Health Matters
Hepatitis B
million people worldwide are chronic carriers
‘ 350 of hepatitis B virus’( courtesy CDC). Chronic hepatitis B could result in hepatocellular carcinoma( liver cancer). Vaccination is a simple, cost effective way of preventing hepatitis B infection.
HEPATITIS B INFECTION
The liver is situated in the upper right quadrant of our abdomen and serves as a detoxifier. What this means is that anything that goes into our blood stream i. e. meals, medication, vitamins, alcohol, first pass through the liver, is filtered, before micronutrients and other factors are transported to where they are needed in the body. The liver also stores energy for later use, helps in digestion and produces proteins important in fighting infection and controlling bleeding. The liver usually regenerates well after acute inflammation and is an important portal in getting rid of degraded red blood cells. Bilirubin( yellow pigment) is a byproduct of degraded red blood cells. When liver inflammation occurs with impact on liver function, this yellow pigment cannot be eliminated effectively and levels rise in the blood stream giving a typical yellow discoloration of the eyes, skin, palms and mucus membranes called jaundice.
WHAT IS HEPATITIS? Hepatitis is inflammation( irritation and swelling) of the liver. There are several things that can cause irritation and swelling of the liver VIRAL HEPATITIS is inflammation of the liver as a result of a viral infection. The most common and clinically significant is hepatitis B virus. Others are the A, C and D viruses and Epstein Barr Virus. These will be discussed in later articles.
ARE THERE ANY OTHER CAUSES OF HEPATITIS?
Yes. Certain medications may also cause hepatitis. It is important to take medications as prescribed and use herbal preparations with care. Alcohol is also a common cause of hepatitis. Alcohol induced hepatitis is associated with long term use of significant quantities of alcohol – individual dependent. Severe bacterial infections could also cause hepatitis. Autoimmune hepatitis may also occur.
HEPATITIS B INFECTION
It’ s an infectious hepatitis caused by the Hepatitis B virus. The virus is transmitted by
• Direct contact with infected blood or blood products
• Exposure to infected body fluids
• Vertical transmission from mum to baby during delivery. If mum is hepatitis B positive transmission to baby would usually occur during vaginal delivery. Caesarian delivery reduces risk of transmission of virus from a seropositive mother to baby, by a significant percentage.
HOW CAN I GET IT?
You could get it through: blood transfusions, dialysis, and unprotected sex with a positive partner. Shared needles and unsterilized surgical equipment used in body piercing, tattooing and like procedures put you at risk. Institutionalized care( including care givers & family members) and healthcare workers are particularly at risk.
YOU CAN’ T GET IT BY:
• Casual contact
• Hugging
• Shaking hands
• Eating or drinking water
• Aerosol dispersion( sneezing, coughing).
Once the virus gets into the blood stream, it causes an acute infection; within one to four months of exposure, there may be a fever, headache, muscle pain, vomiting and abdominal pain / discomfort from mild swelling of the liver. There may also be dark urine and pale stools. These symptoms may mimic several other febrile illness, malaria being the first one on mind in our environment. So it’ s important to get a confirmation of diagnosis for any febrile illness. Along with the fore mentioned symptoms, there may also be yellowing of the eyes or skin / palms( jaundice), which may occur in 9 out of 10 affected. The color change in the eyes and skin / palms will draw the clinicians’ attention to the fact that there is something very wrong. 1 out of the 10 affected may not show any eye or skin changes at all. In this group of patients, the acute stage may proceed without confirmation of diagnosis. During the acute stage, your doctor will give you symptomatic treatment; bed rest, lots of fluids, regular intake of small portions high energy foods / fluids, pain and fever relieving medications all in an effort to get you comfortable and also to rest your liver. If there is persistent vomiting, then hospital admission will be required along with i. v. fluids. It must be noted here that no specific treatment is required during the acute stage. This stage will last a couple of weeks or so, after which you should start feeling better. Recovery time is individual dependent. 9 out of 10 infected adults are able to fight off the virus. This group will have negative repeat hepatitis B antigen tests at the 6 month time line – complete cure. 1 out of the 10 infected adults will still have positive repeat blood tests. This group is outwardly healthy but have been tagged by the virus and are called carriers; they carry the hepatitis B virus and can pass it on but are otherwise healthy looking adults.
The significance of the carrier stage is the long term effect of the presence of the B virus in the liver; over many years( individual dependent), the virus gradually changes the structure of the liver increasing risk of cirrhosis and hepatocellular carcinoma( Liver Cancer)
CHRONIC HEPATITIS
Chronic hepatitis B infection is just another name for the carrier stage. It means, six months after the initial infection, your blood test is still positive for hepatitis B virus. The risk of chronic infection is much greater in children and 9 out of 10 infected children may fall in this category. There are various tests your doctor can do to asses this stage of hepatitis. Liver function tests along with hepatitis B profiling will give information on how well your liver is working, whether the infection is old or new, whether the virus is resting or multiplying and how many viral particles you have circulating. A liver ultrasound may also be ordered. This information will help your clinician plan your care.
TREATMENT
Antiviral treatments are available for chronic hepatitis. These treatments reduce the ability of the virus to multiply in the liver and in turn reduce liver damage. Most of these medications require long term use.
HOW DO I PREVENT HEPATITIS B INFECTION?
The best prevention method is testing and vaccination. A total of 3 shots are required at 0, 1 and 6 months. Under special circumstances, your doctor may prescribe an accelerated vaccination schedule.
For more information or enquiries, email Dr L Decker info @ franklynmedical. com
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