Hepatitis can therefore be viralor non-viral and a distinction is made between acute and chronic hepatitis. Chronic hepatitis occurs when the disease lasts longer than 6 months.
The liver is the largest and most important metabolic organ in humans. It is also the largest gland in our body. Located in the right upper abdomen, its surface is directly adjacent to the diaphragm.
The portal vein system of this organ is of particular importance. Before substances can spread in the organism, they first enter the liver via the portal vein. This "first-pass effect" means that drugs can be metabolized there and their effect can be strengthened or weakened.
At the same time, the body's cells are protected from ingested alcohol, for example. It also first passes from the intestine to the liver for metabolization.
The location of the liver in the human body © yodiyim | AdobeStock
The metabolic performance of the liver depends very much on the function of the liver cells. However, these can be infected by various viruses via the bloodstream. This results in severe inflammation and thus also functional limitations in liver metabolism. Such inflammation of the liver is known as hepatitis .
The commonly used term jaundice is, strictly speaking, imprecise. The conspicuous yellow coloration (= icterus) of the skin and eyeballs does not occur in all cases of liver inflammation. Jaundice can also be the result of a blockage in the bile ducts. This is usually caused by gallstones or tumors.
Regardless of the exact cause, hepatitis always begins with damage to and destruction of liver cells. Proteins and enzymes, known as transaminases, are released from these cells. If these liver transaminases increase in the blood, this is an indication that hepatitis may be present.
Various inflammatory messengers are released during acute hepatitis. They lead to the observed general symptoms such as fever and a flu-like feeling of illness.
In many cases, the inflammation of the liver only becomes noticeable when the liver function is impaired.
Disturbances in haemoglobin and bile acid metabolism lead to an increase in bilirubin. This is a breakdown product of the red blood pigment haemoglobin. Bilirubin in the blood causes
- the typical yellowing of the skin and whites of the eyes,
- the dark coloration of the urine and
- discoloration of the stool and
- itching
and itching. As the energy metabolism is disturbed, sufferers often feel weakened. In the case of very severe liver inflammation, other functions are impaired, such as the production of coagulation factors or the detoxification of the blood.
Typical symptoms of hepatitis at a glance:
- Tiredness
- headaches
- Loss of appetite
- Feeling of pressure in the right upper abdomen
- vomiting
- itching
- fever
- Dark coloration of the urine
- Light coloration of the stool
- Yellowing of the skin, mucous membranes or eyes (so-called jaundice).
For diagnosis , the doctor can quickly clarify a suspected case of hepatitis with the help of a blood sample and a subsequent examination. If specific antibodies against the relevant hepatitis virus can be detected in the blood, then a diagnosis of liver inflammation has been made.
Yellow whites of the eyes are one of the symptoms of hepatitis © blackday| AdobeStock
If chronic hepatitis is suspected, further follow-up examinations are necessary, for example in the form of a tissue sample(liver biopsy).
As soon as a hepatitis disease of type A, B, C, D or E is present, the treating doctor must report this to the public health department in accordance with Section 6 of the Infection Protection Act.
Hepatitis either heals without consequences after the acute phase has been overcome or it turns into chronic hepatitis.
In the long term, chronic progression leads to the development of a so-called shriveled liver(liver cirrhosis). Functional connective tissue is irreversibly (irreversibly) converted into non-functional tissue(fibrosis).
In the final stage of this liver inflammation, the liver becomes largely non-functional. As a result, the blood backs up in front of the liver through the entire circulatory system. As a result, bypass circulations develop, which manifest themselves in the increased formation of internal varicose veins(varices).
Due to the lack of coagulation factors caused by hepatitis, patients are increasingly prone to bleeding and coagulation disorders. In addition, body fluid very frequently leaks into the abdominal cavity, a phenomenon that doctors refer to as ascites (ascites).
The liver dysfunction leads to further symptoms such as
- malnutrition,
- increased susceptibility to infections,
- increased tendency to bleed,
- states of confusion (= "hepatic encephalopathy") and
- metabolic disorders.
In addition, cirrhosis of the liver as a result of chronic hepatitis increases the risk of hepatocellular carcinoma.
Hepatitis is caused by a wide variety of factors, including
- Alcohol,
- toxins and
- Bile retention due to a tumor or gallstone disease.
Viruses also play a major role. Viruses that cause liver inflammation are currently divided into five groups:
- Hepatitis A viruses (HAV), which are mainly ingested via contaminated food.
- Hepatitis B viruses (HBV), which are sexually transmitted infections that use the bloodstream to infect new hosts.
- The hepatitis D virus (HDV) is closely related to hepatitis B. This defect virus is a frequent concomitant infection of hepatitis B and requires its envelope in order to infect new cells.
- Hepatitis C is caused by the hepatitis C virus (HCV) of the same name and is probably the most dangerous hepatitis in this series. If left untreated, it always leads to chronic hepatitis with liver cirrhosis and ultimately culminates in liver cancer.
