LIVER DISEASE

The Threat of Viral Hepatitis

Viral hepatitis, a contagious infection of the liver, afflicts more than 70,000 Americans each year. It is usually caused by one of three different organisms.

Hepatitis A , formerly known as infectious hepatitis, can be contracted by consuming contaminated water or food, most notably shellfish. Since the virus is eliminated in the stool, it also spreads through improper hand washing, especially by restaurant workers or anyone else who handles food. Although hepatitis A is seldom serious, in one percent of the cases it can cause severe liver failure and death. It does not cause chronic hepatitis and will not lead to cirrhosis or other long-term liver problems.

Hepatitis B , formerly known as serum hepatitis, is found in blood and other body fluids such as urine, tears, semen, breast milk, and vaginal secretions. It is usually transmitted in blood, via transfusions, or through illicit injectable-drug use. But it also can be contracted through a minor cut or abrasion, or during such everyday acts as toothbrushing, kissing, or having sex. Infants can contract the disease from the mother at birth, or from the mother's breast milk. Dental work, ear piercing, and tattooing are other ways people can get hepatitis B.

Type C hepatitis virus is the cause of a disease known as "non-A, non-B hepatitis," which is also contracted through contact with contaminated blood, or through household or sexual contact with an infected person. It affects approximately 170,000 Americans each year.

Viral hepatitis may produce no symptoms at all. When they occur in type A, they usually begin suddenly and last for several weeks. This period is followed by a convalescent phase of anywhere from two to 12 weeks. Symptoms of viral hepatitis mimic the flu and include mild fever, fatigue, nausea, muscle and joint aches, loss of appetite, vomiting, occasional diarrhea, and vague abdominal pain. Some people also develop a yellow cast to the skin and whites of the eyes known as jaundice, along with dark-colored urine, clay-colored stools, and itching of the skin. The liver may be enlarged and tender.

Patients usually recover completely from hepatitis A and develop a lifelong immunity to it. Immune globulin (IG) should be administered to anyone exposed to type A hepatitis as soon as possible or within two weeks after jaundice appears. This medication is 80 to 90 percent effective in preventing the disease. A vaccine for hepatitis A is now available.

Hepatitis B also frequently has no symptoms; but if they do occur, they are similar to those of hepatitis A. The disease follows an unpredictable course, sometimes incapacitating a person for weeks or months and leading to complications, but usually ending in full recovery. Hepatitis C is similar to hepatitis B, but milder. However, like hepatitis B, it may develop into a chronic form in approximately 30 to 50 percent of those who contract it.

The problem with hepatitis B is that five to 10 percent of those who become infected with this disease become chronic carriers who can spread it to others for an indefinite period of time. At present there are more than a million of these silent carriers in this country, and their number is growing by two to three percent annually. Consequently, authorities recommend that all children and anyone with a high risk of exposure be vaccinated against this dangerous virus.

Chronic carriers usually do not develop chronic hepatitis. If it does develop, however, cirrhosis and primary cancer of the liver can be long-term consequences. An estimated 4,000 people in the United States die from hepatitis B-related cirrhosis annually. Carriers are many times more likely to get liver cancer than are non-carriers.

Treatment for acute hepatitis consists of rest and small, nourishing meals; fluids; and sometimes anti-nausea drugs such as trimethobenzamide (Tigan). Chronic cases of hepatitis B and C are now being treated with interferon, a biotech medicine derived from the human immune system.

Pediatric liver diseases afflict tens of thousands of children in this country annually, and kill hundreds each year. More than 100 different liver diseases are found in infants and children. Most of these disorders are genetic. Among the more common are:

1.Biliary atresia, an inadequate bile duct, often fatal but sometimes relieved by surgery; 2.Chronic active hepatitis, in which scar tissue forms and destroys the liver;
3.Wilson's disease, in which an abnormally large buildup of copper in the liver is treated with vitamin B6 and d-penicillamine, or, in some cases, corticosteroids such as prednisone; Reye's syndrome, an acute, often fatal disease secondary to flu or other infections in which fat accumulates in the liver and the patient lapses into coma.
(In people with Wilson's disease, copper begins accumulating in the liver immediately after birth, but signs and symptoms rarely occur before the age of 5 or 6. The disease almost always becomes apparent before age 30, but Wilson's disease symptoms sometimes appear much later in life. )