What is hepatitis?

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral
infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis
and hepatitis that occurs as a secondary result of medications, drugs, toxins, and
alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against
your liver tissue.

Hepatitis B
Hepatitis B virus was originally recognized as the agent responsible for “serum hepatitis”, the
most common form of parenterally transmitted viral hepatitis, and an important cause of acute
and chronic infection of the liver. The incubation period of hepatitis B is variable with a range of
1 to 6 months. The clinical features of acute infection resemble those of the other viral
hepatitides. Acute hepatitis B is frequently anicteric and asymptomatic, although a severe illness
with jaundice can occur and occasionally acute liver failure may develop.

Figure:
Electron micrograph of serum containing hepatitis B virus
after negative staining
Acute vs. chronic hepatitis B
Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).
Acute hepatitis B infection lasts less than six months. Your immune system likely can clear
acute hepatitis B from your body, and you should recover completely within a few months. Most
people who get hepatitis B as adults have an acute infection, but it can lead to chronic infection.
Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system
can't fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to
serious illnesses such as cirrhosis and liver cancer.
The younger you are when you get hepatitis B — particularly newborns or children younger than
5 — the higher your risk of the infection becoming chronic. Chronic infection may go undetected
for decades until a person becomes seriously ill from liver disease.
Functions of the liver
The liver regulates most chemical levels in the blood and excretes a product called bile. This
helps carry away waste products from the liver. All the blood leaving the stomach and intestines
passes through the liver.
The liver is a metabolically active organ responsible for many vital life functions. The primary
functions of the liver are:
 Bile production and excretion
 Excretion of bilirubin, cholesterol, hormones, and drugs
 Metabolism of fats, proteins, and carbohydrates
 Enzyme activation
 Storage of glycogen, vitamins, and minerals
 Synthesis of plasma proteins, such as albumin, and clotting factors
 Blood detoxification and purification
Transmission
Transmission of hepatitis B virus results from exposure to infectious blood or body fluids
containing blood. It is 50 to 100 times more infectious than human immunodeficiency
virus (HIV). Possible forms of transmission include sexual contact,blood transfusions and
transfusion with other human blood products, re-use of contaminated needles and
syringes, and vertical transmission from mother to child (MTCT) during childbirth.
Without intervention, a mother who is positive for HBsAg has a 20% risk of passing the
infection to her offspring at the time of birth. This risk is as high as 90% if the mother is
also positive for HBeAg. HBV can be transmitted between family members within
households, possibly by contact of nonintact skin or mucous membrane with secretions or
saliva containing HBV. However, at least 30% of reported hepatitis B among adults
cannot be associated with an identifiable risk factor. Breastfeeding after proper
immunoprophylaxis does not appear to contribute to mother-to-child-transmission
(MTCT) of HBV. The virus may be detected within 30 to 60 days after infection and can
 persist and develop into chronic hepatitis B. The incubation period of the hepatitis B
virus is 75 days on average but can vary from 30 to 180 days.

Risk factors
Hepatitis B spreads through contact with blood, semen or other body fluids from an
infected person. Your risk of hepatitis B infection increases if you:
 Have unprotected sex with multiple sex partners or with someone who's infected
with HBV
 Share needles during IV drug use
 Are a man who has sex with other men
 Live with someone who has a chronic HBV infection
 Are an infant born to an infected mother
 Have a job that exposes you to human blood
 Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands,
Africa and Eastern Europe

Signs and symptoms

Hepatitis B signs and symptoms may include:
 Abdominal pain
 Dark urine
 Fever
 Joint pain
 Loss of appetite
 Nausea and vomiting
 Weakness and fatigue
 Yellowing of your skin and the whites of your eyes (jaundice)
Prognosis
Hepatitis B virus infection may be either acute (self-limiting) or chronic (long-standing).
Persons with self-limiting infection clear the infection spontaneously within weeks to
months.
Children are less likely than adults to clear the infection. More than 95% of people who
become infected as adults or older children will stage a full recovery and develop protective
immunity to the virus. However, this drops to 30% for younger children, and only 5% of
newborns that acquire the infection from their mother at birth will clear the infection. This
population has a 40% lifetime risk of death from cirrhosis or hepatocellular carcinoma. Of
those infected between the age of one to six, 70% will clear the infection.
 Hepatitis D (HDV) can occur only with a concomitant hepatitis B infection, because HDV
uses the HBV surface antigen to form a capsid. Co-infection with hepatitis D increases the
risk of liver cirrhosis and liver cancer. Polyarteritis nodosa is more common in people with
hepatitis B infection.

Estimate of disability-adjusted
life year for hepatitis B per
100,000 inhabitants as of 2004
  no data   100–125
  <10   125–150
  10–20   150–200
  20–40   200–250
  40–60   250–500
  60–80   >500
  80–100 Complications
Having a chronic HBV infection can lead to serious complications, such as:
 Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection
can lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to
function.
 Liver cancer. People with chronic hepatitis B infection have an increased risk of liver
cancer.
 Liver failure. Acute liver failure is a condition in which the vital functions of the liver
shut down. When that occurs, a liver transplant is necessary to sustain life.
 Other conditions: People with chronic hepatitis B may develop kidney disease or
inflammation of blood vessels.