How does hepatitis affect the liver?

The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin, begins to build up in the blood and tissues when the liver isn't working properly. The bilirubin makes the skin of a person who has hepatitis turn a yellow-orange color. This is called jaundice. Bilirubin and other waste products may also cause itching, nausea, fever and body aches.

What is hepatitis A?

There are 6 viruses that cause hepatitis. Each hepatitis virus is named with a letter of the alphabet: hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E and hepatitis G. Hepatitis A is a liver disease caused by the hepatitis A virus. 

Hepatitis A causes inflammation of the liver, which leads to soreness and swelling. Hepatitis A is different from other types of hepatitis because it isn't typically as serious and doesn't develop into chronic hepatitis or cirrhosis like hepatitis B and C can.

How is hepatitis A spread?

Hepatitis A is typically spread through contact with infected feces. You can get infected through close contact with an infected person (for example, changing a diaper or having sexual contact), even if that person does not have any symptoms. In fact, hepatitis A is most contagious before symptoms appear. You can also get infected by eating contaminated food or drinking contaminated water. The virus can live on hands, in water and in soil. Hepatitis A is common in developing countries.

What are the symptoms of hepatitis A?

The hepatitis A virus is usually in your system for one month before symptoms appear.

When symptoms do appear, they can appear suddenly and include:

• Nausea
• Vomiting
• Jaundice (the yellowing of the skin and the whites of the eyes)
• Low-grade fever (fever up to 102 degrees)
• Fatigue
• Pain in your abdomen, especially on your right side
• Dark-colored urine
• Loss of appetite
• Muscle pain

It is important to remember that some people who have the hepatitis A never develop any symptoms. 

Young children are likely to have very mild cases of hepatitis A, while symptoms in older children and adults are more likely to be severe.

See your doctor is you have any of these symptoms. He or she can do a blood test to see if you have hepatitis A. 

How is hepatitis A treated?

There is no specific medicine to treat or cure hepatitis A. If you have the virus, you should get plenty of rest, eat a balanced diet and avoid alcohol and acetaminophen (Tylenol). Both alcohol and medicines like acetaminophen are broken down by the liver and may increase the speed of liver damage in people who have hepatitis.

Talk with your doctor about any other over-the-counter medicines you are taking, as they may need to be changed or stopped while you have the virus.

You may need to stay in the hospital for a short time if you get dehydrated, have severe pain, suddenly become confused or develop bleeding problems.

How long will I be contagious?

You are most contagious soon after you are infected and before symptoms appear. Adults who are otherwise healthy are no longer contagious 2 weeks after the illness begins. Children and people who have weak immune systems may be contagious for up to 6 months.

How can I keep from getting hepatitis A?

Ask your doctor about the hepatitis A vaccine. The shot is safe for anyone over 2 years of age and can provide protection for up to 20 years.

Wash your hands with soap and warm water before and after cooking, after using the bathroom and after changing diapers.

Wash fruits and vegetables thoroughly before eating and avoid raw or undercooked meat and fish.

If you come into contact with someone who has hepatitis A and you have never had the virus or the vaccine, you should see your doctor right away. He or she can give you a shot that will help keep you from getting sick.

What is hepatitis B and how is it transmitted?

Hepatitis B is a serious liver infection that is usually spread through contact with blood and/or body fluids of someone who has the infection. 

You can get hepatitis B if you have unprotected sexual contact with an infected partner. People who use intravenous (IV) drugs can get hepatitis B when they share needles with someone who has the virus. Health care workers (such as nurses, lab technicians and doctors) can get these infections if they are accidentally stuck with a needle that was used on an infected patient. The infection can also be passed from a mother to her baby during childbirth. You are also more likely to get hepatitis B if you travel to areas of the world where hepatitis B is common.

Hepatitis B cannot be transmitted through casual contact. For example, you cannot get hepatitis B by hugging or shaking hands with someone who is infected.

What are the symptoms of hepatitis B?

Symptoms of hepatitis B can include:

• Loss of appetite
• Nausea
• Vomiting
• Weakness and fatigue
• Abdominal pain, especially in the area around your liver
• Dark-colored urine
• Jaundice (the yellowing of the skin and the whites of the eyes)
• Joint pain

Symptoms of hepatitis B can range from mild to severe. If you have a mild case of hepatitis, you may not even realize that you have it. It may not cause symptoms or may only cause symptoms similar to the stomach flu.

