Hepatitis is simply an inflammation of the liver, which can be caused by many reasons. Viral Hepatitis, as the name suggests, is caused by a virus, and there are currently five individually identified viruses, Hepatitis virus A through E, which can cause this disease.
The most common viruses that cause Hepatitis in the United States are Hepatitis A, B, and C. The illness resulting from all three of these viruses is similar but also different in many aspects. Hepatitis A spreads from a fecal-oral transmission route, while Hepatitis B and C are blood-borne viruses. Hepatitis A only causes acute inflammation of the liver, while both Hepatitis B and C can cause acute and chronic Hepatitis. Hepatitis A and B are preventable with a vaccine, but there is no vaccine for Hepatitis C. There is also a difference in their individual risk factors, treatments, and prognosis.
Viral Hepatitis caused by all three viruses is similar in pathology, but almost all other aspects of the disease caused by these viruses are different.
HEPATITIS C VS HEPATITIS A AND B
All three viruses, Hepatitis A, B, and C, cause liver inflammation that is termed Hepatitis. The underlying pathology is the same: the virus infects a cell's genome and takes over its protein-creation mechanism. This way, the virus survives inside host cells replicating its way to immortality until the host cells die of damage and exhaustion. The result of all three types of Hepatitis mentioned above is a damaged liver that cannot perform its normal functions.
However, all three of these viruses are very different in many aspects. For starters, Hepatitis C and B can be both acute and chronic. It means that both of these viruses can cause a short-term illness that either resolves on its own or develops into a long-term illness. Hepatitis C is much more likely to cause the chronic phase of Hepatitis than Hepatitis B. However, Hepatitis A only causes an acute illness that lasts for almost 6 months and then resolves independently. As is evident, a disease caused by Hepatitis A is usually much milder than that caused by the other two viruses.
The way these viruses are transmitted is also different. Hepatitis C and B are both blood-borne viruses, which spread when a person comes into contact with infected blood. Hepatitis B can also spread when a person comes into contact with other infected bodily fluids, such as semen or breast milk. On the other hand, the Hepatitis A virus has a fecal-oral route of transmission and spreads most commonly through infected food made or handled by someone who does not care for their hygiene as much as they should.
Since the transmission route is different for all three of these viruses, their risk factors are also different. Blood transfusions, sharing needles, unprotected intercourse, and getting tattoos and piercings are risk factors for Hepatitis B and C, while consuming street food is a common risk factor for Hepatitis A. Similarly, Hepatitis C is prevented by lowering the risk factors listed above, while Hepatitis A and B both have an effective vaccine against them.
Since Hepatitis C and B both cause the acute and chronic phases of the disease, their symptoms are almost similar. However, Hepatitis C is much more likely than Hepatitis B to cause liver fibrosis (formation of scar tissue in the liver due to prolonged disease) and liver carcinoma. Hepatitis A, on the other hand, only causes the symptoms of an acute phase, which may include abdominal pain, nausea, jaundice, and diarrhea. Hepatitis C is treated with direct-acting anti-retroviral drugs (DAA). In contrast, Hepatitis A and B are treated with supportive measures, such as bed rest, fluid rehydration, and abstaining from alcohol and medication passing through the liver. The chronic phase of Hepatitis B is also treated with DAA drugs.
CAN YOU GET HEPATITIS WITH MORE THAN ONE VIRUS AT A TIME?
Yes. It is possible to get infected with more than one type of Hepatitis virus at one time. Hepatitis B, C, and D viruses are all transmitted through blood and therefore have the highest likelihood of co-infecting a person at one time. Dual infections or triple infections are common with these Hepatitis viruses. Fulminant Hepatitis, a severe liver inflammation, is caused by a co-infection with Hepatitis B and D virus. Similarly, a person can have both Hepatitis B and C at the same time as well.
HOW IS HEPATITIS DIAGNOSED?
