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Liver Diseases
As gastroenterologists, we treat many types of liver disease. Most commonly we seeHepatitis related to viral infections or medications and cirrhosis related to alcoholism.Other less common disorders include Primary Biliary Cirrhosis, Fatty Liver Syndrome,Hemochromatosis and Sclerosing Cholangitis.
1. What Is Hepatitis A?
Hepatitis A is one of five known viruses that cause inflammation of the liver (theothers are B, C, D and E). The Centers For Disease Control and Prevention estimatethat 150,000 people in the U.S. are infected each year by hepatitis A, a low ratecompared to the rate in underdeveloped countries. The vast majority of peoplerecover from the infection within six months without any serious health problems.
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How Is Hepatitis A Transmitted?
Transmission is usually by drinking water or eating food that has been contaminatedwith fecal matter containing the virus. Unlike the hepatitis B and C viruses, thehepatitis A virus remains stable when liver cells secrete it into bile, which then entersthe digestive tract. Fecal matter from an infected person has a high concentration of the virus during a certain period of infection, whereas saliva and other bodily fluidshave a low concentration. The virus can survive in this contaminated fecal matter ona persons hand, for example, or on a surface for three to four hours at normal roomtemperatures. Thus, an eating utensil contaminated with the virus could be a way totransmit the infection to a person. Contaminated shellfish are a frequent source of infection. Direct contact with an infected person is another confirmed transmissionroute, as are kissing on the mouth and anal sex. Contamination of needles used forintravenous administration of drugs is a suspected route of transmission. In over 40percent of the reported cases it is not known how these people were infected.
3. Who Is At Risk For Hepatitis A?
The risk of being infected with the hepatitis A virus generally depends on thehygienic and sanitary conditions in an area. High risk geographic areas are theMiddle East, South America, Eastern Europe, Central America, Africa and SoutheastAsia. There are also areas in the United States where poor sanitary conditions orhygiene have resulted in outbreaks of hepatitis A. It is also after symptoms appearor two to three weeks before the appearance of the symptoms, patients will shed thevirus in high concentration in feces and thus they are most infectious to others. TheCenters for Disease Control and Prevention (CDC) lists household or sexual contact,daycare attendance or employment and recent international travel as the majorknown risk factors for the transmission of hepatitis A. The CDC estimates that a thirdof the U.S. population has been infected. Children at daycare centers spread thevirus because of fecal-oral contamination through diaper changing. Outbreaks havebeen reported in the military, at institutions for the disabled and because of infectedrestaurant workers. Those using injectable drugs with contaminated needles havealso been infected with the virus.
 
4. What Are The Symptoms For Hepatitis A Infection?
As with the other hepatitis viruses a person infected with hepatitis A may not haveany symptoms. However, in those who do have symptoms, they resemble the flu.These symptoms include fatigue, nausea, vomiting, pain in the liver area, dark urineor light colored stools and fever. Liver function tests are elevated, with many adultsdeveloping jaundice. Children under two rarely have symptoms. Most people recoverwithin six months.
5. Can Hepatitis A Result In Serious Complications?
A very small percentage of people infected with hepatitis A risk seriouscomplications. These include people with alcoholic hepatitis, chronic hepatitis withcirrhosis or the elderly over 60 years old. These patients may suffer liver failure afterbecoming infected with hepatitis A. Federal mortality statistics for 1992 lists hepatitisA as the primary cause of death for 82 people. In 1993 an estimated 121 peoplewere hospitalized for hepatitis A. Patients with hepatitis A may show improvement intheir symptoms and liver function tests only to suffer a relapse, usually after fourweeks. A relapse can occur more than once and there is no way to predict who willsuffer a recurrence of acute symptoms. In rare cases, jaundice lasts for two or moremonths. It is rare for pregnant women who are infected with hepatitis A to sufferserious complications to themselves or their newborn children.
6. How Is Hepatitis A Diagnosed ?
Hepatitis A is diagnosed by a blood test that is positive for the antibody to the virus,which appears about four weeks after the infection. There are no false positives ornegatives with this test. Liver function tests (serum alanine aminotransferase [ALT]and asparate aminotransferase [AST]) are elevated above normal, often to very highlevels. Symptoms will normally appear during the first four weeks of infection.How Is Hepatitis A Treated? There is no specific treatment for hepatitis A. Mostpatients are told to rest for one to four weeks after a diagnosis is made, to avoidintimate contact and to consume foods high in protein. People who have come intocontact with the patient should be given temporary immunization with immuneserum globulin (ISE), within two weeks of exposure.
7. What Is The Hepatitis A Vaccine?
The current vaccine for hepatitis A in the U.S. is manufactured by SmithKlineBeecham, Inc. The vaccine is made from an inactive hepatitis A virus that has beensuspended in a sterile solution. It is not made from infected blood. The body reactswith the inactive virus to produce an antibody that protects against infection of theliver by the hepatitis A virus. Clinical trials have shown that the vaccine is effective inpreventing infection in over 90 percent of people who were exposed. There aregenerally no known side effects, except for soreness at the site of the injection. Lessthan 10 percent of those vaccinated become tired and nauseous. Children betweenone and 18 should receive two initial doses of the vaccine and a booster between sixand 12 months. Adults should receive an initial dose and then a booster six to 12months later. It takes at least two weeks before protection is achieved. It is notcertain how long protection will last.
 
Hepatitis B
Hepatitis B is a virus that causes the liver to become inflamed. Most people fight off the infection themselves. However, approximately 5-10 percent of those people whoare infected with the virus will become carriers, an estimated 5-10 percent of thosepeople infected each year will progress to chronic liver disease, cirrhosis and possiblyliver cancer.There are over a million carriers of the hepatitis B virus in the United States and anestimated 200,000 people contract this serious liver disease each year.This disease is more infectious than AIDS and is transmitted through infected bloodand other body fluids (seminal fluid, vaginal secretions, breast milk, tears, saliva andopen sores). However, in approximately 30-40 percent of cases the method of transmission is unknown.
1) Protection Against Hepatitis B ?
You can protect yourself against hepatitis B with a safe and effective vaccine. To befully protected three injections are required; the second one a month after the firstinjection and the third one six months later. Hepatitis B vaccination shots arerecommended for all newborns, infants and teenagers. Shots may be given at anyage. Most cases of hepatitis B occur among sexually active young adults, therefore,teenagers are an important group to be vaccinated. This vaccine provides immunityfor most people for at least five years and possibly longer.
2) Who is at Risk for Hepatitis B?
People who are exposed to blood or body fluids of an infected person are at risk. Youmay also be at risk if you -
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are exposed to blood on the job - first aid or emergency worker, funeraldirector, police personnel, dentist or dental assistant, medical personnel, etc.;
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live in the same household with an infected person;
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have sex with a carrier or chronically infected person;
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use intravenous drugs;
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have more than one sex partner;
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received a blood transfusion prior to 1975 (when a test to screen blood wasdeveloped);
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have hemophilia;
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work or are a patient in a health or long term care facility;
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work or are incarcerated in a prison;
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travel to countries with a high incidence of hepatitis B.Ethnic or racial groups with a high rate of infection are: Blacks, Asians, PacificIslanders, Hispanics, American Indians and Alaskan Natives.
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