Atrium Health Navicent Infectious Disease

Hepatitis B and C

What Is Hepatitis?

Hepatitis is a general term applied to inflammations of the liver. Hepatitis can be caused by a number of different factors including viral infections, autoimmune diseases and the ingestion of certain medications or excessive amounts of alcohol, but the symptoms of the disease are more or less the same whatever its cause. Viruses cause both Hepatitis B (HBV) and Hepatitis C (HCV).

What Does Your Liver Do?

Your liver, which is located in the upper right quadrant of your body, is the second largest organ in your body. It performs a variety of digestive and endocrine functions, which are essential for healthy life.

Your liver produces bile, which is an alkaline substance that aids in the digestion of fat. It helps process carbohydrates, fats, and proteins that are absorbed from the small intestine and regulates the excretion of bilirubin, cholesterol, hormones, and toxins. Moreover, your liver also provides storage for glycogen and Vitamins A, D, E, and K.

Your liver also plays a vital role in synthesizing plasma proteins such as albumin and in synthesizing blood-clotting factors such as fibrinogen and Prothrombin. Additionally, it activates enzymes that are essential for many of your body's metabolic processes.

Since the liver is associated with so many physiological processes, symptoms associated with liver dysfunction or liver failure tends to affect a number of systems within your body.

Hepatitis Symptoms

While some people who develop hepatitis remain asymptomatic, many develop some or all of the following symptoms:

Jaundice

When your liver is not functioning optimally, it cannot facilitate the excretion of bilirubin efficiently. Jaundice is the term used to describe the yellowish tinge that the skin and the whites of the eyes develop when blood bilirubin levels become too high. In addition to developing a yellowish, your skin may feel very itchy; this is another sign of elevated blood bilirubin levels.

Dark Urine

Your urine may become dark because your kidneys have to filter more bilirubin than normal.

Pale Stool

Bile gives your stool its customary color. If your liver is not producing bile efficiently, your stool will develop clay like color.

Nausea, Vomiting and Loss of Appetite

Nausea, vomiting, and loss of appetite are associated with decreased bile production since your digestive systems can no longer process fats efficiently.

Bleeding and Bruising

When your liver is compromised, it can no longer manufacture the factors that are necessary to facilitate proper blood clotting.

What is Hepatitis B?

Hepatitis B is caused by a virus that is spread through contact with infected blood or through sexual contact with an HBV carrier. It can also be passed from mother to child during both vaginal births and caesarean sections. People who share needles with an infected individual when they inject drugs or who let themselves be tattooed with unsterile instruments run a particularly high risk of developing the disease.

Hepatitis B can manifest as either an acute or a chronic infection. The Centers for Disease Control and Prevention (CDC) estimate that in 2014, between 850,000 and 2.2 million Americans were living with an HBV infection. Many of these people may be unaware that they are infected. An HBV vaccine is widely available.

Hepatitis B is diagnosed through a simple blood panel. Because HBV can be transmitted during childbirth, HBV testing during the first trimester of pregnancy is a routine part of prenatal care.

Acute Hepatitis B

The acute form of Hepatitis B can last for as long as six months. In many instances, people who develop HBV will not even realize they're infected because they'll either have no symptoms at all, or the symptoms they experience will be very mild. Since the disease most often resolves on its own, people with acute HBV generally are not treated with antiviral medications although they may receive supportive treatment.

Symptoms can occur at any point within 45 and 180 days after the initial infection. People with acute HBV can pass the infection along to uninfected individuals even if they are not experiencing symptoms.

Chronic Hepatitis B

Approximately 5% to 10% of all adults with acute hepatitis B infections will go on to develop a chronic HBV infection. There's a direct relationship between the age at which a person is infected with HBV and the subsequent development of the chronic disease: 90% of all infants and as many as 50% of all children between the ages of one and five who are infected with HBV will go on to develop the chronic form of the disease.

Children and adults with chronic hepatitis B need to be monitored more closely by physicians than members of the general population since they are at higher risk of developing cirrhosis, liver failure, and liver cancer. They may require antiviral medications such as alpha interferon and peginterferon alpha-2a.

What is Hepatitis C?

Hepatitis C is spread most commonly through exposure to infected blood. Less commonly, it can be spread through sexual contact and childbirth.

Hepatitis C is diagnosed through a two-part testing procedure. An initial antibody-screening test can indicate whether an individual has ever had an HCV infection. If that test is positive, a follow-up Hep C RNA Qualitative Test will be performed to determine whether an active infection exists.

Currently, there is no vaccine, which can prevent hepatitis C, but vaccines for hepatitis positive patients are recommended.

Chronic Hepatitis C

Like hepatitis B, the hepatitis C virus can produce either an acute or a chronic infection, but a much higher proportion of newly infected individuals will go to develop a chronic HCV infection. According to the CDC, that proportion is between 75% to 85% of everyone who is infected with HCV.

The CDC estimates that while there are approximately 16,000 acute HCV infections every year, as many as 3.5 million Americans may be living with a chronic HCV infection. Two out of every three chronic HVC cases involves people born between 1945 and 1965.

With age, many people infected with chronic HCV may progress from an asymptomatic presentation to advanced liver disease, so people with chronic HCV need to be more closely monitored by their physicians. The CDC strongly recommends that all people born within this time interval be tested for HCV.

Knowing that you are infected can also help you make the lifestyle changes necessary to decrease your risk of developing cirrhosis, liver failure, or liver cancer. Some of these changes include the smoking cessation, the avoidance of alcohol, and the avoidance of medications like ibuprofen and acetaminophen.