What Is It?

Hepatitis is inflammation of the liver. There are several types of hepatitis, and the disease has several causes.

In the United States today, most infectious cases of hepatitis are caused by an infection with one of the hepatitis viruses (A, B, C, D or E). An infection with one of these viruses might not cause any symptoms or might cause only a mild flu like illness. However, it also can lead to liver failure, coma and death. Hepatitis A is usually a short term illness, while hepatitis B, hepatitis C and hepatitis D can cause long term infections. Hepatitis E has only been found in people who have lived or traveled outside the U.S.

Depending on the virus, hepatitis can be spread in a number of ways, including:

• Contact with the stool of an infected person (hepatitis A)
• Eating shellfish from waters contaminated with sewage (hepatitis A)
• Contact with the blood, vaginal fluids, semen or breast milk of an infected person (hepatitis B)
• Unprotected sex (hepatitis B and C)
• Sharing contaminated needles (hepatitis B, C and D)

Since the early 1990s, improved techniques for screening donated blood have greatly reduced the risk of catching hepatitis B or C from blood transfusions. According to the U.S. National Institutes of Health (NIH), the current risk of catching hepatitis C is one in 100,000 units of transfused blood.

Hepatitis has many other possible causes, including:

• Alcohol consumption at high levels, a common cause of hepatitis in the U.S.
• Medications, including a variety of cholesterol lowering drugs, nitrofurantoin (Furadantin, Macrobid, Macrodantin), methyldopa (Aldomet, Amodopa), phenytoin (Dilantin and other brand names), isoniazid (Laniazid, Nydrazid), ketoconazole (Nizoral) and dantrolene (Dantrium). Hepatitis develops for unclear reasons among a small number of people who take these medications, even at prescribed doses.
• Viruses, including cytomegalovirus, Epstein-Barr virus (which causes infectious mononucleosis), herpes simplex virus, varicella virus (which causes chickenpox) and rubella (which causes German measles)
• Bacteria, including those that cause typhoid fever, syphilis, brucellosis, Legionnaires’ disease, and leptospirosis (though these diseases rarely cause hepatitis in the U.S.)
• Fungi, including histoplasmosis and candida (in people with compromised immune systems)
• Parasites, including those that cause ascariasis, toxocariasis, amebiasis, strongyloides, schistosomiasis, toxoplasmosis and malaria
• Your immune system can cause a condition called autoimmune hepatitis when the immune system attacks the cells of the liver

Symptoms of hepatitis vary depending on the cause of the illness and how much the liver has been damaged. In mild cases, many people do not have any symptoms or have flulike symptoms that can include fever, a generally tired or ill feeling, loss of appetite, nausea and vomiting, diarrhea and muscle aches.

In more severe cases, chemicals from th eliver can build up in the blood and urine, causing the following symptoms:

• A yellow tint to the skin and whites of the eyes (jaundice)
• Bad breath
• A bitter taste in the mouth
• Dark, tea colored urine
• Light, clay colored stools
• Pain or tenderness in the area of the liver (the upper-right side of the abdomen near the lower-front ribs)

Your doctor will ask about your history of alcohol use, exposure to toxic chemicals, use of medications that can cause liver damage, history of unprotected sex, history of intravenous drug use, a recent meal of shellfish from potentially polluted waters, travel to a country where hepatitis infections are common, or exposure to someone known to have hepatitis. Your doctor will examine you to look for a yellowish tint in your skin and the whites of your eyes, and to check for tenderness and swelling near your liver.

To make sure that you have hepatitis, your doctor will order blood tests. In some cases, your doctor may need to order other tests, including urine tests, laboratory cultures, stool samples, blood tests to rule out bacteria or parasites as a cause of hepatitis, blood coagulation tests, an ultrasound or computed tomography (CT) scan of the abdomen, or a liver biopsy.

How long hepatitis lasts depends on the type of hepatitis and the age and health of the person. For example, most previously healthy adults and children who develop hepatitis A recover completely in about one month.

About 5 percent of adults who get hepatitis B develop a long lasting form of the disease. The rate is much higher for babies and young children. A small percentage of these people eventually develop cirrhosis or liver cancer.

Up to 80 percent of people infected with hepatitis C develop chronic infection, and about 20 percent to 30 percent develop cirrhosis or liver cancer.

Hepatitis caused by bacterial or parasitic infections usually improves when the infection is treated, but in some cases, permanent liver damage will result.

Medication related hepatitis often improves when the problematic medication is withdrawn, but in some cases, the liver damage may not go away.

You can reduce your chance of getting viral hepatitis by following some basic guidelines:

• Wash your hands frequently.
• Purchase shellfish only at reputable food stores.
• If you catch your own shellfish, take them only from safe waters that have been inspected by health authorities.
• Before traveling to foreign countries, ask your doctor whether you need the hepatitis A vaccine or immunoglobulin to protect you from infection.
• If you are sexually active, have sex only with one person who is not infected with hepatitis, and use condoms.
• Avoid injecting illegal drugs.
• If you expect to have surgery, ask your doctor about donating some of your own blood beforehand. If necessary, this blood can be transfused back to you during surgery. This is called autologous blood transfusion.
• Ask your doctor whether you need to be vaccinated against hepatitis B. This vaccine, which is now routine for infants, may make sense for some adults who have a higher risk of getting hepatitis B.
• If you think that you have been exposed to someone with hepatitis B, ask your doctor whether you need the hepatitis B immune globulin and/or hepatitis B vaccine.

A person with a severe case of viral hepatitis may need to see a a doctor who specializes in the digestive system (a gastroenterologist) and may require hospital treatment. For milder cases, your doctor may recommend bed rest and a modified diet — usually small, frequent, high calorie meals, with plenty of fluids. A variety of medications are available to treat hepatitis B and C.

Call your doctor if you have symptoms of hepatitis, or if you believe you have been exposed to someone with hepatitis. If you are planning to travel to a foreign country, ask your doctor whether you need hepatitis immunization before your trip.

Most people with either hepatitis A or B recover without treatment. Up to 85 percent of those with hepatitis C, and a smaller number of those with hepatitis B, develop long lasting (chronic) hepatitis. Some people with hepatitis B become lifelong “carriers” of the illness, and can spread the hepatitis infection to others. Patients with chronic hepatitis C also are infectious, and can spread the virus through blood-to-blood contact.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.