Hepatitis B and C 

Introduction
Hepatitis means that the liver is inflamed.  Liver inflammation can occur for several reasons, and there are different types of hepatitis.  Hepatitis B and C result from viral infections.  Hepatitis B and C are transmitted from an infected person to a non-infected person in blood or other body fluids, such as semen and vaginal secretions.

Hepatitis B and C may or may not cause symptoms.  Chronic forms of these diseases can result in life-threatening medical complications and death.  In some cases, medications can slow progression of the disease.  A liver transplant is the only permanent treatment for total liver failure.  There is a vaccine to prevent Hepatitis B.  There is not a vaccine to prevent Hepatitis C.

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Anatomy
Your liver is one of the largest organs in your body, second only to your skin.  The liver is unique in that it can regenerate itself.  If part of the liver is removed, the liver can grow tissue to be whole again.  Your liver performs over 100 functions—most of them are related to keeping you alive and healthy.  The main structures and functions of the liver are described below.
 
Your liver is divided into right and left lobes.  It is further divided into smaller lobes called the caudate and quadrate lobes.  The right lobe is the largest part of your liver.
 
About 25% of your total blood volume passes through your liver each minute.  Your liver receives blood from two sources, the portal vein and the hepatic artery.  Additionally, blood from your spleen drains into the splenic vein and connects with the portal vein.  Most of the blood received by your liver is from the portal vein.  Blood travels from your heart and through your gastrointestinal tract before returning to your liver via the portal vein.  This way, your liver is the first to receive substances from digested food. 
 
Your liver receives toxins, alcohol, nutrients, germs, and medications from your digestive tract.  As a result, one function of the liver is to metabolize toxins, alcohol, nutrients, and medications.  The liver kills germs that enter your body through your intestines.

The hepatic artery is the second source of blood supply to the liver.  Blood delivered through the hepatic artery comes directly from the heart.  It is higher in oxygen than blood from the portal vein.  Once inside the liver, blood from the portal vein and the hepatic artery mix.  The blood flows through tiny blood vessels in the liver called sinusoids.  Components in the blood are delivered by the sinusoids to the hepatocytes.

Hepatocytes are the major cell type in the liver.  The hepatocytes metabolize nutrients, toxins, and drugs from the blood.  Blood leaves the liver through the hepatic vein.  The blood flows through the vena cava and back to the heart. 

The hepatocytes perform numerous chemical processing functions that are necessary to keep you healthy and alive.  The hepatocytes play a role in blood clotting and secreting albumin.  Albumin helps to regulate the amount of fluids in your body.
 
The hepatocytes metabolize nutrients including carbohydrates, fats, cholesterol, and proteins.  Your liver functions to maintain appropriate ammonia and blood sugar (glucose) levels.  Correct levels of ammonia are necessary for good brain functioning.  Your cells use blood sugar for energy.  Your liver also stores vitamins, iron, and other minerals.
 
Another function of the hepatocytes is to filter certain compounds from the blood.  Blood arriving from the portal vein contains environmental toxins that were absorbed in the stomach.  The liver “detoxifies” or filters the toxins from the blood.  The toxins are secreted by your kidneys in urine or secreted into bile that leaves the liver.
 
Bile is a substance that is produced by your liver and stored in your gallbladder.  When you eat fatty foods, bile leaves your gallbladder via the common bile duct and travels to the duodenum, the first part of your small intestine.  There, the bile aids in breaking down fats for digestion.
 
Bile receives its yellow color from bilirubin.  Bilirubin is formed from the break down of old red blood cells.  Your spleen breaks down your old red blood cells. The hepatocytes metabolize the hemoglobin in old red blood cells into a form of bilirubin that can be excreted with bile.  This form of bilirubin is called “conjugated bilirubin.”  It eventually is removed from your body in your urine or stools.  Only a very small amount returns to your bloodstream.
 
The liver is unique in that it can regenerate itself.  If part of the liver is removed, the liver can re-grow tissue.  You need a liver to live.  If the liver is severely damaged, it needs to be replaced.

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Causes
Hepatitis means that the liver is inflamed.  Liver inflammation can occur for several reasons, and there are different types of Hepatitis.  Hepatitis B and C result from viral infections.  There is a vaccine to prevent Hepatitis B.  There is not a vaccine to prevent Hepatitis C.
 
Hepatitis B is caused by infection from the hepatitis B virus (HBV), and hepatitis C is caused by infection from the hepatitis C virus (HCV).  HBV and HCV are categorized as blood-borne viruses because they are transmitted from an infected person to a non-infected person in blood or other body fluids, such as semen and vaginal secretions.
 
