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Hepatitis A

Alternative names: Viral hepatitis

What is hepatitis?
What is hepatitis A infection?
What are the signs of hepatitis A?
What causes hepatitis A?
How does my doctor tell if I have hepatitis A?
How is hepatitis A treated?

What is hepatitis?

The word "hepatitis" comprises two elements:

  • "-itis" at the end of the word indicates inflammation
  • the first part comes from the organ called hepar, which means liver

Hepatitis therefore means inflammation of the liver, like appendicitis means inflammation of the appendix and colitis means inflammation of the colon.

Inflammation is the local reaction in the body to fight a damaging agent. There are multiple causes of inflammation and in the case of liver disease they include viruses (hepatitis A, B, C, etc.), alcohol and a variety of other diseases. Any disease that becomes chronic can lead to a scarred liver (cirrhosis).

What is hepatitis A infection?

Hepatitis A is infection of the liver by the hepatitis A virus.

Hepatitis A is one of five different kinds of hepatitis viruses (A-E). Only hepatitis B, C and D can become chronic conditions, and possibly cause cirrhosis.

Hepatitis A can go undiagnosed as a minor gastrointestinal illness, particularly in childhood, or can cause significant liver disease accompanied by jaundice (yellowing of the eyes and skin). The rule is complete recovery of the liver without significant scarring. In exceptional cases the disease can be fatal unless liver transplantation is done.

What are the signs of hepatitis A?

As with the other hepatitis viruses, a person infected with hepatitis A may not have any symptoms. Others may have symptoms much like those of a gastrointestinal upset and/or flu-like illness, including:

  • Fatigue (feeling tired)
  • Nausea (feeling sick)
  • Diarrhea
  • Loss of appetite and weight loss
  • Fever
  • Jaundice: yellowing of the skin and whites of the eyes
  • Dark urine
  • Pain in the liver area (middle of the back, on the right side)

Adults are more likely to have symptoms than children.

What causes hepatitis A?

Hepatitis A is a so-called "water-borne disease." This means that infection is associated with contaminated drinking water, or poor hygiene. This is why major outbreaks can take place after natural disasters. In the United States, the disease may occur without any identifiable source. Occasionally there are outbreaks associated with contamination in restaurants by personnel who prepare or serve food. It can also occur in places where hygiene is more difficult to maintain (institutions for the mentally impaired, etc.) and it can be sexually transmitted (anal intercourse).

The virus multiplies in the gastrointestinal system (stool is infectious) and then affects the liver. The reaction of the body's immunes system means that a person with heptatis A is less infective soon after clinical symptoms show.

How does my doctor tell if I have hepatitis A?

People who contract hepatitis A often feel quite ill. When an infected person seeks medical attention, the doctor may suspect hepatitis A based on the symptoms, the patient's story (history) of the illness and the physical exam, which may reveal jaundice and an enlarged and tender liver. A blood test will tell for certain if the hepatitis A virus is present. This test checks for the antibody to the virus (anti-HAV IgM), which shows up about 2-6 weeks after infection.

How is hepatitis A treated?

The patient

  • Simple rest is the best way to make it through the time when the symptoms are most severe. Rest does not mean bed rest, and some physical activity may be a good thing.
  • Most patients are told to rest for one to four weeks after being diagnosed with the virus, and to avoid intimate contact with other people.
  • Hygiene: wash hands, segregate bathrooms if feasible, keep the toilet clean.
  • Patients should be encouraged to eat and drink. If they tolerate fat poorly (maldigestion), they may want to leave that out for a while and eat other foods. Fat, however, is not forbidden, and if tolerated, it is an important source of calories.
  • Patients should avoid alcohol and anything that is toxic to the liver, including acetominophen (Tylenol).
  • Hospitalization may be required for those who are really ill: persistent nausea, vomiting, confusion and other symptoms.

The disease environment

  • Hygiene: wash hands!
  • Anyone who has come in close contact with the infectious patient should be given protective immune globulin and be vaccinated. The immune globulin can significantly decrease disease severity in those who were already infected.
  • The public health department typically assists in identifying people who need screening and vaccination. They will also review potential infectious sources in the community in case of outbreaks of the disease.

Disease outcome

  • Most people recover from the hepatitis A virus within six months. Jaundice may disappear in weeks, but it may take a lot longer before the patient feels completely well again. A degree of fatigue may last for quite a while. Some patients have a second flare-up after a few weeks (the "final clearance" of the virus).
  • There tend to be no long-term health problems, and chronic disease does not develop. Hepatitis A does not cause cirrhosis.
  • Patients who recover from hepatitis A develop antibodies that provide life-long immunity.
  • Adults are more at risk to develop serious, even fatal disease, and occasionally need liver transplantation.

Prevention

  • With increased hygiene in the developed world, fewer adults are immune and therefore are at greater risk to contract the disease. They tend to have more serious outcomes than younger people.
  • Increasingly, world-wide vaccination is implemented with the combined hepatitis A and B vaccine (Twinrix). Priority is given to high risk groups that include institutionalized patients, the military, and those who constantly travel world-wide, such as business people, educators, etc.
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