The word hepatitis simply means an inflammation of the liver without pinpointing a specific cause.

Someone with hepatitis may:

have one of several disorders, including viral or bacterial infection of the liver have a liver injury caused by a toxin (poison) have liver damage caused by interruption of the organ's normal blood supply be experiencing an attack by his or her own immune system through an autoimmune disorder have experienced trauma to the abdomen in the area of the liver

Hepatitis is most commonly caused by one of three viruses:

1. the hepatitis A virus 2. the hepatitis B virus 3. the hepatitis C virus In some rare cases, the Epstein Barr Virus (which causesmononucleosis) can also result in hepatitis because it can cause inflammation of the liver. Other viruses and bacteria that also can cause hepatitis include hepatitis D and E, chickenpox, andcytomegalovirus (CMV). Hepatitis A In children, the most common form of hepatitis is hepatitis A (also called infectious hepatitis). This form is caused by the hepatitis A virus (HAV), which lives in the stools (feces or poop) of infected individuals. Infected stool can be present in small amounts in food and on objects (from doorknobs to diapers). HAV is spread:

when someone ingests anything that's contaminated with HAV-infected stool (this makes it easy for the virus to spread in overcrowded, unsanitary living conditions) in water, milk, and foods, especially in shellfish

Because hepatitis A can be a mild infection, particularly in children, it's possible for some people to be unaware that they have had the illness. In fact, although medical tests show that about 40% of urban Americans have had hepatitis A, only about 5% recall being sick. Although the hepatitis A virus can cause prolonged illness up to 6 months, it typically only causes short-lived illnesses and it does not cause chronic liver disease.

Hepatitis B Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide spectrum of symptoms ranging from general malaise to chronic liver disease that can lead to liver cancer. HBV spreads through:+

infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine a contaminated blood transfusion (uncommon in the United States) shared contaminated needles or syringes for injecting drugs sexual activity with an HBV-infected person transmission from HBV-infected mothers to their newborn babies

Hepatitis C The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. The symptoms of the hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with HCV can lead to chronic liver disease and is the leading reason for liver transplant in the United States. The hepatitis C virus can be spread by:

sharing drug needles getting a tattoo or body piercing with unsterilized tools blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease) transmission from mother to newborn sexual contact (although this is less common)

Hepatitis C is also a common threat in kidney dialysis centers. Rarely, people living with an infected person can contract the disease by sharing items that might contain that person's blood, such as razors or toothbrushes.

Diagnosis
All of these viral hepatitis conditions can be diagnosed and followed through the use of readily available blood tests.

Signs and Symptoms

Hepatitis, in its early stages, may cause flu-like symptoms, including:

malaise (a general ill feeling) fever muscle aches loss of appetite

nausea vomiting diarrhea jaundice (a yellowing of the skin and whites of the eyes)

But some people with hepatitis may have no symptoms at all and may not even know they're infected. Children with hepatitis A, for example, usually have mild symptoms or have no symptoms.

If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

jaundice foul breath a bitter taste in the mouth dark or "tea-colored" urine white, light, or "clay-colored" stools

There can also be abdominal pain, which may be centered below the right ribs (over a tender, swollen liver) or below the left ribs (over a tender spleen).

Contagiousness
Hepatitis A, hepatitis B, and hepatitis C are all contagious. The hepatitis A virus can be spread in contaminated food or water, as well as in unsanitary conditions in child-care facilities or schools. Toilets and sinks used by an infected person should be cleaned with antiseptic cleansers. People who live with or care for someone with hepatitis should wash their hands after contact with the infected person. In addition, when traveling to countries where hepatitis A is prevalent, your child should be vaccinated with at least two doses of the hepatitis A vaccine.

The hepatitis B virus can be found in virtually all body fluids, though its main routes of infection are through sexual contact, contaminated blood transfusions, and shared needles for drug injections. Household contact with adults with hepatitis B can put people at risk for contracting hepatitis. But frequent hand washing and good hygiene practices can reduce this risk.

All kids in the United States are routinely vaccinated against hepatitis B at birth and use of the hepatitis B vaccine can greatly decrease the incidence of this infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they're at risk.

The hepatitis C virus can be spread through shared drug needles, contaminated blood products, and, less commonly, through sexual contact. Although hepatitis C can be spread from a mother to her fetus during pregnancy, the risk of passing hepatitis C to the fetus isn't very high (about 5%). If you're pregnant, contact your doctor if you think you may have been exposed to hepatitis C.

Over the past several years, improved medical technology has almost eliminated the risk of catching hepatitis from contaminated blood products and blood transfusions. But as tattoos and acupuncture have become more popular, the risk of developing hepatitis from improperly sterilized equipment used in these procedures has increased. Shared needles in drug use and shared straws in cocaine use are two very common ways for hepatitis C to spread.

