Hepatitis is a general term for any inflammation in the liver, usually from an infection with a virus, and also from alcohol, drugs and various diseases. Malpractice is a potential issue for investigation in any failure to properly treat and diagnose some of the most serious causes of hepatitis.
The usual causes of viral hepatitis are viruses that have been arbitrarily named (by their order of discovery) Hepatitis A, B or C. (Less frequent but known are Hepatitis D and E.). Some other viruses that can inflame the liver include adenovirus, cytomegalovirus, Epstein Barr virus, and (rarely) herpes simplex virus.
The different viruses have different ways of getting into the body and then into the liver:
- Hepatitis A usually comes from ingestion of fecal matter (unwashed hands of restaurant workers are a prime offender).
- Hepatitis B and C can come from needles (including tattoos), blood transfusions, sexual transmission and from a baby’s passage through its infected mother’s birth canal.
Hepatitis can be life-threatening when it produces liver failure, and the patient needs a transplant to live, or liver cancer, or cirrhosis of the liver.
Liver cancer usually happens from longstanding hepatitis B or C infection, often in adults who were infected at birth through their mothers. In some populations, particularly in East Asia, liver cancer from hepatitis B is so common that it is the number one cancer killer. Health authorities estimate that one in 20 people in the world – 300 million – have longstanding or chronic hepatitis B infection.
Anyone with longstanding hepatitis infection needs regular monitoring of liver enzymes, viral load (the number of viral particles in the body), and ultrasound of the liver to look for early cancers. Early detection can be life-saving for a liver cancer patient, because surgery can be curative. The liver is also the only organ in the body that can regenerate itself after a large piece of it has been cut out.
When someone catches a hepatitis virus as an adult, the acute infection usually produces symptoms: fatigue, loss of appetite, nausea and vomiting. Jaundice can show up with yellowed skin or yellow in the whites of the eyes. Hepatitis C, however, is notorious for sometimes not producing any acute symptoms, and people find out about it typically when they get a blood test years later for other reasons.
In the worst cases of acute infection, the patient develops liver failure. The liver stops producing clotting factors so the blood becomes “thin” and the patient bleeds easily. In the very worst cases, called fulminant hepatic failure, the brain gets involved. The brain swells and the patient goes into a coma. About half of these patients die without an emergency transplant.
There is a vaccine for hepatitis B which is 95% effective. Drugs can be used to treat chronic hepatitis B and hepatitis C but the track record of success is mixed.
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