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The Symptoms and the Disease
Contents:
1. The Symptoms (Click Here)
2. The Acute Disease (Click Here)
3. The Chronic Hepatitis B
Carriers (Click Here)
4. Complications from Chronic
Carriage (Click Here)
5. Agents which cause
Hepatitis (Click Here)
6. The Liver Function Test
(LFT) (Click Here)
1.
The Symptoms of
an Infection:
- Fever
- Chills
- Nausea
- Anorexia
- Persistent fatigue
- Loss of appetite
- Itching of the skin
- Jaundice (observable
from the yellowing of skin and whites of the eyes)
- Abdominal pain
- Pale stools
- Liver enlargement
- Presence of bililrubin
in urine, causing it to become dark-coloured
- Detection of the Dane
particle ( the infectious HBV) in the stools or blood
- Abnormal Liver
Function Tests (LFT)
- For infected expectant
mothers, amniocentesis, prolonged labour and other
obstetrical manipulations may encourage the development
of intrauterine infection.
2.
The Acute
Disease:
- Acute hepatitis B
infection causes hepatitis.
- Hepatitis: an inflammation of the
liver, which can be caused by viral infections, toxic
agents (excessive consumption of alcohol) or drugs,
during which a person will experience some of the
symptoms listed above.
- After infection, there
is an incubation period before the HBV becomes active.
This ranges from 15 to 150 days, with and average of 8
weeks.
- Of adult cases, acute
hepatitis B infection may end fatally in 1-2% of cases,
or become chronic in 5-10% of cases.
- Of infected adults, 70
to 80% will recover fully.
- Time taken for full
recovery ranges from 3 to 6 months.
- During which a lot of
rest is required. Some may even require hospitalization.
- 90% of infected
mothers pass the HBV into their new-borns during
delivery.
- Perinatal infection
does not cause congenital malformations.
- Most infected infants
who were not vaccinated at birth become chronic carriers.
3.
The Chronic
Hepatitis B Carriers:
- A
chronic Hepatitis B carrier is an infected person
who is unable to eliminate HBV completely from the body
and carries the virus in the body for the rest of the
person's life.
- A
carrier is able to infect others, although the
"infectiousness" of a person varies greatly
from one ot another.
- Nearly
40% of all carriers world-wide are infected at birth.
- A
chronic carrier will not show symptoms of hepatitis B for
many years, hence a person can be a carrier and not know
about it.
- "Infectiousness"
of a carrier can be determined through a blood test for the
relevant antigens and antibodies.
- Approximately
5% of the world-wide population are asymptomatic
carriers, the rates varying from near zero in parts of
the western world to over 15% in some Asian and African
countries.
- In the
1990 census by WHO, the global prevalence of HBV carriers
had increased from 280 million a decade ago to 350
million, and it is thought that more than 2 billion
have been infected.
- In
South-East Asia, it is estimated that there are 45
million carriers.
- Chronic
carriers have a 50% lifetime risk of dying from complications of chronic
HBV carriage.
- Males
have a higher carrier rate for HBV than females, a ratio
of 4:1.
4. Complications
from Chronic Carriage:
Subcontents:
1. Cirrhosis (Click Here)
2. Primary Liver Cancer (Click Here)
3. Symptoms of Primary Liver
Cancer (Click Here)
1. Cirrhosis of the Liver:
- Cirrhosis is
anatomically characterized by widespread fibrosis and
nodule formation in the liver.
- Liver cells are
replaced by non-functioning, fibrous tissues and
shrinking of the liver.
- Hence the normal liver
architecture is distorted and this interferes with blood
flow to the liver.
- Ultimately, cirrhosis
leads to liver failure, as the hepatocytes can no longer
perform its normal biochemical functions.
- Cirrhosis is most
commonly associated with alcohol abuse and hepatitis.
2. Primary Liver Cancer (PLC):
- Primary liver cancer
is the eighth most common cancer in the world.
- In Singapore, it is
the third most common cancer, and the second most common
cancer in males.
- It is crudely
estimated that over a million people die annually from
it.
- PLC afflicts all
ethnic groups.
- There is an unusually
high predilection for males over females by a ratio of
4:!.
- Up to 90% of PLC is
primary hepatocellular carcinoma (HCC).
- HCC rarely occurs in
people who become chronically infected in adult life but
frequently occurs in those with chronic infection
acquired in infancy.
- The major causes of
PLC are chronic HBV carriage, alcohol, and smoking.
- Up to 80% of liver
cancers are due to HBV.
- Universally, it is
accepted that when HCC presents clinically, the disease
is fatal.
- The median survival
frequency of HCC patients is less than 3 months.
- However, if the growth
detected early and under 3 cm in size, there is a 85%
chance of a cure.
- Treatment involves
surgery, hepatic irradiation, and anticancer drugs.
3. Symptoms of Primary Liver Cancer:
- Prolonged periods of
tiredness
- Poor physical
performance at work, exercise and leisure
- Upper abdomen pain
- Difficulty in eating
- Loss of appetite
- Persistent diarrhoea
- Abdominal swelling
- Swelling of the legs
- Yellowing of the eyes
- Passing of blood in
the stools
- Drowsiness
5.
Some of the Agents which cause Hepatitis:
- Hepatitis A virus
(HAV)
- Hepatitis B virus
(HBV)
- Hepatitis C virus
(HCV)
- Delta hepatitis virus
- Hepatitis E virus
(HEV)
- Hepatitis B mutant
variants
- Cytomegalovirus
- Epstein-Barr virus
- Herpes-simplex virus
- Adenoviruses
- Coxsackieviruses
- Childhood exanthemata
- Measles
- Rubella
6.
The Liver Function Test (LFT):
- Below are some of the
things that would be tested for in a typical LFT.
- I don't know what most
of the names mean. Sorry.
| Test |
Normal values |
| Bilirubin (Total) |
Up to 1.5 mg/dl |
| g-Glutamyl Transpeptidase (g-GT) |
Males: 9-50 , Females 8-40 u/l |
| Alkaline Phosphatase |
36-120 u/l |
| Aspartate Amino-Transferase (AST) |
16-40 u/l |
| Alanine Amino-Transferase (ALT) |
8-54 u/l |
| Total Protein |
6.6-8.7 g/dl |
| Albumin |
3.7-5.2 g/dl |
| Globulin |
2.5-3.9 g/dl |
| Alpha-Fetoprotein (AFP) |
Up to 15 ng/ml |
The typical blood test
for hepatitis
B screening would
involve testing for:
- Hepatitis Bs Antigen
- Hepatitis Bs Antibody
- Hepatitis Be Antigen
- Hepatitis Be Antibody
References:
C.J.Oon, 1995, Viral
hepatitis from A to F
C.J.Oon, Hepatitis B:
clinical features and prospects for elimination
C.J.Oon, 1991, Landmarks in
the prevention and treatment of hepatitis B virus infection
C.J.Oon, 1986, Prevention
and control of primary liver cancer
C.J,Oon, 1987, Primary
liver cancer: prospects for prevention and elimination
El-Fadil E Omer, 1995, Clinical
significance of markers of hepatitis B
Paul Miskovitz, 1996, Overview
of viral hepatitis
Howard J. Worman, Cirrhosis
Robert's HBV Page
InsideMEDICINE Report
Public information pamphlet by SmithKline Beecham
Pharmaceuticals