Prevention
In general, to prevent viral hepatitis you should:

Follow good hygiene and avoid crowded, unhealthy living conditions.

Take extra care, particularly when drinking and swimming, if you travel to areas of the world where sanitation is poor and water quality is uncertain.

Never eat shellfish from waters contaminated by sewage.

Remind everyone in your family to wash their handsthoroughly after using the toilet and before eating. Use antiseptic cleansers to clean any toilet, sink, potty-chair, or bedpan used by someone in the family who develops hepatitis.

Because contaminated needles and syringes are a major source of hepatitis infection, it's a good idea to encourage drug awareness programs in your community and schools. At home, speak to your child frankly and frequently about the dangers of drug use. It's also important to encourage abstinence and safe sex for teens, in order to eliminate their risk of hepatitis infection through sexual contact.

A hepatitis A vaccine is available to kids 12 months and older. In the past, the vaccine was only recommended to those at high risk for the disease (such as those who lived in or traveled to locations with high rates of HAV), but now the vaccine is available to anyone who desires immunity to hepatitis A.

If you're planning to travel abroad, consult your doctor in advance so you and your family have enough time to complete the required immunizations. The vaccine is especially useful for staff of childcare facilities or schools where they may be at risk of exposure.

There's also a hepatitis B vaccine, which should be given to both children and adults as part of routine immunization.

Unfortunately, there's no vaccine for hepatitis C animal studies indicate that it may not be possible because the virus doesn't cause the kind of response that would be needed for a vaccine to be successful.

Duration
For viral hepatitis, the incubation period (the time it takes for a person to become infected after being exposed) varies depending on which hepatitis virus causes the disease:

For hepatitis A, the incubation period is 2 to 6 weeks. For hepatitis B, the incubation period is between 4 and 20 weeks. For hepatitis C, it's estimated that the incubation period is 2 to 26 weeks.

Hepatitis A is usually active for a short period of time and once a person recovers, he or she can no longer pass the virus to other people. It's practically unheard for people to become chronic carriers of hepatitis A. Almost all previously healthy persons who develop hepatitis A will completely recover from their illness in a few weeks or months without long-term complications.

With hepatitis B, 85% to 90% of patients recover from their illness completely within 6 months, without long-term complications.

However, 75% to 85% of those who are infected with hepatitis C do not recover completely and are more likely to continue to have a long-term infection. People with hepatitis B (the percentage who don't recover completely) or hepatitis C who continue to be infected can go on to develop chronic hepatitis and cirrhosis of the liver (the chronic degeneration and disruption of the structure of the liver). Some people with hepatitis B or C may also become lifelong carriers of these viruses and can spread them to other people.

Treatment

When symptoms are severe or laboratory tests show liver damage, it's sometimes necessary for hepatitis to be treated in the hospital. Here's a quick look at the treatments available for the various hepatitis viruses:

There are no medications used to treat hepatitis A because it's a short-term infection that goes away on its own.

Hepatitis B can sometimes be treated using medications. Four drugs are approved for use in adults with hepatitis B, but there hasn't been enough research yet on their use in children. However, you can talk to your child's doctor about a drug that may be available in some centers on a research basis for children.

The treatment of hepatitis C has improved significantly with the use of two medications, only one of which is approved for use in children. Another more effective drug isn't approved for children yet but is available for kids in some centers on a research basis. In those adults who've just been infected with hepatitis C (by accidental needle injury, for example), combination therapy with the two drugs is the treatment of choice and can eliminate the virus in about 50% of the people infected.

Children with mild hepatitis may be treated at home. Except for using the bathroom, they should rest in bed until the fever and jaundice are gone and their appetite is normal. Kids with a lack of appetite should try smaller, more frequent meals and fluids that are high in calories (like milkshakes). They should also eat healthy foods rich in protein and carbohydrates and drink plenty of water.

When to Call the Doctor

Call the doctor if your child:

has symptoms of hepatitis attends a school or child-care facility where someone has hepatitis has been exposed to a friend or relative with the illness

If you have an older child who volunteers at a first-aid station, hospital, or nursing home, be sure that he or she is aware of proper safety procedures for preventing contact with blood or body fluids. You may also want to have your child immunized against the hepatitis B virus. Call your doctor if you believe your child may have been exposed to a patient with hepatitis. If you already know your child has hepatitis, call your doctor if you notice any of the following symptoms, which may be signs of their liver condition worsening:

confusion or extreme drowsiness skin rash itching

Also, monitor your child's appetite and digestive functions, and call the doctor if your child's appetite decreases, or if nausea, vomiting, diarrhea, or jaundice increase.

