Hepatitis: causes, risks, symptoms, and how to treat it

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Definition

What is hepatitis?

Hepatitis is a disease that is a major health threat in the world. This disease causes inflammation of the liver due to a viral infection, so it is easily transmitted from person to person.

The liver (liver) is a digestive organ and plays an important role in the body's metabolic processes. Hepatitis virus infection can cause liver dysfunction in the digestive process to filter out toxins and harmful substances in the body.

This liver disease is divided into 5 types, namely:

• hepatitis A,
• hepatitis B,
• hepatitis C,
• hepatitis D, and E.

The causes of hepatitis also range from abuse of alcohol and drugs, to immune system disorders (autoimmune). However, viral infection is the main cause of this disease.

How common is this condition?

Hepatitis is a health problem that occurs throughout the world, including in Indonesia. In Indonesia, hepatitis itself affects the quality of public health, productivity, life expectancy, and the socio-economic impact of the community.

According to data from the Indonesian Ministry of Health's Basic Health Research (Riskesdas) in 2014, Indonesia is the second country with the highest hepatitis B outbreak in Southeast Asia after Myanmar.

Until now, it is estimated that 10 out of 100 Indonesians (28 million people) are infected with hepatitis B or C. Fourteen million cases of them have the potential to develop to a chronic stage.

From a chronic stage, there will be a higher risk of suffering from liver cancer. With an increasing prevalence in the population over 15 years of age.

Broadly speaking, the most common types of hepatitis in Indonesia are caused by the hepatitis A (19.3%), B (21.8%), and C (2.5%) viruses.

Signs and symptoms

What are the signs and symptoms of this disease?

Not all cases of hepatitis show symptoms. Less obvious symptoms appear in the early stages of infection in about 80% of cases. The rest may show symptoms to varying degrees, including:

• fever,
• fatigue,
• loss of appetite,
• nausea or vomiting,
• stomach pain,
• joint or muscle pain,
• changes in the frequency of bowel movements and urination,
• yellowing of the skin and whites of the eyes (jaundice),
• itchy rash,
• mental changes, such as lack of concentration or a coma, as well
• internal bleeding.

When to see a doctor?

If you experience the signs and symptoms mentioned, consult a doctor immediately. That way, you can get the right treatment according to the conditions.

Causes and risk factors

What are the causes of hepatitis?

Here are some things that can cause this disease.

Hepatitis virus

The main cause of hepatitis is a viral infection that occurs in the liver, causing inflammation.

The most common cases in Indonesia are infection with hepatitis, A, B, and C viruses (HAV, HBV, and HCV). The three of them have different characteristics, so the mode of transmission is different.

Hepatitis A

Hepatitis A (HAV virus infection) is a common disease in people in developing countries. This disease causes the mildest symptoms compared to other types.

Most cases of this disease do not cause symptoms. When it is acute, the sufferer can experience headaches, nausea, and vomiting. HAV transmission can occur in several ways, namely:

• consumption of contaminated food and drinks,
• direct contact with sufferers, as well
• having sex without a condom.

Viruses that cause liver disease include viral RNA that is not shielded. After entering the liver, HAV has an incubation period of 2-6 weeks. When infecting, HAV replicates in liver hepatocyte cells.

Unlike most viruses, HAV does not cause damage to liver cells. The damage that occurs is caused by a response from the immune system. Therefore, in people infected with HAV can be found anti-HAV IgM and anti-HAV IgG.

Hepatitis B

Initially, people who are infected with HBV will suffer from acute hepatitis B. Symptoms of this condition usually include:

• pain in the right upper abdomen,
• jaundice, as well
• urine turns dark and concentrated.

Acute HBV infection is at risk of progressing to a chronic stage. This disease can be prevented through early vaccination.

95% of HBV transmission occurs vertically, namely during the perinatal period or delivery process, and 5% takes place horizontally, through the process of blood transfusions, use of needles, razors, and organ transplants.

Hepatitis C

Patients with chronic liver disease, such as liver cirrhosis or liver cancer, tend to be more prone to hepatitis C. This condition is generally caused by HCV infection that has progressed to a chronic stage, so special treatment is needed.

So far there is no vaccine that can reduce the spread of HCV. In fact, this virus is also divided into 6 types of genes or genotypes with different viral characteristics. That is why, vaccine manufacture needs to create antibodies that can fight against variations of the HCV genotype.

