Hepatitis (Viral Hepatitis)
Viral hepatitis is an inflammation of the liver caused by one of four hepatitis viruses -- A, B, C, or D. In its earlier stages, the disease may be mistaken for flu, with fever, fatigue, nausea, diarrhea, loss of appetite, and muscles and joint aches the major symptoms. These are followed by the characteristic jaundice, or yellowing of the eyes and skin due to a buildup in the blood of bile, a digestive substance that the liver normally controls. Excessive bile can also cause severe itchiness and a darkening of urine and the stool becomes light colored.
Hepatitis A is the most common strain, infecting tens of thousands of Americans each year. The virus is shed in the stool, and is usually contracted by consuming food or fluids that have been contaminated by human feces.
The virus that causes hepatitis B, once known as serum hepatitis, is found in blood, semen, saliva, and other body fluids. It is spread by blood transfusion, sharing of contaminated hypodermic needles, sexual contact, and other exposure to bodily fluids. Worldwide, there are some 200 million carriers of hepatitis B, who can pass the disease to others without experiencing any symptoms themselves.
Hepatitis C. formerly referred to as non-A, non-B hepatitis, is spread mostly through blood transfusion.
Hepatitis D is spread by close personal contact in endemic areas such as the Mediterranean countries. In the United States and other non endemic areas, most cases of hepatitis D are contracted through frequent blood transfusions, such as those required by people with hemophilia, or by drug users who share needles.
Most people with hepatitis A recover completely in one to two months. The other forms of viral hepatitis may lead to chronic liver disease and increased risk of liver cancer.
Diagnostic Studies and Procedures
When hepatitis is suspected, a doctor will palpate the liver during a physical examination for signs of enlargement. The liver will be tender to the touch and the spleen may also be enlarged. Laboratory analysis of blood and urine samples confirm the diagnosis. A liver biopsy is rarely needed unless other liver disorders are suspected.
Medical Treatments
The majority of people with hepatitis do not require extensive medical treatment, although hospitalization may be necessary for elderly patients or those with concomitant diseases. Fulminant hepatitis, a serious complication of hepatitis B in which large portions of the liver are destroyed (hepatic necrosis), generally requires hospitalization. With intensive supportive care, there is a possibility that the damaged liver will regenerate itself.
To alleviate severe itching, cholestyramine (Questran), a drug normally taken to lower blood cholesterol, may be prescribed. This drug binds with bile salts, which are the cause of the itchiness, and helps the body rid itself of them.
Persons who have been exposed to hepatitis may be given immune globulin containing hepatitis antibodies. Hepatitis A, B, and D can now be prevented with vaccines. The American Academy of Pediatrics recommends hepatitis B immunization for all babies. Immunization is also advocated for health-care workers, family members or sexual partners of people with the disease, and others who are at high risk of contracting hepatitis.
Alternative Therapies
Some alternative therapies may help speed recovery from mild hepatitis, but a physician should oversee treatment of severe or chronic cases.
Herbal Medicine. Herbalists recommend turmeric capsules to reduce liver inflammation and jaundice. Milk thistle capsules are a popular tonic among European herbalists. Artichokes steamed with garlic, as well as dandelion capsules or extract, are also promoted as liver tonics.
Nutrition Therapy. Proper nutrition plays a critical role in recovery from viral hepatitis. Usually, extra calories are needed, but meals should be small, frequent, and low in fat. Intravenous feeding may be necessary if persistent nausea and vomiting interfere with eating.
Naturopaths recommend lecithin supplements to promote normal liver function, but its value is unproved.
Self-Treatment
Most cases of hepatitis can be treated at home, provided that proper precautions are taken to prevent the spread of the disease. The person who is ill should have a separate set of eating and drinking utensils and these should be boiled before being used again. The alternative is to use disposable ones. Also, she should not handle food or beverages intended for others.
The patient (and anyone who has contact with him) must be scrupulous about washing the hands thoroughly and frequently, particularly after a bowel movement.
In mild cases, it is not necessary to stay in bed, but frequent naps or rest periods are important to speed recovery. The disease usually resolves itself in four to eight weeks, but people vary widely as to when they can return to work and other activities.
Alcohol and medications that are potentially toxic to the liver must be avoided. These include acetaminophen, birth control pills, methyldopa (a blood pressure medication), phenytoin (an anticonvulsant), and certain antibiotics. Check with your doctor before taking any medications, including nonprescription drugs.
Other Causes of Liver Inflammation
Alcoholism can cause a chronic form of hepatitis, as can exposure to a number of chemicals and toxic fumes. Wilson's disease, a genetic disorder in which copper builds up in the liver, is also a cause of hepatitis. Jaundice may develop as a complication of mononucleosis, pancreatitis, gallbladder disease, cancers of the liver and pancreas, bacterial or parasitic infections, and yellow fever.