Save Your Liver From Viral Hepatitis
The liver is a vital organ that processes nutrients, filters blood and fights infections. “Hepatitis” means inflammation of the liver. When the liver is inflamed, in due course it ends up in scarring and its function gets deranged. Heavy alcohol use, toxins, some medications, herbal remedies and rarely certain genetic conditions can cause hepatitis. However, hepatitis is most often caused by a virus. In India, the most common types of viral hepatitis are Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E.
Mode Of Transmission
Viral hepatitis is either transmitted through contaminated food or water (A, E) or via blood and body fluids (B, C). The viruses which get transmitted through water and food are mostly self- limited resulting in acute illness with full resolution. The blood borne viruses (B, C) are villainous and notorious to persist in the body for long, induce scarring, liver cancer and liver cirrhosis.
The water borne viruses spread when unsanitary conditions allow water or food to become contaminated by human waste containing the viruses (fecal oral mode of transmission). Hepatitis A is typically spread among household members and close contacts through
oral secretions or stool (poor hand washing). It is common to have waterborne viral hepatitis spreading to customers in restaurants and among children and workers in day care centers if hand washing and sanitary precautions are not observed.
Blood borne hepatitis viruses (B, C) spread when transfer of blood or body fluid occurs from an infected person. HBV can spread by sexual contact, sharing needles among drug abusers, accidental needle stick injury, blood transfusions, hemodialysis and by infected mothers to their newborns. The infection also gets transmitted by tattooing, body piercing, sharing of razors and toothbrushes.
What are the symptoms & signs of viral hepatitis?
The period of time between exposure to hepatitis and the onset of the illness is called the “incubation period”. It varies between virus to virus. Hepatitis A and E viruses have an incubation period of about 2 to 6 weeks while Hepatitis B and C roughly have an incubation period of 2 to 6 months.
Symptoms – Acute Hepatitis
Symptoms of acute viral hepatitis include flu like symptoms, fatigue, dark urine, light colored urine, fever, vomiting and jaundice (yellow discoloration of skin and white of the eye). However, infection with these viruses may occur with minimal symptoms and may go unnoticed. Rarely, acute viral hepatitis can end up in fulminant liver failure (drastic decline of liver function in a short span of hours to days). Treatment of acute fulminant hepatitis should be done in centers that can perform liver transplantation since fulminant hepatitis has high death rate to the tune of 80% without liver transplantation.
Lifestyle Measures And Precautions To Prevent Liver Damage Due To Viral Hepatitis
Ensure hygienic drinking water. It is desirable to install water purifiers with UV and or RO methods in addition to mechanical filtration using candle type filters( Candle filters are inbuilt in most commercially available water purifiers- in Hyderabad those apartment complexes which rely on bore well source should install additional candle filter), While travelling bottled mineral water from standard brands and reliable retailers to be used.
Avoid roadside food vending, especially fruit juices, milk shakes. Barber shops, beauty salons – sharing of razor blades, metal scraper used to remove black heads and white heads from facial skin can act as source of infection if not disposable or if not properly sterilised. Sexual transmission is common in Hepatitis B and less so in HCV. Safe sexual practices to be observed. Intravenous Drug use (IVDU)- is a growing epidemic in Indian campuses. Sharing of needles happens especially since the user won’t be in his full senses. Warn your kids on the risk. Hepatitis A and B are vaccine preventable. The only vaccine preventable cancer is Hepatitis B induced liver cancer. Early detection of silent long standing persistence by Screening of HBV and HCV. Effective treatment is available for both these viruses which induce liver cancer and liver cirrhosis.
Mortality of acute liver failure in patients presenting with deep coma (grade 4 hepatic encephalopathy) is 60- 80 per cent. Such patients should be treated in special liver intensive care units as well as centers where liver transplantation is available.
For chronic hepatitis B , treatment is reserved for those who have active disease (inflamed liver, high liver enzymes, evidence of liver scarring etc). Those who do not meet these criteria for therapy, should still be kept on follow up and surveillance against liver cancer (HCC).
Against chronic hepatitis C, very effective drugs are available which are called directly acting antivirals (DAASs). Caution should be exercised in treating patients with advanced liver disease (liver decompensation), as these drugs may exacerbate liver dysfunction in this subset of patients.
References:
- News Article on Save your liver from Viral Hepatitis by Dr. Dharmesh Kapoor in The Hindu, Hyderabad. 29th March, 2021.
About Author –
Dr. Dharmesh Kapoor, Sr. Consultant Hepatologist, Yashoda Hospital, Secunderabad
Liver Diseases & Transplant Surgery