Just like HBV, HCV infection can be transmitted through blood transfusions, body fluids, and organ transplants. Transmission of the virus during childbirth or through sexual contact can also occur, but the probability is still very small.

This virus consists of a single RNA cell protected by a sheath that can only live on human or chimpanzee cells. HCV replicates rapidly so that the numbers increase dramatically in the blood during infection.

The increase in hepatitis C virus cannot be followed by the number of antibodies (anti-HCV) produced by the immune system against HCV infection. The reaction of the immune system, which has difficulty fighting HCV infection, then causes inflammation of the liver.

Hepatitis D and E

Although two other hepatitis viruses, namely HDV (hepatitis D virus) and HEV (hepatitis E virus), are not found in many cases in Indonesia, their spread needs to be watched out for.

HDV or what is called delta virus is the type of hepatitis virus that is rarely found, but also the most dangerous among other hepatitis viruses.

HDV requires HBV to reproduce so it can only be found in people with hepatitis B.

HEV has characteristics that are more or less the same as HAV, namely including the type of RNA virus that is transmitted through fecal oral or enter by mouth.

Non-viral hepatitis

Inflammation of the liver can also be caused by toxic substances, drug substances, and harmful chemicals that can destroy cells in the liver or are called hepatocytes.

Exposure to these toxic substances can cause 70 - 85 percent of hepatocyte damage in the liver. Moreover, non-viral hepatitis can occur due to the use of dietary supplements that affect liver function.

Alcoholic hepatitis

Alcoholic hepatitis is an inflammation that occurs in the liver caused by years of alcohol consumption. However, people who are dependent on alcohol do not necessarily develop this disease.

In some cases, people who consume alcohol in normal limits can also get this disease.

Patients with this disease usually experience symptoms of loss of appetite due to excessive alcohol consumption, upper abdominal pain, to nausea and vomiting.

Not infrequently, sufferers also often easily lose focus or experience changes in behavior during this disease. This is caused by increased levels of toxins in the body.

In addition, alcohol content can also weaken the work of the liver, making you more susceptible to hepatitis virus infection.

Even alcohol consumption can lead to several other liver diseases, such as alcoholic fatty liver or a condition where there is too much fat accumulation in the liver or cirrhosis, which is chronic liver damage.

Autoimmune hepatitis

Autoimmune hepatitis is a condition when the immune system attacks liver cells. Not only inflammation, this liver cell damage can also cause liver failure if not treated immediately.

The main cause of this liver problem is not known for sure. However, this disease is a genetic disorder that develops due to environmental factors.

The symptoms are generally the same as other symptoms. However, this health disorder can be controlled by taking drugs to suppress the work of an overly reactive immune system.

Autoimmune hepatitis is divided into two types, namely autoimmune type 1 which is more common and autoimmune type 2. In addition, people with this disease can also experience other autoimmune diseases, including:

• celiac disease,
• rheumatoid arthritis, and
• ulcerative colitis.

What factors can increase the risk of developing this condition?

Hepatitis disease can be triggered by a number of risk factors, namely as follows.

• Sharing needles with others, whether for medicinal use or for tattoos or piercings.
• Have HIV because it can lower the immune system.
• Having sex without a condom.
• Use of drugs that can damage the liver, such as acetaminophen and methotrexate.
• Sharing eating utensils with people with hepatitis A and E.
• Use of contaminated water and food sources.
• Performing medical procedures, such as blood transfusions or chemotherapy.
• Transmission from mother to child.

Complications

What are the complications of hepatitis?

Hepatitis complications are more prone to occur in patients with hepatitis B and C. It is also more common when HBV infection lasts for a long time or includes chronic infection.

Here are some of the complications that arise due to liver dysfunction.

Fibrosis

The initial stage of liver damage is fibrosis, which is hardened liver tissue. If left untreated, fibrosis will develop into cirrhosis.

This condition takes 20-30 years to develop and blocks blood flow to the liver (cirrhosis).

Cirrhosis

Inflammation of the liver that occurs as a result of hepatitis virus infection can cause injury that damages liver function in the long term. Cirrhosis, which is characterized by the appearance of injury to the liver, causes the liver to no longer function normally.

