The topic this month is about your liver and hepatitis. The liver is a very important organ in your body, and it has many vital functions. The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm and on top of the stomach, right kidney and intestines. The liver “lobes” are connected by small ducts (tubes) that connect to larger ducts to form the common hepatic duct. The common hepatic duct transports the bile made by the liver cells to the gallbladder and duodenum (the first part of the small intestine) via the common bile duct. Some of the liver functions include: (a) production of bile that carries away waste and breaks down fats in the small intestine during digestion; (b) converts excess glucose into glycogen for storage; (c) processing of hemoglobin for use of its iron content (the liver stores iron); (d) conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine); (e) clearing the blood of drugs and other poisonous substances; (f) regulating blood clotting; (g) resisting infections by making immune factors and removing bacteria from the bloodstream; and (h) vitamin storage.
Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal. There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. While they all cause liver disease, they differ in important ways including means of transmission, illness severity, global geographical distribution and prevention methods. In particular, types B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths. An estimated 354 million people worldwide live with hepatitis B or C.
Hepatitis can be caused bya virus (viral hepatitis), alcohol, drug use, or because of a dysfunction of the immune system that causes it to attack liver cells. Hepatitis can be an acute (short-term) infection or a chronic (long-term) infection. Some types of hepatitis cause only acute infections; other types can cause both acute and chronic infections.
Hepatitis A: This type of hepatitis is caused by the hepatitis A virus, usually found in food or water contaminated with fecal matter from an infected person. This version of the disease is usually short-term and treatable. Hepatitis A can easily spread from one person to another by putting something in the mouth (even if it looks clean) that has been contaminated with the stool of a person with Hepatitis A. This can happen when people do not wash their hands after using the toilet and then touch or prepare other people’s food. This virus is also spread when someone ingests the virus through close personal contact with an infected person or through eating contaminated food or drink. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Sometimes hepatitis A can cause liver failure and death. Although this outcome is rare, it occurs more commonly in people older than 50 and people with other liver diseases. Prevention involves washing your hands after using the bathroom and before preparing food. When traveling, especially in developing countries, pay attention to water (always use bottled, avoid ice cubes of questionable water source) and food (avoid raw or undercooked foods). Living with someone at home with hepatitis A forces us to take certain measures because it is transmissible. Do not share cutlery, plates, or toothbrushes, wash your hands thoroughly and frequently, etc. This type of hepatitis has a vaccine available. Discuss this with your doctor.
Hepatitis B: Hepatitis B is the most common serious liver infection in the world. This virus can cause short-term and chronic forms of the disease. It is caused by the hepatitis B virus (HBV) which is 100 times more infectious than the AIDS virus. This can occur through direct blood-to-blood contact, sex, illicit drug use, through items that may come in contact with infected blood such as razors, toothbrushes, nail clippers, needles and syringes, glucose meters, etc. The hepatitis B virus (HBV) can live on surfaces for up to a week.
Hepatitis B isn’t spread through saliva (spit), so you CAN’T get hepatitis B from sharing food or drinks or using the same fork or spoon. Hepatitis B is also not spread through kissing, hugging, holding hands, coughing, or sneezing. HBV spreads because many people are unaware they are infected with the virus and unknowingly pass it on to those who are in close contact with them. Approximately 350 million people worldwide are chronically infected with HBV. The risk of infection can be reduced by not having unprotected sex, not sharing needles or other items that may be exposed to blood, and making sure your acupuncturist or tattoo artist only uses sterile needles. About two-thirds of people with chronic HBV infection are chronic carriers. These people do not develop symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third develops “active” hepatitis, a disease of the liver that can be very serious. A vaccine is available for adults who may be at risk for infection – discuss this with your doctor.
Hepatitis C: The hepatitis C virus that causes this form of the disease spreads in the same way as the hepatitis B virus, causing liver disease. It is frequently seen in healthcare workers who are exposed to contaminated blood. Hep C can also be spread from tattoo or piercing needles that have not been properly cleaned, from blood transfusions and organ transplants performed prior to 1992. It is sometimes called Hep C or HCV for short and can be a mild illness that only lasts for a few weeks or months, or a serious chronic condition that lasts your whole life. Hepatitis C doesn’t always have symptoms. If you do have it, you’re most likely to feel the symptoms 4-12 weeks after being exposed and for most people, Hep C turns into a chronic (lifelong) condition. Hepatitis C can lead to serious illnesses like cirrhosis of the liver and liver cancer. Unfortunately, most people with hepatitis C don’t develop symptoms until the disease creates liver complications. Up to 70% of those chronically infected with hepatitis C develop chronic liver disease, and up to 20% develop cirrhosis.
Hepatitis D/HDV: This disease affects only people already infected with hepatitis B, as it needs the type D virus to survive. It is contracted through the same means as Hep B. This type of hepatitis can make a hepatitis B infection worse and make symptoms more severe.
Hepatitis E/HEV: It is transmitted like hepatitis A. Unlike A, it does not have a vaccine.
Hepatitis can be caused by immune cells in the body that attack the liver, infections with viruses such as hepatitis A, B, or C, bacteria, parasites, liver damage from alcohol or toxins (poisons), ingestion of toxic mushrooms, medications such as an acetaminophen/Tylenol “overdose,” or fatty liver. Liver disease can also be caused by inherited disorders such as cystic fibrosis or hemochromatosis – a condition that involves having too much iron in the body, or Wilson’s disease – a disorder in which the body retains too much copper.
Liver disease symptoms can include bleeding easily, bruising easily, fatigue, not wanting to eat, yellowing of the skin called jaundice (it may show up more in white-skinned people), yellowing of the whites of the eyes in white, black and brown skin people, dark-colored urine, itchy skin, belly pain, fluid buildup in the stomach area called ascites, clay/light-colored stools, unexplained fever, swelling in the legs, unexplained weight loss, mental confusion, drowsiness and slurred speech – called “hepatic encephalopathy,” spider-like small blood capillaries on the skin above waist level called “spider angiomas,” and blotchy red palms.
If you think you have had exposure to the hepatitis virus or show signs/symptoms of liver disease, see your doctor. Do not put off doing this. Time is not your friend. Your health care provider may ask that you have blood tests, an abdominal ultrasound, CT scan or MRI to determine the problem and discuss treatment options with you. Treatments will vary depending on the cause of your liver disease, and current health status.
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