- Hepatitis E viruses (HEV) are mainly transmitted through drinking water contaminated with faeces. They are particularly widespread in Africa and Asia.
Hepatitis viruses are therefore transmitted via the bloodstream (B, C and D) or through so-called smear infections (A and E). This means that in the case of a viral infection, there has been oral or fecal contact. This can happen through sexual contact or through contact in a shared household via utensils.
In general, contaminated sanitary facilities are a danger zone. Contaminated food can be a source of epidemic infection. This includes vegetables or shellfish fertilized with faeces and occasionally drinking or bathing water. Many people then fall ill at the same time.
In general, third world countries are risk areas for hepatitis. Travelers in particular should therefore always bear the following saying in mind: "Boil it, peel it or leave it" ("Boil it, peel it or leave it"). This means that any food that has not been cooked or peeled should be avoided.
However, special care must also be taken in the case of hepatitis B and C with regard to sexual contact and fleeting vacation acquaintances. If left untreated, both diseases can develop into a permanent form of liver inflammation and have a massive impact on the rest of your life.
However, in addition to the general rules of conduct, there is also the option of vaccination in the case of some hepatitis viruses. The following section therefore deals with infection routes and preventive measures.
Hepatitis A (HAV) is spread worldwide. However, it can lead to frequent infections in southern countries in particular. The virus is characterized by its extreme resistance even outside the human body.
Due to this characteristic, the hepatitis A virus survives if it is flushed into the sea via faeces. Shellfish and other marine animals absorb it from the water and accumulate it unintentionally via filtration mechanisms. Anyone who then enjoys a seafood pizza on vacation can easily become infected with the virus.
This is why hepatitis A is now one of the classic diseases that can occur when traveling ("travel hepatitis").
The duration until the outbreak of the disease after infection(incubation period) is very long at 15 to 50 days. In many cases, the vacation is already over by then, making hepatitis A more difficult to detect. To make matters worse, children in particular are usually asymptomatic, i.e. they show no signs of the disease at all.
If symptoms do occur, the main symptoms for a diagnosis are
- Gastrointestinal complaints
- feeling of fullness
- nausea
- General feeling of illness
- Mild fever
- Yellowing (= icterus, "jaundice") of the skin and whites of the eyes
Hepatitis A is always acute and, unlike hepatitis B and C, does not develop into a chronic disease.
After surviving an infection, a person is immune for life, making re-infection impossible.
However, this liver inflammation can be completely prevented by vaccination. Travelers to southern Europe or Africa and Asia in particular should be aware of this before they travel.
Depending on the health insurance company, such a vaccination is even reimbursed as a precautionary measure for travel protection. In any case, children up to the age of 18 receive the vaccination free of charge in combination with the hepatitis B vaccination.
The hepatitis B virus (HBV) is transmitted via the bloodstream as well as other bodily fluids, including
- semen,
- tear fluid,
- saliva and colostrum.
The disease is therefore a sexually transmitted infection (STI).
In the acute disease, the first symptoms after 60 to 120 days are
- nausea,
- vomiting,
- joint pain,
- fever and
- fatigue.
Later, the characteristic yellow coloration also occurs in hepatitis B. Around one percent of patients die from acute hepatitis, especially if the organ has already been damaged by cirrhosis or other causes. A further ten percent eventually develop chronic liver inflammation.
Vaccination offers reliable protection against hepatitis B © Sherry Young | AdobeStock
The situation is different in children: 90 percent of infections develop into a permanent form. Chronically infected people are a source of infection for the rest of their lives and are not allowed to work in the hospitality or healthcare sectors, for example. This means that hepatitis B also has a profound impact on the lives of those affected.
Between 0.7 and one percent of people in Germany are chronically infected. The best protection is provided by the triple vaccination, which is free of charge if given in childhood.
Are you unsure whether you should be vaccinated? The following list shows the groups of people who are currently recommended to be vaccinated:
- All infants and young children can receive the hepatitis B vaccination. In addition, all previously unvaccinated adolescents between the ages of 9 and 17 should be immunized.
- If the mother is infected with hepatitis B, newborns should also be vaccinated immediately after birth as a precautionary measure (passive immunization).
- People who are already weakened by other persistent illnesses should also be vaccinated. This group of people includes, for example
- with chronic kidney disease,
- dialysis patients,
- People with frequent transmission of blood or blood components,
- patients before major operations and
- people who mainly live or work in psychiatric or other care facilities or in sheltered workshops.
- People with chronic liver disease and HIV-positive people who have not yet been infected with hepatitis B will also benefit.