According to the American College of Gastroenterology, about 20% of people with chronic hepatitis C will develop cirrhosis. Once cirrhosis occurs, about 50% of patients will experience life-threatening complications in the next 5 - 10 years.

Until now, there is no medicine that can cure this disease. Liver transplant is the only option for recovery.

Heart cancer

Liver cancer is one of the most susceptible complications in hepatitis patients. If left untreated, liver cancer can cause severe symptoms.

That is why doctors will recommend an ultrasound examination every 6 to 12 months to show if a tumor has formed. The sooner it is found, the treatment for liver cancer opens a greater chance of cure.

Treatment that can be done is through surgical removal of cancer cells and parts of the liver that are damaged or perform a liver transplant.

Hepatitis B fulminant

Hepatitis B fulminant is a condition when the immune system reacts to fight a viral infection, causing severe liver damage. Symptoms of this disease also vary, including:

• passed out,
• swelling of the stomach, and
• appears jaundice (jaundice).

This disease requires immediate medical attention because it can cause liver failure.

Diagnosis

How to diagnose this condition?

Many people who have hepatitis don't even know they have the virus. That is why, this disease is more often detected accidentally during routine medical examinations.

The best way to check for this disease is to have a blood test that will show the results of liver function by measuring:

• SGPT and SGOT,
• bilirubin,
• albumin, and
• total protein (TP).

In addition to blood tests, doctors can diagnose this disease through a physical examination of the symptoms experienced, such as yellowing of the skin or eyes. A history check is needed to find out where you could have caught the virus.

How do you treat hepatitis?

Here are some ways to deal with hepatitis.

Drugs

The most common drugs in the treatment of hepatitis include the following.

• Interferon
• Protease inhibitor antivitus drugs
• Nucleoside analogue antivitus drugs
• Polymerase inhibitors and combination drug therapy

Interferon

Interferon is a combination of antiviral drugs. This medication aims to reduce side effects and allow the drug to remain in the body for a longer time.

In addition, interferon also increases protein intake to fight infection and helps the immune system fight HCV so that complications do not occur. Interferons include the following.

• peginterferon alfa-2a (Pegasys) injection
• peginterferon alfa-2b injection (PegIntron, Sylatron)
• interferon alfa-2b (Intron A) injection

Protease inhibitor antiviral drugs

Protease inhibitors are used to prevent the spread of the virus by stopping its reproduction. These drugs can be used orally. Listed below are some protease inhibitor antiviral drugs.

• Telaprevir (Incivek)
• Boceprevir (Victrelis)
• Paritaprevir (this is a protease inhibitor but only available in Viekira Pak)

Nucleoside analogue antiviral drugs

Nucleoside analogue antiviral drugs also work to prevent the formation of new viruses. This drug is also used in combination with other therapies to treat hepatitis.

The most common drug of this type is ribavirin (Copegus, Moderiba, Rebetol, Ribasphere, Ribasphere Ribapak, Virazole).

Even so, the side effects of ribavirin are quite dangerous, namely causing birth defects in newborns. That is why, pregnant women are not advised to use this drug.

In addition, ribavrin can also suppress growth in children. This risk can be transferred from the man to the female partner at conception.

Polymerase inhibitors and combination drug therapy

Polymerase inhibitors prevent the progression of hepatitis by stopping the production of the virus. These treatments include the polymerase inhibitor Sovaldi (Sofosbuvir).

This medication is sometimes used in combination with ribavirin for up to 24 weeks.

Doctors can also use a combination of ledipasvir and sofosbuvir (Harvoni) to treat this disease. These medicines must be used with food and must not be crushed.

Common side effects include:

• nausea,
• itchy,
• insomnia, as well
• weakness.

Home remedies

What are the home remedies for treating hepatitis?

Hepatitis treatment usually focuses on reducing symptoms. You can also do some simple treatments to reduce the risk of complications, which are as follows.

• Get more rest.
• Divide food into smaller portions to treat nausea.
• Choose high calorie foods, such as fruit juices or milk for energy.
• Stop alcohol consumption while infected with the virus.
• Avoid having sex without a condom.
• Always wash your hands, especially after going to the toilet.
• Not preparing food for other people while infected.

Hepatitis is an inflammatory infection caused by a virus. By applying good hygiene such as washing your hands, you will be protected from this liver disease.

If you have further questions, please consult with your doctor to get the right questions.