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Anal Fissure
Barrett's Esophagus
Colon Polyps and Cancer
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Diarrhea
Diverticulosis & Diverticulitis
Esophagitis and Stricture
Gallstones
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Gastroparesis
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H Pylori
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Lactose Intolerance
Ostomy
Pancreas Disease
Peptic Ulcer Disease
Prevention of Colon Polyps and Cancer
Rectal Bleeding
Ulcerative Colitis
Autoimmune Hepatitis
Cirrhosis
Fatty Liver
Hemochromatosis
Hepatitis
Hepatitis B
Hepatitis C
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis (PSC)
| | Hepatitis B
The Liver
The liver is the largest organ in the body. It is found high in the right upper
abdomen, behind the ribs. It is a very complex organ and has many functions.
They include:
 | Storing energy in the form of sugar (glucose)
| Storing vitamins, iron, and other minerals
| Making proteins, including blood clotting factors, to keep the body
healthy and help it grow
| Processing worn out red blood cells
| Making bile which is needed for food digestion
| Metabolizing or breaking down many medications and alcohol
| Killing germs that enter the body through the intestine |
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The liver shoulders a heavy work load for the body, and almost never
complains. It even has a remarkable power to regenerate itself. Still it should
not be taken for granted. The liver is subject to illnesses, such as hepatitis
B, which may lead to serious liver damage. 
What is Hepatitis?
When cells in the body are injured by such things as chemicals or infection, the
area that is hurt becomes inflamed. Hepatitis is inflammation of the liver,
which in turn causes damage to individual liver cells. It is most often caused
by viral infection. However, it can also be caused by alcohol, certain drugs,
chemicals or poisons, or other diseases.
 Hepatitis
may be either acute or chronic. In acute hepatitis the inflammation develops
quickly, and lasts only a short period of time. The patient usually recovers
completely, but it can take up to several months. Occasionally, a person fails
to recover fully, and the hepatitis becomes chronic. In other words, it
continues at a smoldering pace. Chronic hepatitis can develop over a number of
years without the patient ever having acute hepatitis or even feeling sick. As
the liver repairs itself, fibrous tissue develops, much like a scar forms after
a cut or injury to the skin heals. Advanced scarring of the liver is called
cirrhosis. Over time, cirrhosis irreversibly damages the liver, eventually
ending in liver failure.
What is Hepatitis B?
Hepatitis B is caused by the hepatitis B virus (medically abbreviated as HBV).
Current estimates are that over 250,000 people in the United States contract HBV
each year. It is often spread through sexual contact, accounting for about 50%
of the reported cases. It is also spread through contact with blood or body
fluids from a person carrying HBV. Some groups have a higher risk of becoming
infected with HBV. These include:
| Intravenous drug users
| Health care workers, funeral workers, police
| People in an HBV infected person's household
| People with multiple heterosexual or, especially, homosexual partners
| Residents of nursing homes
| Hemophiliac and hemodialysis patients
| Prisoners and prison workers
| Travelers to underdeveloped countries
| Certain ethnic groups such as Asians, Hispanics, American Indians, Alaskan
Natives, or people from developing countries |
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In pregnancy, the virus is passed from an infected mother to her child in
about 90% of the cases. This usually occurs during delivery. HBV is also carried
in breast milk. In about 30% of all cases of hepatitis B, however, it is unknown
how the patient contracted the virus. This situation is known as community
acquired disease.
HBV is much more contagious than the AIDS virus. For example, it can live
outside the body on a dry surface for up to 10 days. Once a person gets the
virus, it may take from one to six months for the infection and symptoms to
develop. One of three things can then happen -- most patients develop acute
Hepatitis B and recover completely; a small percentage become HBV carriers; and
some develop chronic hepatitis B.
Acute Hepatitis B
Many patients with acute hepatitis B have no symptoms, or the symptoms are mild
and often mistaken for flu. Their bodies are able to fight the virus off
quickly. Some, however, can become quite sick while their bodies are fighting
off the virus. The following are symptoms of acute hepatitis B:
| Loss of appetite, nausea, vomiting, fever
| Aching muscles and sometimes joint pain
| Tenderness in the right upper abdomen
| Jaundice (yellowing of skin and eyes)
| Tea-colored urine; putty-like or white stool |
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 Diagnosis
of the disease is made by a blood test. It is called the hepatitis B surface
antigen test (HBsAg). No specific treatment is available or usually necessary
for acute hepatitis infection. The physician may recommend supportive measures
to help the patient maintain strength and avoid taxing the liver while the
body's natural defenses are fighting the virus. Acute hepatitis B patients
recover completely within six months and develop antibodies that give them a
life-long immunity.