What are the complications of chronic hepatitis B?

In some people, chronic hepatitis can lead to cirrhosis of the liver. Cirrhosis occurs when the liver cells die and are replaced by scar tissue and fat. The damaged areas of the liver stop working and can't cleanse the body of wastes. Cirrhosis can lead to liver failure and even liver cancer.

If you have hepatitis B, you are also susceptible to hepatitis D (also called delta virus). Hepatitis D can only develop in people who already have hepatitis B. It can make your symptoms of hepatitis B or liver disease worse. It is spread through contact with infected blood or other body fluids of people who have hepatitis D.

How is hepatitis B diagnosed?

Blood tests are used to diagnose hepatitis B. Blood tests can tell your doctor whether your liver is working properly, and they can also be used to monitor your condition during treatment.

Your doctor may want to look at your liver with an ultrasound exam or X-rays. A liver biopsy may also be needed. With a liver biopsy, a small piece of the liver is removed and looked at under a microscope. A liver biopsy can help your doctor diagnose your illness and see the condition of your liver directly.

How is chronic hepatitis B treated?

If you have chronic hepatitis B, your family doctor will probably refer you to a gastroenterologist or other subspecialist that treats people who have chronic liver problems. There are a number of medical treatments available that are often successful. These include interferon and other antiviral medicines. 
Treatment may take a year or more, depending on the severity of the infection and the response to treatment.

Can hepatitis B be prevented?

The best way to prevent hepatitis B is to have protected sex (use a condom) and to avoid sharing needles.

A vaccine is available to prevent hepatitis B. It is now routinely given in the first year of life to all newborn infants. It is safe and requires 3 shots over a 6-month period. This vaccine should be given to people who are at high risk for this illness, such as health care workers, all children, people who travel to areas where the infection is widespread, drug users and those who have multiple sex partners. 

What is hepatitis C?

Hepatitis C is usually spread through contact with blood products. People who use intravenous (IV) drugs can get hepatitis C when they share needles with someone who has the virus. Health care workers (such as nurses, lab technicians and doctors) can get these infections if they are accidentally stuck with a needle that was used on an infected patient. You are also at a higher risk if you got a blood transfusion or an organ transplant before 1992 (improvements in blood-screening technology were made in 1992). 

Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.

Most people who are infected with hepatitis C don't experience any symptoms for years. However, hepatitis C is a chronic illness (which means it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (scarring of the liver) and liver cancer.

What are the symptoms of hepatitis C?

At first, hepatitis C does not usually produce any symptoms. When it does, symptoms are typically flu-like and can include:

• Mild fatigue
• Achiness in your joints and muscles
• Nausea
• Lack of appetite
• Tenderness in the areas of your liver

As the disease progresses, symptoms may still not appear. When they do, they can include:

• Fatigue
• Nausea
• Vomiting
• Lack of appetite
• Jaundice (yellowing of the skin and eyes)
• Low-grade fever (fever up to 102 degrees)

I've never used IV drugs or been stuck with a dirty needle. How did I get hepatitis C?

Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It can also be transmitted by needles used for tattooing or body piercing. In rare cases, hepatitis C can be passed from a mother to her unborn baby. This virus can be transmitted through sex, sharing razors or toothbrushes, although these occurrences are also rare. Many times, the cause of hepatitis C is never found. 

Hepatitis C can't be spread unless a person has direct contact with infected blood. This means a person who has hepatitis C can't pass the virus to others through casual contact such as sneezing, coughing, shaking hands, hugging, kissing, sharing eating utensils or drinking glasses, swimming in a pool, using public toilets or touching doorknobs.

Could I give hepatitis C to someone else?

Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you cannot donate blood. You should avoid sharing personal items like razors and toothbrushes, although it is very rare to pass hepatitis C in these ways. Always use a condom when you have sex. If you have hepatitis C, your sexual partners should be tested to see if they also have it.

Talk to your doctor first if you want to have children. The virus isn't spread easily from a mother to her unborn baby, but it is possible so you need to take precautions. However, if you're trying to have a baby, do not have sex during your menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.

How should I take care of myself if I have hepatitis C?