Hepatitis B and C can be sudden and short term (acute) or ongoing and long term (chronic).  A small amount of people with hepatitis B develop a severe condition called fulminant hepatitis.  This form of acute hepatitis B is severe and life threatening.  Most people that contract hepatitis B are able to fight the infection.  However, some adults with acute hepatitis B develop chronic hepatitis B.  Chronic hepatitis B is a serious liver disease that can become a permanent condition.  Further, people with chronic HBV are chronic carriers of the virus and can transmit it other people, even if they do not get sick.
 
Hepatitis C is the most common cause of viral hepatitis and one of the most common causes of chronic liver disease in the United States.  The majority of people infected with hepatitis C develop chronic hepatitis C, however, most remain without symptoms.  HCV can lead to serious and life threatening medical conditions.  Both HBV and HCV can cause liver cirrhosis, end-stage liver disease, and liver cancer.  Cirrhosis causes the liver to scar, become hard, and stop functioning.  In cases of liver failure, a liver transplant is the only permanent treatment.

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Symptoms
Some people with hepatitis B and many people with hepatitis C do not experience symptoms.  Both forms of hepatitis produce similar symptoms including abdominal pain, loss of appetite, nausea, and vomiting.  You may feel tired all of the time.  Your skin may itch and you may develop jaundice, a yellowing of the skin and eyes.  The color of your urine may change and become as dark as cola or tea.  The color of your stools may change and become gray or clay colored. 
 
Fulminant hepatitis is an uncommon and severe form of acute hepatitis B.  Symptoms of fulminant hepatitis can occur suddenly and be life threatening.  Symptoms of fulminant hepatitis include abdominal swelling and jaundice.  You may feel extremely tired and collapse.  Fulminant hepatitis can cause hepatic encephalopathy, a brain condition.  Hepatic encephalopathy can cause confusion, hallucinations, extreme tiredness, extreme sleepiness, and coma. 
 
Fluid loss associated with nausea, vomiting, and loss of appetite can lead to dehydration.  Dehydration can be severe and life threatening.  Dehydration causes sleepiness, thirst, and dry mouth.  It can produce a lack of tears and urine production.  Older adults with dehydration may experience behavior changes and confusion.  Their skin may appear to be loose.  Consult your doctor if you or your loved one experiences signs of dehydration.

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Diagnosis
Many people without symptoms do not know that they have hepatitis B or C.  For some, it may be discovered during blood testing for physicals or insurance exams.  You should contact your doctor if you think someone with hepatitis has possibly exposed you.  You should contact your doctor if you think you are at risk for hepatitis.  Further, you should contact your doctor if experience the symptoms of hepatitis B and C.
 
Your doctor can start to diagnose hepatitis B or C by reviewing your medical history and conducting a physical examination.  You should tell your doctor about your risk factors, possible exposures, and symptoms.  Your doctor will test your blood for antibodies specific to hepatitis.  Antibodies are produced by your immune system to defend against a certain infection.  The antibody tests can indicate which type of hepatitis you have.  Blood tests will also be used to assess your liver functioning.  Your doctor may test for exposure to other viruses as well, such as HIV.  Imaging tests and a liver biopsy (obtaining a tissue sample for examination) may be needed in cases of advanced liver disease.

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Treatment
Some symptoms of hepatitis B and C can be treated at home.  You should drink plenty of foods and eat balanced meals to maintain adequate nutrition and hydration.  If you experience dehydration, you should contact your doctor.  Some people may need intravenous (IV) fluids.  Your doctor can prescribe medications to reduce nausea and vomiting.  You should avoid drinking alcohol and using street drugs.  You should avoid using medications that contain acetaminophen, such as Tylenol, because they may harm the liver.  Get plenty of rest and avoid strenuous exercise until your symptoms improve.
 
Treatment for and recovery from acute hepatitis B differs from person to person.  Most cases of acute hepatitis B resolve on their own.  There is no treatment to prevent acute hepatitis B from becoming chronic hepatitis B. 
 
Antiviral medications can help stop the HBV from multiplying in some people with chronic hepatitis B virus and allow the liver to heal.  Antiviral medications do not work for all people, and they may not be an appropriate option for select individuals.  In some cases of liver failure, a liver transplant is the only treatment that may help.
 
There is no cure for hepatitis C.  Some people with hepatitis C respond to prescription medications that fight HCV including interferon products and antiviral medications, or a combination of both. The long term medical consequences of hepatitis C differ from person to person.  Some people never develop complications.  Like hepatitis B, the only permanent treatment for end-stage liver disease is a liver transplant.