Other Names:Adrenal insufficiency, Adrenocortical hypofunction, Hypocortisolism Definition: Addisons disease is a disorder that occurs when your body produces insufficient amounts of certain hormones produced by your adrenal glands. In Addisons disease, your adrenal glands produce too little cortisol and often insufficient levels of aldosterone as well.

Consequently, insufficient amounts of these hormones are available, which results in disturbances in body chemistry and leads to a wide range of symptoms.

These corticosteroid hormones include: Aldosterone regulates salt and water loss through the kidneys and so helps control blood pressure and fluid levels in the body. Cortisol (or hydrocortisone) and corticosterone these affect almost every cell in the body. Their main job is to help the body deal with stress of any form, maintain glucose or sugar levels in the blood, control blood pressure, keep a check on inflammation within the body and regulate the metabolism of fats, carbohydrates and proteins. Male and female sex hormones testosterone and oestrogen are produced in small amounts by the adrenal glands. The frequency rate of Addisons disease in the human population is sometimes estimated at roughly 1 in 100,000. Some research and information sites put the number closer to 40-60 cases per 1 million population. (1/25,000-1/16,600) (Determining accurate numbers for Addisons is problematic at best and some incidence figures are thought to be underestimates.) Addisons can afflict persons of any age, gender, or ethnicity, but it typically presents in adults between 30 and 50 years of age. Research has shown no significant predispositions based on ethnicity. Symptoms: Symptoms of adrenal failure dont usually appear until about 90 per cent of the adrenal tissue has been damaged. Onset may be slow, often over weeks or months, and symptoms are usually vague and variable at first, so it can be years before the condition is diagnosed. People with Addisons disease may feel increasingly weak, lethargic, lose their appetite and weight, and may suffer recurrent abdominal pain and vomiting. Other symptoms include: Falling blood pressure (especially on standing up quickly). Nausea. Vomiting. Diarrhoea. Irritability. Depression. Changes in salt levels (rising blood potassium levels and falling sodium levels in the blood) which can cause a craving for salty foods. Headache. Sweating. Irregular or absent periods in women. A characteristic feature of Addisons disease is a change in pigmentation on certain parts of the body. Skin creases of the palms, knuckles, elbows and knees may darken, becoming brownish in colour (hyperpigmentation). The inside of the mouth may also darken. If the demand for corticosteroid hormone rapidly outstrips the ability of the glands to produce it, an Addisonian crisis (or acute adrenal insufficiency) may occur. This most typically occurs when someone with Addisons is put under extra stress, for example during illness or surgery, and urgently needs increased amounts of adrenal hormones. During an Addisonian crisis, symptoms rapidly worsen and may include: *Weight loss and decreased appetite *Dehydration. *Confusion. *Weakness.

*Vomiting. *Severe abdominal pain resulting from excessive loss of salt and water. Acute adrenal failure (addisonian crisis) Sometimes, however, the signs and symptoms of Addisons disease may appear suddenly. In acute adrenal failure (addisonian crisis), the signs and symptoms may also include: *Pain in your lower back, abdomen or legs *Severe vomiting and diarrhea, leading to dehydration *Low blood pressure *Loss of consciousness *High potassium (hyperkalemia) It can lead to coma and even death unless treated quickly. An Addisonian crisis may be the first obvious sign that alerts doctors to a diagnosis of Addisons disease. Causes: Addisons disease results when your adrenal glands are damaged, producing insufficient amounts of the hormone cortisol and often aldosterone as well. These glands are located just above your kidneys. As part of your endocrine system, they produce hormones that give instructions to virtually every organ and tissue in your body. Your adrenal glands are composed of two sections. The interior (medulla) produces adrenaline-like hormones. The outer layer (cortex) produces a group of hormones called corticosteroids, which include glucocorticoids, mineralocorticoids and male sex hormones (androgens).

Some of the hormones the cortex produces are essential for life the glucocorticoids and the mineralocorticoids. *Glucocorticoids. These hormones, which include cortisol, influence your bodys ability to convert food fuels into energy, play a role in your immune systems inflammatory response and help your body respond to stress. *Mineralocorticoids. These hormones, which include aldosterone, maintain your bodys balance of sodium and potassium to keep your blood pressure normal. *Androgens. These male sex hormones are produced in small amounts by the adrenal glands in both