- Staff in the health service, including
- Trainees and students,
- Laboratory and cleaning staff,
- staff in psychiatric institutions, in homes for asylum seekers and workshops for the disabled and
- other people at risk of infection through blood contact (e.g. first responders, police officers, waste disposal workers)
- Those who travel frequently to tropical and subtropical areas where hepatitis B is common should also be vaccinated. The same applies if close (including sexual) contact is to be expected during the vacation trip.
The vaccination provides long-lasting protection against infection with hepatitis B viruses. Nevertheless, regular booster vaccinations are recommended after 15 years, depending on the antibody titre in the blood. After risk contacts or for people who work in the health service, booster vaccinations may be advisable after 10 years.
Hepatitis C (HCV) is the most insidious of all hepatitis infections in humans. After a rather short acute phase, hepatitis progresses to a persistent form. The acute phase is often symptom-free. Within 15 to 30 years, liver cirrhosis slowly develops, which can progress to liver cancer.
The incubation period until the first symptoms appear is usually six to eight weeks. Flu-like symptoms are very common, which eventually lead to jaundice. Chronic hepatitis C is usually silent and is therefore often not noticed.
However, there are a number of other symptoms that may indicate such an ongoing infection:
- Fatigue
- loss of performance
- Upper abdominal discomfort
- Itching of the skin
- Joint problems and other rheumatic diseases
- Kidney diseases
- Depression
Unfortunately, vaccination against hepatitis B, D and A is not possible with hepatitis C. The only protection is therefore to avoid blood-to-blood contact, as blood is still the main route of infection.
The following are therefore particularly at risk
- Injecting drug addicts
- Tattoo lovers who have a new tattoo made abroad, and
- people who are prone to risky sexual practices.
Until the early 1990s, contaminated blood or blood products were the main cause of new infections. The virus was not identified until 1989. Since then, blood products can be tested for hepatitis viruses.
In general, however, hepatitis C is now considered curable. This is thanks in particular to new drugs approved in 2014 that inhibit the replication of the virus in the liver.
The prognosis for a complete cure is between 60 and 95%. Influencing factors for this are
- the virus genus (1-6),
- the degree of liver cirrhosis,
- the presence of concurrent infections with other pathogens, such as HIV or hepatitis B.
Early diagnosis and treatment should therefore always be sought.
The hepatitis D virus (HDV) is a so-called defect virus. This means that it cannot replicate in the liver cells alone. Hepatitis D requires a simultaneous infection of the cells with hepatitis B for its reproduction cycle. It practically uses the envelope of the B virus as a helper virus to infect new liver cells.
Transmission is similar to hepatitis B. Double infections with both viruses can occur with frequent sexual intercourse. Such co-infections with hepatitis B and D are usually even more severe than infections with hepatitis B alone.
If a D variant develops, it is therefore important for the patient to know whether
- a simultaneous infection with B and D has occurred(simultaneous infection) or
- the D variant has developed later(superinfection).
The liver suffers significantly more in the case of a superinfection. However, the course of the disease is also much slower compared to the B variant.
Up to 90 percent of those affected then develop a chronic liver infection, which can lead to liver cirrhosis and liver cancer. It is therefore very important to treat dual infections with hepatitis B and D with antiviral medication at an early stage. This offers the best chance of slowing down the progression of the disease or reducing the viral load.
The best protection against infection with hepatitis D is also provided by the hepatitis B vaccination.
This form of inflammation of the liver with hepatitis E (HEV) is a disease that occurs worldwide. It occurs mainly in Asia, Africa and third world countries. Similar to hepatitis A, it is transmitted to humans via contaminated water.
In Europe, the risk of infection lies in the consumption of undercooked pork or contaminated wild boar meat. The Federal Institute for Risk Assessment recommends meticulous hygiene when preparing wild boar meat. Anyone who cuts up a wild boar or parts of it themselves should always wear gloves.
Contaminated wild boar meat can transmit hepatitis E © photocrew | AdobeStock
People with an acute or chronic immunodeficiency are among the residual risk groups. For them, a hepatitis E virus is more likely to trigger a hepatitis E infection.
Around 40 days after infection, typical symptoms appear with yellowing of the skin and eyes. As the disease is usually asymptomatic in children, there is a lack of reliable evidence in this age group.
Hepatitis E is usually over after around two to three weeks. Persistent forms of the disease are not known. There is neither a therapy directed against the virus nor a vaccination approved in Europe against the infection.
What can be done to prevent infection with hepatitis? Here are some tips that are particularly useful for long-distance travel and potentially risky everyday situations:
- When traveling in distant countries, peel or cook vegetables and fruit before eating them.
- Do not use ice cubes in Asia, Africa and South America (the water should be boiled).
- Only eat meat products and especially offal from pork, wild boar, deer or venison when fully cooked.
- Use a condom to protect yourself during sexual intercourse, especially when changing partners.
- Ensure good hygiene conditions when using sharp objects such as scissors, needles or knives (in nail salons, for hand and foot care and in tattoo stores).
