1. What is Hepatitis?
Hepatitis is an inflammation of the liver that, depending on the agent causing it, can be cured simply with rest, can require prolonged treatments, or even liver transplantation, when severe complications are developed, like of cirrhosis and liver failure, or liver cancer, which can lead to death.
Viruses are the primary cause but there are other non-viral etiologies such as excessive consumption of alcohol and other toxic products, such as certain medications and chemicals, and certain plants. There is also autoimmune hepatitis resulting from a disturbance of the immune system, which, for unknown reasons, begins to develop autoantibodies that attack the liver cells, rather than protect them.
There are six different types of hepatitis viruses (A, B, C, D, E and G). The main difference between the viruses is their means of propagation and their impact on health. Hepatitis is usually described as acute or chronic. The acute illness has a short duration; whereas the chronic illness has a long duration, sometimes with periods of exacerbation and remission. When hepatitis B lasts longer than six months it is referred to as chronic hepatitis B.
Each of these pathologies always involves medical consultation and proper monitoring. In many cases, having hepatitis is hardly a real “headache”, since the body has immune defences which, in the presence of the virus, react by producing antibodies, a sort of soldiers fighting against infectious agents and annihilating them. But, in some situations, these antibodies are not enough to stop the invader’s power, making it necessary to resort to antiviral treatments.
Although there is still much to study in this area, scientific research has come a long way in the fight against the disease, having already developed vaccines against hepatitis A and B (which has significantly reduced its propagation) and discovering substances (such as interferons) that can stop the virus from multiplying and provide hope of prolonging the life of many patients. These treatments, however, are costly and are not always available in developing countries, which are the most affected areas.
The hepatitis viruses can be transmitted through food and water contaminated with fecal matter (A and E), through contact with contaminated blood (B, C, D and G) and through sexual intercourse (B, C and D). The viruses have different periods of incubation and, in many cases, the patients have no symptoms. Hepatitis A and E do not become chronic, while the transition to the chronic situation is quite high in hepatitis C and common in hepatitis B, D and G, although this last illness is not very severe.
Unlike with other diseases, patients with chronic hepatitis can lead an almost normal daily life, without needing to remain inactive, isolated from others or meet strict diets, but they should know their limitations and learn to live with hepatitis.
2. How are viral hepatitis A, B or C transmitted?
Hepatitis A is an infection of fecal-oral transmission, by ingesting food or water contaminated with the virus. Hepatitis B and C are transmitted through parentage, sexual contact, blood transfusion or derivatives, syringes contaminated with the virus, contact with the blood, secretions, urine, tears, etc., of an infected patient.
3. It is possible to clinically differentiate the type of viral hepatitis?
Hepatitis A, B and C, the most frequent types of hepatitis, are indistinguishable since they share the same common signs and symptoms: jaundice, asthenia, anorexia, etc. The clinical history of the particular case may point to a possible type of hepatitis, but, nevertheless, it will remain unspecific. A smaller percentage of patients suffer from an asymptomatic anicteric Hepatitis, which accounts for serologic evidence, but not for the medical history of the illness. This variety is more common in the C virus infection (HCV).
4. Is it important to carry out the differential and specific diagnosis of the type of Hepatitis?
Yes, as the evolution and prognosis differ between Hepatitis A, B, and C. Hepatitis A has a favourable course, although less than 1% of those infected may evolve into fulminant hepatitis with a high mortality rate. Hepatitis B can either be resolved or follow different paths, as approximately 50% of cases turn into potentially contagious asymptomatic carriers.
About 10% of patients develop chronic hepatitis, cirrhosis and liver failure. Furthermore, the risk of liver cancer is much higher in patients with this infection. Hepatitis C can be asymptomatic in most cases and, regardless of the symptomatic course, more than 75% of those infected develop. Just as HBV, HCV can be closely associated with the development of hepatocellular carcinoma.
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