Hepatitis A, B, C

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Original Editors - Emily Schmidt & Allyson Simmonds from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Hepatitis A is a contagious liver infection cause by the hepatitis A virus. It causes inflammation that affects your livers ability to function. It is the most common of the two hepatitis viruses enterically transmitted hepatitis viruses in the US and one of the two that is vaccine preventable.

Hepatitis C is an infection caused by a virus that attacks the liver and leads to inflammation. Most people who have the infection often do not know that they have the disease, and are often asymptomatic. It is considered to be among the most serious of the hepatitis viruses. About 80% of people who have the virus develop chronic hepatitis, and many people also can develop cirrhosis or even liver cancer.

Prevalence

About 3,600 cases of Hepatitis A are reported each year. However, since not all people are symptomatic, several more people are infected than are diagnosed and reported.

Every year around 3-4 million people are infected with the hepatitis C virus. About 150 million people are chronically infected and at risk of developing liver cirrhosis and even liver cancer. More than 350,000 people die from hepatitis C-related liver disease every year.

Characteristics/Clinical Presentation

Hepatitis A symptoms usually do not appear until 2-6 weeks after you have been exposed to the virus. They are usually mild, but can last up to several months (2-6 months), especially in adults. The symptoms include:
1. Dark urine
2. Fatigue
3. Itching
4. Loss of appetite
5. Low-grade fever
6. Nausea and vomiting
7. Pale or clay-colored stools
8. Jaundice
9. Abdominal pain
10. Headache
11. Diarrhea
12. Muscle Pain
It is important to note that not everyone will develop signs and symptoms of the virus.
A vaccination is recommended for children age 12-23 months and for adults who are at high risk for the infection.

Early on, Hepatitis C usually is asymptomatic. When signs and symptoms begin to set in, they are generally mild and flu-like. Associated signs and symptoms of hepatitis C include:
1. Fatigue
2. Fever
3. Nausea or poor appetite
4. Muscle and joint pains
5. Tenderness of your liver
6. Abdominal pain
7. Dark urine
8. Grey-coloured feces
9. Jaundice
10. Abdominal swelling
11. Itching
About 75-85% of recently infected people develop chronic disease and 60-70% of chronically infected people develop chronic liver disease. Also 5-20% develop cirrhosis and 1-5% die from cirrhosis or liver cancer.

Associated Co-morbidities

Some co-morbidities that may be associated with Hepatitis C include:
1. Diabetes
2. Obesity
3. HIV
4. ESRD
5. Maladaptive lifestyle habits
6. Poor quality of life
7. Liver Disease
8. Disorders of Lipid Metabolism
9. Non-traumatic joint Disorders
10. Non-specific chest pain
11. GI Disorders

Medications

There is no specific treatment for Hepatitis A. Rest is recommended when the symptoms are most severe. When in the acute stages it is recommended that you avoid any toxic substances to the live, including Tylenol.

Since HCV infects the blood and can lead to cirrhosis of the liver or liver cancer, the goal of medication is to prevent this from happening. Many patients with hepatitis C benefit from treatment with medications. The most common medication include antiviral medications including pegylated interferon alfa and ribavirin. Typically pegylated interferon alfa is receivied weekly through injections. Ribavirin is a capsule taken twice daily. Treatments are given fro 24-48 weeks. Two newer drugs that may be available for use for patients with genotype 1 are Telaprevir and Boceprevir. These medications do have several side effects, and therefore, patients need to be watched closely. Some of the side effects of the medications can include depression and flu-like symptoms. If patients develop cirrhosis or liver cancer, the patient may be a candidate for a liver transplant.

Diagnostic Tests/Lab Tests/Lab Values

A primary care physician will conduct a physical exam when looking for Hepatitis A Virus. During the physical exam, they may find that you have an enlarged and tender liver. Also, they will have you partake in blood tests. The blood tests will look at IgM and IgG antibody levels as well as liver enzymes. In both cases the antibody and enzyme levels will be raised. 

Blood tests are done to check for the Hepatitis C Virus. They specifically look at EIA assay to detect the hepatitis C antibody and the hepatitis C RNA assay to measure virus levels. Genetic testing can be done to check for the hepatitis C genotype. Six different genotypes exist. Most people have genotype 1 infection, which is the hardest to treat. Genotypes 2 and 3 are also common, but typically respond better to treatment. Tests can also be done to monior the amount of liver damage: albumin levels, liver function tests, and prothrombin time. A liver biopsy can also be done to assess liver damage.

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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