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Prevention
If you have been diagnosed with hepatitis, you will have regular appointments with your doctor.  It is important that you attend all of your appointments and follow your doctor’s instructions.  Do not drink alcohol or use street drugs.  Ask your doctor or pharmacist if your prescription medications and over-the-counter medications are safe for your liver.  Rest, drink plenty of fluids, and eat a balanced diet to stay as healthy as possible. 
 
There is a vaccination to prevent hepatitis B, but not hepatitis C.  People at risk for exposure to hepatitis B should receive the vaccination to prevent development of the disease.  If you are a healthcare worker, public safety worker, or family caregiver of a loved one with hepatitis, use routine barrier precautions when handling blood and body fluids and safe methods for handling needles and sharps.
 
If you are at risk for exposure to hepatitis B and C, do your best to control the risk factors that are controllable.  Stop using IV street drugs (“shooting up drugs”).  If you use IV street drugs, use only sterile needles once and participate in needle exchange programs. 
 
Practice safe sex methods if you are sexually active.  Using a condom may reduce the risk of hepatitis transmission.  If you are with multiple partners, get checked and receive prompt treatment for sexually transmitted diseases.
 
Be cautious about receiving tattoos or body piercing.  Ask questions to find out about the health and sterilization practices of the facility.  Avoid “home” tattoo or piercing methods.
 
Procedures are in place to screen blood, blood product, and organ donations for hepatitis in the United States.  Today, kidney dialysis centers have procedures to prevent the spread of hepatitis from their equipment.  You should ask questions about preventative procedures when receiving donated blood, blood products, organs, or hemodialysis. 
 
If you become pregnant, you should inform your doctor if you are positive for hepatitis or at risk for hepatitis.  Hepatitis can be transmitted from a mother to her baby during the birth process.  

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Am I at Risk

Risk factors may increase your likelihood of developing hepatitis B or C.  People with all of the risk factors may never develop hepatitis; however, the chance of developing the condition increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Hepatitis B and C is transmitted from the blood or body fluid of an infected person to an uninfected person.  Blood or body fluid contact is possible in several situations.  Risk factors for contracting Hepatitis B and C:

_____ Healthcare workers including doctors, nurses, dentists, family caregivers, and public safety personnel are at risk from fluid contact or needle sticks during their job duties. 
_____ Virus transmission can occur during unsafe sex with an infected person.  Using a latex condom may help reduce transmission.
_____ People with multiple sex partners, people with sexually transmitted diseases, people who participate in oral/anal sex, and men who have sex with men have a higher risk of contracting hepatitis B and C.
_____ Sharing needles, syringes, or water during injected street drug use (“shooting up”) can spread hepatitis B and C.
_____ People that received blood transfusions, blood products, or organ donations that were not screened for hepatitis have a risk of contracting the conditions.
_____ People that receive kidney dialysis, particularly those that have been on long term kidney dialysis, may be at risk for getting hepatitis B and C
_____  Sharing razors, nail clippers, toothbrushes, and other personnel care items can spread hepatitis B and C.
_____ Tattoo, body piercing, and acupuncture procedures can spread hepatitis B and C if the needles, instruments, and other supplies are contaminated.
_____ A mother can transmit hepatitis B and C to her baby during childbirth.

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Complications
Complications of hepatitis B and hepatitis C can be serious and life threatening.  People with these forms of hepatitis are at risk for developing chronic hepatitis.  Chronic hepatitis can lead to cirrhosis of the liver, cancer, and liver failure.  Liver failure can lead to death, and the only permanent treatment for end-stage liver disease is a liver transplant.  Additionally, complications from hepatitis C can affect the skin, blood, bone marrow, connective tissues, muscles, joints, or kidneys.
 
Fluid loss associated with nausea, vomiting, and loss of appetite can lead to dehydration.  Dehydration can be severe and life threatening.  Dehydration causes sleepiness, thirst, and dry mouth.  It can produce a lack of tears and urine production.  Older adults with dehydration may experience behavior changes and confusion.  Their skin may appear to be loose.  Consult your doctor if you or your loved one experiences signs of dehydration.
 
If you test positive for hepatitis C, ask your doctor about being tested for hepatitis B and other diseases that can be transmitted in a similar fashion.  You should talk to your doctor about being tested for HIV, the virus that causes AIDS.  Some people at risk for hepatitis C may also be at risk for contracting HIV.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.