Some patients who become infected, however, do not recover completely. Up to
10% of adults with Hepatitis B and up to 50% of infected children under five
years of age are not able to completely fight off the virus within six months.
This occurs because their bodies are unable to develop antibodies against
hepatitis B. Most of these patients become HBV carriers. 
HBV Carriers
HBV carriers recover from the infection completely and feel healthy. They have
no ongoing hepatitis or liver damage. However, their blood tests show they still
have the virus and have not developed hepatitis B antibodies. Therefore, they
can pass on the virus. This is called an HBV carrier. Because carriers do not
develop symptoms or feel sick, thousands of people who become carriers of HBV
never know it. There may be as many as one million Americans carrying HBV. There
is no treatment presently available for this situation. Carriers have a
responsibility to practice safe lifestyle habits that will prevent their passing
the virus on to others. This especially includes protected sex. 
Chronic Hepatitis B
A smaller percentage of patients who cannot fight off the virus will develop
chronic hepatitis B. Like HBV carriers, chronic hepatitis B patients are also
able to pass on HBV. However, there is a very important difference with chronic
hepatitis B. These patients will also have ongoing hepatitis and liver damage. A
few may have an increased risk for developing cancer of the liver. Once again,
blood tests show that no antibodies have developed.
The physician usually suspects the condition when abnormal enzyme tests are
found on routine blood testing. There are rarely any symptoms in the early
stages of chronic hepatitis B. Additional tests, such as ultrasound, are helpful
to determine the condition of the liver. A liver biopsy is always performed to
determine the degree of inflammation and scarring. Under local anesthesia, a
slender needle is inserted through the right lower chest to extract a small
piece of liver for examining under a microscope.
Patients with chronic hepatitis B should avoid alcohol because it can cause
additional liver damage. Some medicines and drug combinations may cause liver
injury, so patients should review all medications they are taking with their
physicians. Patients should never take over-the-counter drugs without the
physician's approval. Chronic hepatitis B can now be treated with interferon
(trade name: Intron A). Some patients, however, are not good candidates for
interferon therapy. A liver disease specialist is often required to determine if
the patient should be placed on this therapy. Interferon has been shown to
reduce inflammation and liver damage in about 30% of treated patients. A few go
on to apparent complete recovery. In some, however, the disease returns when
therapy is stopped, and treatment may have to be restarted. There are bothersome
side effects with the drug, and treatment must be evaluated with the physician
on an individual basis.
Liver Transplantation
Liver transplantation is a newer and very successful form of therapy for people
with a badly damaged liver. In those patients with chronic hepatitis B, the new
liver usually becomes infected with the virus, but most transplant medical
centers are dealing with this effectively. There are new drugs for chronic
hepatitis B now under investigation. However, at the present time the best
defense against HBV is prevention.
Prevention and Vaccination
There is a safe and effective vaccine to protect or immunize a person against
hepatitis B. The vaccine usually offers protection for about 10 years or more.
However, it is of no use to those already infected with HBV. Persons who have
not been vaccinated and who know they have been exposed to HBV should receive an
injection of hepatitis B immune globulin within two weeks of exposure to the
virus. This is called a passive immunization. It gives immediate short-term
protection for 3-6 months. The Hepatitis B vaccine is active immunization.
Active immunization provides long-term (sometimes lifelong) protection.
Therefore, people who are at risk of coming in contact with the virus, and
especially newborn infants and sexually active teenagers, should be immunized.
In the U.S., pediatricians now recommend that all children be actively
vaccinated.
There are other precautions people should take to protect themselves against
hepatitis B. Since the virus is most often spread through sexual contact, it is
most important to avoid unprotected sex with those who have or are likely to
have the infection. Precautions must be taken to avoid coming in contact with
blood or body fluids from an infected individual. For those living in households
with infected patients, surfaces which may hold the virus should be cleaned with
one part household bleach to 10 parts water. Items such as razors, toothbrushes,
IV needles or pierced earrings should never be shared. People should also avoid
such practices as tattooing and ear piercing in places where sterile conditions
are questionable. Women who are pregnant should be tested for HBV and follow
their physicians' advice to protect their unborn children.
Summary
Hepatitis B is a serious disease that may result in long-term complications.
While most people recover, some develop chronic hepatitis. Some people become
carriers of HBV without knowing it. For this reason, it is important to prevent
spread of the disease by vaccination and by lifestyle practices that avoid
contact with infected blood and body fluids. For acute infections, no therapy is
available or usually necessary. Researchers are continually learning more about
hepatitis, and research into new treatments is ongoing. Chronic hepatitis B
patients who are monitored frequently and follow the advice of their physicians
have every reason to expect a good quality of life.
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