VitaminMD

Hepatitis is inflammation of the liver. There are several types of hepatitis, and the disease has several causes.

In the United States today, most infectious cases of hepatitis are caused by one of three hepatitis viruses (A, B or C). An infection with one of these viruses might not cause any symptoms or might cause only a mild flulike illness. However, it also can lead to liver failure, coma and death. Hepatitis A is usually a mild short-term illness, but hepatitis B, hepatitis C and hepatitis D can cause long-term infections. Two other hepatitis viruses, D and E, are very common in the United States. Hepatitis D infects only people who have already been infected with the B virus. Hepatitis E has been found only in people who have lived or traveled outside the United States.

Depending on the virus, hepatitis can be spread in a number of ways, including:

• Contact with the stool of an infected person (hepatitis A)
• Eating shellfish from waters contaminated with sewage (hepatitis A)
• Contact with the blood, vaginal fluids, semen or breast milk of an infected person (hepatitis B)
• Unprotected sex (hepatitis B and C)
• Sharing contaminated needles (hepatitis B, C and D)

Since the early 1990s, improved techniques for screening donated blood have greatly reduced the risk of catching hepatitis B or C from blood transfusions. According to the U.S. National Institutes of Health (NIH), the current risk of catching hepatitis C this way is 1 in 100,000 units of transfused blood.

Hepatitis has many other possible causes, including:

• Alcohol consumption at high levels, a common cause of hepatitis in the United States
• Medications, including a nitrofurantoin (Furadantin, Macrobid, Macrodantin), methyldopa (Aldomet, Amodopa), phenytoin (Dilantin and other brand names), isoniazid (Laniazid, Nydrazid), ketoconazole (Nizoral, dantrolene (Dantrium) and some cholesterol-lowering drugs. Hepatitis develops for unclear reasons in a small number of people who take these medications, even at prescribed doses.
• Other Viruses, including cytomegalovirus, Epstein-Barr virus (which causes infectious mononucleosis), herpes simplex virus, varicella virus (which causes chickenpox) and rubella (which causes German measles)
• Bacteria, including those that cause typhoid fever, syphilis, brucellosis, Legionnaires' disease and leptospirosis (though these diseases rarely cause hepatitis in the United States)
• Fungi, including histoplasmosis and candida (in people with compromised immune systems)
• Parasites, including those that cause ascariasis, toxocariasis, amebiasis, strongyloides, schistosomiasis, toxoplasmosis and malaria
• Your immune system, which can cause a condition called autoimmune hepatitis, in which the immune system attacks the cells of the liver

Symptoms of hepatitis vary depending on the cause of the illness and how much the liver has been damaged. In mild cases, many people do not have any symptoms or have flulike symptoms that can include fever, a generally tired or ill feeling, loss of appetite, nausea and vomiting, fatigue, discomfort in the upper right side of the abdomen and muscle aches.

In more severe cases, chemicals from the liver can build up in the blood and urine, causing the following symptoms:

• A yellow tint to the skin and whites of the eyes (jaundice)
• Dark, tea-colored urine
• Light, gray-colored stools

Your doctor will ask about your:

• History of alcohol use
• Exposure to toxic chemicals
• Use of medications that can cause liver damage
• History of unprotected sex
• History of intravenous drug use
• Recent meal of shellfish from potentially polluted waters
• Travel to a country where hepatitis infections are common
• Exposure to someone known to have hepatitis

Your doctor will examine you to look for a yellowish tint in your skin and the whites of your eyes, and to check for tenderness and swelling near your liver.

To make sure that you have hepatitis, your doctor will order blood tests and other tests, such as a liver biopsy.

How long hepatitis lasts depends on the type of hepatitis and the age and health of the person. For example, most previously healthy adults and children who develop hepatitis A recover completely in about one month.

About 5% of adults who get hepatitis B develop a long-lasting form of the disease. The rate is much higher for babies and young children. A small percentage of these people eventually develop cirrhosis or liver cancer.

Up to 80% of people infected with hepatitis C develop chronic infection, and about 20% to 30% develop cirrhosis. Approximately 10% of those with cirrhosis will develop liver cancer over a 10-year period.

Hepatitis caused by bacterial or parasitic infections usually improves when the infection is treated, but liver damage will be permanent in some cases.

Medication-related and alcohol-induced hepatitis usually improve when the offending agents are withdrawn, but some liver damage may last in some cases.

You can reduce your chance of getting viral hepatitis by following some basic guidelines:

• Wash your hands frequently.
• Purchase shellfish only at reputable food stores.
• If you catch your own shellfish, take them only from waters that have been deemed safe by health authorities.
• Before traveling to foreign countries, ask your doctor whether you need the hepatitis A vaccine or immunoglobulin to protect you from infection.
• If you are sexually active, have sex only with one person who is not infected with hepatitis, and use condoms.
• Avoid injecting illegal drugs.
• If you expect to have surgery, ask your doctor about donating some of your own blood beforehand. If necessary, this blood can be transfused back to you during surgery. This is called autologous blood transfusion.
• Ask your doctor whether you need to be vaccinated against hepatitis B. This vaccine, which is now routine for infants, may make sense for some adults who have a higher risk of getting hepatitis B.
• If you think that you have been exposed to someone with hepatitis B, ask your doctor whether you need the hepatitis B immunoglobulin and/or hepatitis B vaccine.

A person with a severe case of viral hepatitis may need to see a doctor who specializes in the digestive system (a gastroenterologist) and may require hospital treatment. For milder cases, your doctor may recommend bed rest and a modified diet - usually small, frequent, high-calorie meals, with plenty of fluids. A variety of medications are available to treat hepatitis B and C.

Call your doctor if you have symptoms of hepatitis, or if you believe you have been exposed to someone with hepatitis. If you are planning to travel to a foreign country, ask your doctor whether you need hepatitis immunization before your trip.

Most people with either hepatitis A or B recover without treatment. Up to 85% of those with hepatitis C, and a smaller number of those with hepatitis B, develop long-lasting (chronic) hepatitis. Some people with hepatitis B become lifelong carriers of the illness, and can spread the hepatitis infection to others. People with chronic hepatitis C also are infectious, and can spread the virus through blood-to-blood contact.