flu-like symptoms
Types of Hepatitis
Hepatitis can be divided in to 2 main categories, infectious and non-infectious.
Hepatitis A – This is caused by the hepatitis A virus (HAV) that is passed on through food and drink contaminated with faeces from someone infected with hepatitis A. Infections are usually mild and bed rest is usually all that is needed to recover. However it can be severe in the elderly or in pregnant patients. The hepatitis A vaccine prevents infection and is usually given to children between the ages of 12 – 18 months.
Hepatitis B – This is passed on through bodily fluids infected with the hepatitis B virus (HBV). You can acquire HBV from unprotected sex or by sharing infected injection needles (usually through drug use) or razors. This version of hepatitis can also be prevented through vaccinations that are administered to children in 3 doses between birth and 6 months of age. Chronic hepatitis B is treated with antiviral drugs in treatment that can last between a few months and sometimes years.
Hepatitis C – Hepatitis C virus (HCV) is passed on in the same way as hepatitis B and there is no vaccine for this virus. However, oral antiviral medication can help cure this viral disease.
Hepatitis D – This serious liver disease is not very common and is directly transmitted through contact with infected blood. It is caused by the hepatitis D virus (HDV). While there is no vaccine against HDV, protection is available through the hepatitis B vaccine since hepatitis D requires hepatitis B to replicate. Interferons can be used to treat hepatitis D but have significant side effects.
Hepatitis E – This infection is similar to hepatitis A and is typically transmitted through contaminated water, often in areas with poor sanitation. It is an acute infection so often resolves on its own with plenty of rest, fluids and the right nutrients. However, pregnant women and seniors who become infected need to be monitored closely. There is no medication available for the treatment of hepatitis E.
Autoimmune hepatitis – In some instances, the body can treat the liver as a foreign object and attack it, causing mild or serious damage. The condition is more common in women than in men and it is treated with immune-suppressing drugs.
Alcoholic and Toxic hepatitis – Long-term abuse of alcohol can cause the cells in the liver to change and over time can lead to cirrhosis, a scarring of the liver, which is permanent and can reduce liver function. Overdose of drugs or ingestion of poisons can also lead to hepatitis and seriously damage the liver.
How is hepatitis diagnosed?
Should hepatitis be suspected, your doctor will take a complete medical history and perform a physical examination. There are very few signs unless the liver is failing with obvious yellow discolouration of the skin or eyes (jaundice).
Usually hepatitis is found incidentally on a screening blood test showing an abnormal liver function. If the results are abnormal, further diagnostic blood tests will be ordered to exclude viral hepatitis, autoimmune hepatitis or other medical conditions commonly associated with heart disease, diabetes or stroke. An ultrasound scan will be required for assessment. A blood test or an elastogram may also be required to determine if there is any scarring of the liver caused by the hepatitis. Lastly a liver biopsy (the removal of a sample of liver tissue through a needle) may also be required to determine the underlying etiology of the hepatitis if the initial assessment did not yield a diagnosis.
How serious is hepatitis?
Any chronic hepatitis can be serious and can lead to liver cirrhosis, liver failure or liver cancer.
Liver failure can cause complications including ascites (a build-up of fluid in the abdomen), portal hypertension (increased blood pressure in the veins entering the liver), hepatic encephalopathy (a build-up of toxins that result in fatigue, memory loss and diminished mental abilities), bleeding disorders and kidney failure.
If you have chronic hepatitis, you will be advised to avoid alcohol, and to always check with your doctor before starting any form of medication.
Signs of liver failure
When the liver starts to fail, in addition to the aforementioned symptoms of hepatitis, you may have the following warning signs:
- General itching of the skin
- Bleeding takes a longer time to stop
- Bruising easily
- Swollen stomach or ankles
- Spiderlike blood vessels on the skin
Is a liver transplant a cure?
A liver transplant may be necessary when the liver is failing despite medications or if a primary liver cancer developed which meets the transplant criteria. This involves replacing your diseased liver with a healthy one from a donor. Medication will also be necessary post-transplant to prevent your body from rejecting the new liver.
Prevention is always better than cure, especially where an organ as vital as your liver is concerned. Here are some tips to help avoid unnecessary transmission of the disease in its various forms:
- Practise good hygiene and avoid consuming the local water, ice, undercooked shellfish and raw fruit and vegetables when travelling in developing countries.
- Avoid sharing needles, razors or toothbrushes.
- Do not touch spilled blood.
- Practise safe sex by using condoms.
- Get vaccinated against hepatitis A and B.
If you suspect you may have hepatitis, consult a gastroenterologist for an accurate diagnosis of your condition and the available treatment options.
Article reviewed by Dr Vincent Lai, gastroenterologist at Gleneagles Hospital
Hepatitis. Retrieved 13/7/20 from https://www.healthline.com/health/hepatitis
Hepatitis. Retrieved 13/7/20 from https://medlineplus.gov/hepatitis.html#:~:text=Hepatitis%20is%20an%20inflammation%20of,healthy%20cells%20in%20the%20liver.
What is hepatitis? Retrieved 13/7/20 from https://www.who.int/news-room/q-a-detail/what-is-hepatitis
Hepatitis C. Retrieved 16/7/20 from https://transplantsurgery.ucsf.edu/conditions--procedures/hepatitis-c.aspx
Hepatitis B. Retrieved 16/7/20 from https://transplantsurgery.ucsf.edu/conditions--procedures/hepatitis-b.aspx