men and women. They cause sexual development in men and influence muscle mass, libido and a sense of well-being in men and women. Primary adrenal insufficiency Addisons disease occurs when the cortex is damaged and doesnt produce its hormones in adequate quantities. Doctors refer to the condition involving damage to the adrenal glands as primary adrenal insufficiency. The failure of your adrenal glands to produce adrenocortical hormones is most commonly the result of the body attacking itself (autoimmune disease). For unknown reasons, your immune system views the adrenal cortex as foreign, something to attack and destroy. Other causes of adrenal gland failure may include: *Tuberculosis *Other infections of the adrenal glands *Spread of cancer to the adrenal glands *Bleeding into the adrenal glands Secondary adrenal insufficiency Adrenal insufficiency can also occur if your pituitary gland is diseased. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH can lead to insufficient production of hormones normally produced by your adrenal glands, even though your adrenal glands arent damaged. Doctors call this condition secondary adrenal insufficiency. Another more common cause of secondary adrenal insufficiency occurs when people who take corticosteroids for treatment of chronic conditions, such as asthma or arthritis, abruptly stop taking the corticosteroids. Addisonian crisis If you have untreated Addisons disease, an addisonian crisis may be provoked by physical stress, such as an injury, infection or illness. Diagnosis: Suggestive featuresRoutine investigations may show: *Hypercalcemia *Hypoglycemia, low blood sugar (worse in children due to loss of glucocorticoids glucogenic effects) *Hyponatraemia (low blood sodium levels), due both to a deficiency in Aldosterone (a mineralocorticoid) dependant Sodium retention and also the effect of Corticotropin-releasing hormone to stimulate secretion of ADH *Hyperkalemia (raised blood potassium levels), due to loss of production of the hormone aldosterone *Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells) *Metabolic acidosis (increased blood acidity), also due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule is linked with acid/hydrogen ion (H+) secretion. Low levels of aldosterone stimulation of the renal distal tubule leads to sodium wasting in the urine and H+ retention in the serum. Testing: In suspected cases of Addisons disease, one needs to demonstrate that adrenal hormone levels are low even after appropriate stimulation (called the ACTH stimulation test) with synthetic pituitary ACTH hormone tetracosactide . Two tests are performed, the short and the long test. The short test compares blood cortisol levels before and after 250 micrograms of tetracosactide (IM/IV) is given. If, one hour later, plasma cortisol exceeds 170 nmol/L and has risen by at least 330

nmol/L to at least 690 nmol/L, adrenal failure is excluded. If the short test is abnormal, the long test is used to differentiate between primary adrenal failure and secondary adrenocortical failure. The long test uses 1 mg tetracosactide (IM). Blood is taken 1, 4, 8, and 24 hours later. Normal plasma cortisol level should reach 1000 nmol/L by 4 hours. In primary Addisons disease, the cortisol level is reduced at all stages whereas in secondary corticoadrenal insufficiency, a delayed but normal response is seen. Other tests that may be performed to distinguish between various causes of hypoadrenalism are renin and adrenocorticotropic hormone levels, as well as medical imaging usually in the form of ultrasound, computed tomography or magnetic resonance imaging (MRI). Adrenoleukodystrophy, and the milder form, adrenomyeloneuropathy, cause adrenal insufficiency combined with neurological symptoms. These diseases are estimated to be the cause of adrenal insufficiency in approximately 35% of male patients with idiopathic Addisons disease and should be considered in the differential diagnosis of any male with adrenal insufficiency. Diagnosis is made by a blood test to detect very long chain fatty acids (VLCFA). Treatment: Treatment of Addisons itself simply involved replacing or substituting the hormones that arent being produced in sufficient quantities by the adrenal glands. For example, synthetic oral corticosteroid drugs such as prednisone can be taken to cortisol, and a drug called fludrocortisone can be taken to replace aldosterone. Occasionally, the dose of treatment may need to be increased, such as during times of infection or other stress. Patients with Addisons are always given clear advice about these issues, about the importance of always letting a doctor or dentist know theyre taking steroid medication, and not to stop treatment suddenly. Crisis: Standard therapy involves intravenous injections of glucocorticoids and large volumes of intravenous saline solution with dextrose, a type of sugar. This treatment usually brings rapid improvement. When the patient can take fluids and medications by mouth, the amount of glucocorticoids is decreased until a maintenance dose is reached. If aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate. Prognosis: With proper medication, patients can expect to live a healthy and normal life. A person with adrenal insufficiency should always carry identification stating their condition in case of an emergency. The card should alert emergency personnel about the need to inject 100 mg of cortisol if its bearer is found severely injured or unable to answer questions. The card should also include the doctors name and telephone number and the name and telephone number of the nearest relative to be notified. When traveling, a needle, syringe, and an injectable form of cortisol should be carried for emergencies. A person with Addisons disease also should know how to increase medication during periods of stress or mild upper respiratory infections. Immediate medical attention is needed when severe infections, vomiting, or diarrhea occur, as these conditions can precipitate an Addisonian crisis. A patient who is vomiting may require injections of hydrocortisone, since oral hydrocortisone supplements cannot be adequately metabolised.