You should eat a healthy diet and start exercising regularly. A dietitian can help you plan a diet that is healthy and practical. Talk to your doctor about medicines that you are taking, including over-the-counter medicine. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. You should also limit alcohol use, as it also speeds the progression of liver diseases like hepatitis C. An occasional alcoholic drink may be okay, but check with your doctor first.

Is there a vaccine for hepatitis C?

No, not for hepatitis C. There are vaccines for hepatitis A and hepatitis B. If you have hepatitis C, your doctor may want you to take the vaccine for hepatitis B (and maybe the vaccine for hepatitis A), if you don't already have these viruses. If you have hepatitis C, you are more likely to catch hepatitis A or hepatitis B, which would cause more damage to your liver.

Is there a treatment for hepatitis C?

Good health habits are essential for those who have hepatitis C, especially avoidance of alcohol and other medicines and drugs that can put stress on the liver. There is not yet a proven cure for hepatitis C, but it is noteworthy that after taking medicines for 6 months to 1 year, a significant number of people (45% to 75%) do not experience any more problems from hepatitis C. You should discuss treatment with a doctor if you have hepatitis C. 

What should I know about interferon?

Before you can start taking interferon, you will have a liver biopsy. This means that a tiny bit of your liver will be taken out in a surgical operation and your doctor will check this sample to see how much damage there is. Younger patients who have mild liver disease and fewer virus particles in the liver usually respond better to interferon and ribavirin treatment. 

What are the side effects of drug treatment?

Side effects of interferon therapy may include the following:

• Trouble sleeping
• Nausea
• Vomiting
• Fever
• Body aches
• Extreme fatigue
• Irritability
• Depression
• Concentration and memory problems

Side effects of ribavirin supplements may include the following:

• Decrease in red blood cells (anemia)
• Skin rashes and itchiness
• Extreme fatigue
• Nasal congestion
• Birth defects

Side effects are usually worst during the first few weeks of treatment and become less severe over time. If you are having trouble dealing with the side effects of your medicine, talk to your doctor. He or she can suggest ways to relieve some of the side effects. For example, if your medicine makes you feel nauseated, it may help to take it right before you go to sleep.

If taking medicine to treat hepatitis C makes you feel worse than the actual disease does, you may be tempted to stop taking your medicine before your treatment is done. However, if you don't prevent chronic inflammation from damaging your liver, you'll be much sicker in the long run. Don't stop taking your medicine until your doctor tells you to.

Do I have to have drug treatment?

The choice is up to you and your doctor. Some people who have hepatitis C don't have any symptoms. They only have slight inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to keep a close watch on you. This is done by checking your blood at least once a year (maybe up to 3 times a year). Your doctor might decide to start drug treatment only if the hepatitis C virus reaches a certain level in your body or you start experiencing many symptoms.

The decision to use drug therapy can be hard to make because of the side effects. Your doctor will pay attention to the type of the virus and the amount of the virus in your body. Your overall health, the results of your blood tests and the liver biopsy are also important factors to consider before you and your doctor start drug treatment for your hepatitis C.

How will I know if my treatment works?

The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that can't be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.

If your blood has so few copies of the virus that tests can't measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response (SVR). People who have an SVR have a good chance of avoiding serious liver problems in the future.

If treatment doesn't reduce your viral load, or if you don't have an SVR after treatment, your doctor will discuss other treatment options with you. For example, if one round of treatment did not decrease your viral load enough, your doctor may recommend a second round of treatment. Even if treatment doesn't keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.

 How can I cope with my feelings about having hepatitis C?

Coping with hepatitis C isn't easy. You may feel sad, scared or angry, or you may not believe you have the disease. These feelings are normal, but they shouldn't keep you from living your daily life. If they do—or if they last a long time—you may be suffering from depression. People who are depressed have most or all of the following symptoms nearly every day, all day, for 2 weeks or longer:

• Feeling sad, hopeless and having frequent crying spells
• Losing interest or pleasure in things you used to enjoy (including sex)
• Feeling guilty, helpless or worthless
• Thinking about death or suicide
• Sleeping too much, or having problems sleeping
• Loss of appetite and unintended weight loss or gain
• Feeling very tired all the time
• Having trouble paying attention and making decisions
• Having aches and pains that don't get better with treatment
• Feeling restless, irritated and easily annoyed

Talk to your doctor if you notice any of these symptoms. Your doctor can help by recommending a support group or a therapist, and/or by prescribing a medicine for you to take.