The diagnosis of Hepatitis involves a series of steps that help a physician eliminate all possible differential diagnoses along the way. Your doctor will first take a detailed history of your presenting symptoms. This may include questions about any abdominal pain that you might be feeling, questions about your past medical history, and questions about your family history as well.
Once a detailed history is taken, you will undergo a physical examination. Your doctor may try to look for any abdominal tenderness, signs of jaundice, abdominal distension, or other related signs pointing to a diagnosis of Hepatitis.
Your doctor may order multiple investigations to confirm a diagnosis of Hepatitis. Blood tests are very useful in detecting Hepatitis. There are two kinds of blood tests that aid in this diagnosis: an antibody detecting test and a surface antigen detecting test. Antibody detecting test confirms the presence of antibodies against the Hepatitis virus. However, these tests cannot discern whether the antibodies are due to a current ongoing infection or a past infection that may have been resolved on its own or by treatment. Surface antigen detection tests are useful in confirming the presence of active viral Hepatitis. Surface antigens are detected when an ongoing viral infection is infecting the liver. Both of the blood tests are extremely useful in diagnosing Hepatitis accurately.
Imaging studies are also very helpful in establishing a diagnosis of Hepatitis. Ultrasound provides very useful information and confirms the diagnosis. Similarly, MRI and CT scans also show radiographic changes consistent with an active liver infection, but they are a little expensive. In some cases, a liver biopsy may be necessary to diagnose Hepatitis.
THE CHRONIC PHASE OF HEPATITIS
Viral Hepatitis mostly has both an acute phase and a chronic phase. The disease is labeled chronic when the disease process lasts for more than 6 months. Chronic liver disease has a different set of symptoms than those of the acute phase. Most of these symptoms are silent, meaning that the patient is not always aware of the damage caused to the liver in chronic disease.
Once chronicity develops, the most frequent outcome for the liver is to undergo cirrhosis. Cirrhosis of the liver results when the disease process continues to damage the tissues, replacing healthy tissue with scar tissue. Scar tissue cannot perform normal tissue function, so a healthy liver's function is gradually lost. Symptoms of liver cirrhosis may include:
- Decrease in appetite
- Drastic weight loss
- Itchy skin
- Tenderness in the abdomen
- Distension of the abdomen
- Ankle swelling
Liver cirrhosis may result in complete scarring and ultimately liver failure. Liver failure results in a complete shutdown of the liver and its functions. Liver failure is an emergency and needs urgent medical care. Liver cirrhosis may also allow the development of hepatic carcinoma, i.e., liver cancer.
COMPLICATIONS CAUSED BY HEPATITIS
Hepatitis can cause multiple complications if left untreated. Some of these complications appear short-term. However, other complications can have lasting effects and can persist for much longer. Sometimes, these complications can even cause irreversible damage, such as liver fibrosis and scarring.
Liver failure is one of the most dreaded complications of Hepatitis. Hepatitis B, C, and D can all cause liver failure depending on the severity of the infection. Liver failure can cause all sorts of problems because the liver performs some of the most important functions in the body. One of the most serious effects of liver failure is coagulopathy. The liver manufactures important clotting factors that function to maintain hemostasis. A failing liver can't manufacture these clotting factors as effectively as needed, and thus, the patient starts to lose blood due to internal bleeding. This is characterized by bruising all over the body. This is a serious medical emergency and needs to be corrected immediately.
Chronic Hepatitis can trigger immune responses that damage other organs of the body as well. For example, a complication of chronic Hepatitis includes glomerulonephritis, where hyperactive immune response causes damage to the kidneys and inflames them.
Portal hypertension may develop as a result of chronic Hepatitis. Portal hypertension develops when the liver undergoes cirrhosis. The follow-up to portal hypertension is ascites, i.e., fluid buildup in the abdominal cavity. Massive ascites can be troublesome for the patient in multiple ways.
Hepatic encephalopathy can also develop once a liver undergoes failure following a chronic course of the disease. Hepatic encephalopathy is simply the inflammation of the brain. The patient may experience delirium, confusion, loss of memory, altered conscience, and even go into a coma.