MEDICAL SURFARI; HEPATITIS HITS ANYONE

The liver has the distinction of being the largest gland in the body weighing in at about three to four pounds. Turgid with nourishment, it is teeming with fiercely efficient enzymes that detoxify our body. The liver is a smooth, maroon organ crouched under the right side of the diaphragm among its more submissive and slippery bellymates. Through its sinusoids and canaliculi blood and bile sluice quietly to perform the thankless job of converting and storing the food that we eat and removing deleterious substances that we inadvertently, although sometimes intentionally, ingest. The liver is appropriately named because without it there is no living.

There are many different types of diseases that may threaten this vital organ and hepatitis is one such category of diseases. Hepatitis is an inflammation of the liver. This can be caused by a multitude of toxins but the most common forms of hepatitis are caused by viruses. There are at least five virus types (hepatitis A, B, C, D and E). Although these viruses are quite different, they often produce similar symptoms including jaundice (yellow skin), fatigue, abdominal pain, loss of appetite, intermittent nausea and diarrhea.

Hepatitis A is usually transmitted by fecal-oral route or through food or waterborne outbreaks. Bloodborne transmission is very rare. Hepatitis B and C may be transmitted through blood or sexual contact and infants born to infected mothers may develop these forms of hepatitis. Viral hepatitis may be either acute or chronic, depending upon the type and hepatitis A and B are preventable by vaccination.

There are different prevention strategies for the various types of hepatitis. Good hygiene and sanitation are important to the prevention of hepatitis A and screening of blood, organ and tissue donors as well as counseling to reduce and modify high-risk sexual practices are important to the prevention of hepatitis B and C. Healthcare workers are particularly at risk for hepatitis B and C and their risk may be reduced by practicing universal precautions for blood and other body fluids.

Hepatitis D and E are less well studied. There are no vaccinations available for hepatitis C, D or E.

There is no specific treatment for hepatitis A or B other than supportive measures. Most people can be cared for at home and they require plenty of rest for anywhere from one to four weeks after the diagnosis is made. During this time, intimate contact with other individuals should be avoided. Individuals who have come in contact with patients who have hepatitis B may be given temporary immunization if treated within two weeks of exposure.

There are some medical treatments that have been tried for treating individuals with chronic hepatitis C, however, only 10-15 percent of patients treated have a long-lasting response.

If you are at particular risk for either hepatitis A or B, discuss the possibility of vaccination with your family physician.

World Wide Web Resources

Hepatitis Foundation International

www.hepfi.org/

The Hepatitis Foundation International focuses on bringing viral hepatitis under control, supporting research, educational programs, and materials for medical professionals, those with hepatitis, and the public.

Hepatitis Homepage

www.cdc.gov/nci/dod/diseases/hepatitis.htm

The Centers of Disease Control and Prevention provides a homepage devoted to information on hepatitis diagnosis, treatment and prevention.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.