Hepatitis - Liver Infection

The liver is a triangular-shaped organ tucked under the ribcage on the right side of the body. In an average adult, the liver is about the size of a football and weighs about three pounds. The liver is responsible for filtering out toxins from the blood, aiding with digestion and metabolism, and producing many important substances including blood-clotting proteins.

Hepatitis is a liver disease spread through blood contact and comes in three types, A, B, and C. Hepatitis A is a liver infection that does not lead to long-term health problems and almost always goes away on its own. However, hepatitis B and C are more serious and require monitoring and care.

In the United States, routine screening of blood donors for hepatitis B began in 1971. The most accurate screening test for hepatitis C became available in 1992.

Treatment for children’s cancer often requires transfusion of blood and blood products. Survivors who received blood products before these dates may have been infected with hepatitis B or C.

Signs and Symptoms of Hepatitis

Most people do not experience symptoms of hepatitis B or C when first infected. Some people have symptoms similar to the flu, such as fatigue, loss of appetite, nausea, vomiting, or low-grade fever. Some people may experience symptoms more directly related to the liver, such as jaundice (yellowish eyes and skin), dark urine, severe itching, or pale (clay-colored) stools. In rare cases, people may become very ill and develop liver failure.

Unfortunately, many people who become infected with hepatitis B or C during childhood become “chronically” infected. People with chronic hepatitis infections may have no symptoms and feel well, but they are at risk for scarring (cirrhosis) of the liver and other complications. In rare cases, liver cancer can develop. People with chronic hepatitis infections are also at risk for spreading the infection to others.

Tests to Check for Hepatitis

A blood test can be done to check for hepatitis:
  • People with chronic hepatitis B infection will test positive for hepatitis B surface antigen (HbsAg) and usually also test positive for hepatitis B core antibody (HbcAb or anti-HBc).
  • People with chronic hepatitis C infection usually test positive for the hepatitis C antibody (HCAb). If the test for hepatitis C antibody is positive, or if the person has impaired immunity (immunosuppression), the hepatitis C “PCR” test may also be done to check the level of hepatitis C virus in the blood.

Who is at risk for hepatitis B and C?

Anyone who received the following blood or serum products is at risk for hepatitis B (if transfused before 1972) and hepatitis C (if transfused before 1992):
  • Packed red blood cells
  • Whole blood
  • White blood cells (granulocytes)
  • Platelets
  • Fresh-frozen plasma
  • Cryoprecipitate
  • Immunoglobulin preparations (IVIG, VZIG)
  • Bone marrow or stem cells from an allogeneic donor (someone other than the patient)
Other risk factors include:
  • Blood clotting factors (such as Factor VIII or Factor IX) made before 1987
  • Solid organ transplants (such as kidney, liver, or heart) before 1993
  • Long-term kidney dialysis (lasting for at least several months)
  • Shooting or snorting drugs
  • Body piercing, tattoos
  • Sharing razors, nail clippers, or toothbrushes with people who have hepatitis
  • Occupational exposure to blood and body fluids
  • High-risk sexual behavior, multiple sexual partners, unprotected sexual intercourse

Follow-Up for Those at Risk

People at risk for hepatitis B or C should have blood tests to see if they are infected. If the blood tests show evidence of chronic hepatitis infection they should:
  • Have blood tests (ALT, AST, bilirubin, AFP, prothrombin time) done at least yearly to monitor the status of the liver.
  • Receive ongoing evaluation (and in many cases treatment) by a liver specialist.

Keeping the Liver Healthy

  • If someone does not have immunity to hepatitis A and B, they should get immunized against these common infections in order to protect the liver (there is currently no vaccine to protect against hepatitis C). A blood test can determine if someone has immunity to hepatitis A and B (Hepatitis A IgG antibody and Hepatitis B surface antibody).
  • Drink alcohol in moderation.
  • Drink plenty of water.
  • Eat a well-balanced, high-fiber diet. Cut down on fatty, salty, smoked, and cured foods.
  • Do not take more than the recommended doses of medications.
  • Avoid taking unnecessary medications.
  • Do not mix drugs and alcohol.
  • Do not use illegal street drugs.
  • Be careful about using herbs and natural supplements, especially when combined with medications.
  • If sexually active, use barrier protection (such as latex condoms) during intimate sexual contact to prevent infection by viruses that can harm the liver.
  • Avoid exposure to chemicals (solvents, aerosol cleaners, insecticides, paint thinners, and other toxins) that can be harmful to the liver. When using these substances, wear a mask and gloves and work in a well-ventilated area.
If someone has chronic hepatitis, they should also:
  • See a liver specialist for evaluation and possible treatment.
  • Tell their healthcare providers about all over-the-counter medications and supplements they are taking.
  • Avoid alcohol.
  • Avoid over-the-counter pain or fever-reducing medications containing acetaminophen (such as Tylenol).
  • Female patients who are pregnant should discuss their hepatitis status with their healthcare providers (including their obstetrician and the infant’s pediatrician).

Preventing the Spread of Infection

Hepatitis B and C are not spread by casual contact, such as hugging or shaking hands. However, if someone has hepatitis B or C they can prevent spreading the infection to others by:
  • Avoiding direct contact of blood and body fluids with others
  • Cleaning any spilled blood or body fluids with bleach
  • Covering cuts or other open sores
  • Avoiding sharing sharp personal objects, such as razors, toothbrushes, nail clippers, ear or body rings, or any object that may come in contact with blood
  • Making sure that new sterile needles are used for body piercing, injections, or acupuncture
  • Never sharing needles
  • Making sure all close household members and sexual partners are screened for hepatitis B. If they do not have immunity, they should be given the hepatitis B vaccine.
  • Using barrier precautions (such as latex condoms) during intimate sexual contact
  • Talking with a healthcare provider about whether a sexual partner should be tested for hepatitis C.