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Tummy troubles: hepatitis TUMMY TROUBLES: HEPATITIS
Q. Hepatitis seems to be a common disorder in Australia. Please tell us about it?
A. It is common. To confuse the issue, there are several different kinds, with strange names such as Hepatitis A (once called infectious or viral hepatitis) and a more severe form named Hepatitis B, once called serum hepatitis because it was related to blood transfusions. Another kind which is neither of the above two is called "non-A and non-B hepatitis".
Q. Let us hear about the first kind, Hepatitis A.
A. Hepatitis A is the most frequent notifiable infectious disease in Australia and the most common infection of the liver. It may occur in epidemics but it generally smoulders on in isolated cases throughout the community at any time of the year. It takes about 2 to 6 weeks for the virus to produce symptoms after attacking the system.
Many people have sub-clinical bouts. They may feel off colour for a few days and recover without the typical picture of jaundice.
At the other end of the picture are severe fulminating cases in which death is imminent within a few days. These, fortunately, are rare. Middle-aged women tend to have more serious bouts and are more likely to develop the dangerous stages.
Q. What are the symptoms?
A. The onset may be abrupt or insidious. Often there is an elevated temperature, a sense of feeling unwell and general malaise, aches and pains in the muscles all over the body, often with severe backache and a headache that persists. Fever, chills, becoming very tired and symptoms like the "flu" are common symptoms.
Later, lack of appetite, nausea and maybe vomiting are common. Sometimes there is abdominal pain and maybe diarrhoea or constipation.
Often with the appearance of jaundice, a yellowing of the skin and whites of the eyes occurs. The eyes are often the parts in which this is first noticed. The urine becomes progressively dark (colour similar to that of strong, clear tea). As this deepens, the stools often become light in colour.
As the liver, spleen and lymph glands in the body become affected, they swell and may become tender. The liver can often be felt as it juts down from underneath the right lower margin of the rib cage. The spleen on the opposite side may be felt also. When an epidemic is in swing, diagnosis is often fairly simple. However, in milder, sporadic cases, this may be much more difficult, especially in the absence of the typical tell-tale signs, particularly jaundice.
Q. What about diagnosis and treatment?
A. Sometimes diagnosis is fairly easy but in others it is difficult. Various tests may be carried out to assist the doctor. Mild cases are treated at home, serious ones require hospital attention. Bed rest is advisable in the early stages. Whatever food that is desired is given — there are no restrictions, as in previous times, when fat was excluded rigidly. A high level of personal hygiene is essential to prevent its spread. Drug medication is usually kept to a minimum for it seldom helps. The patient is allowed to resume normal activities when he feels able. Although most cases improve fairly quickly, some deteriorate and specialised medical therapy becomes necessary. At present there is no vaccine available in Australia although it is being used overseas. Contacts are often given gamma globulin by injection and this confers some temporary protection.
Q. What about the other kind, Hepatitis B?
A. A more serious form of hepatitis has been occurring with increasing frequency over the past few years. It is referred to as Hepatitis B. Symptoms come on slowly after infection and may take as long as six months or more to develop. It is transmitted through contaminated blood contacting a person. At first, it was found in some patients following blood transfusions. But now it is well recognised that a person with few if any symptoms may act as a silent carrier of the disease for many years. Minute amounts of infected blood may set up the infection in another person who contacts it.
Although some laboratories have claimed to have isolated the virus, a product called hepatitis B surface antigen (HBsAg) is readily detected by special tests. This is not the virus but is present in all cases and indicates the virus is also present. In recent years, HBsAg has been detected in many other body fluids in infected persons, such as saliva, breast milk, urine, vaginal and seminal secretions. Whether or not these are all infectious is not known. The infection is much more common among male homosexuals, the promiscuous, and sexual transmission appears likely. The effect of kissing on infection is also unknown but it may be a hitherto unrecognised route.
In recent years, it is believed there is a close link between this disease and AIDS, for both appear to be more common in certain lifestyles.
Q. We often hear that Hepatitis B is more common in drug addicts. Is this true?
A. Because the virus is transmitted by blood, the disease is common amongst drug addicts and those using unsterile needles and syringes for injections. Several cases (and fatalities) have followed ear piercing when carried out in unsterile establishments.
For several years, Hepatitis B was a major problem in hospitals using large volumes of blood, particularly in open heart surgery wards and haemodialysis units. However, with an improvement in methods used for screening blood, and testing all nursing and medical staff, this problem has now largely been overcome in Britain and Australia.
The mortality rate is much higher than with Hepatitis A and figures ranging from 12-20 per cent have been quoted by authorities.
Q. What about treatment of Hepatitis B?
A. This must be under the doctor's supervision. General cleanliness and personal hygiene are essential. It is essential all precautions be taken to prevent the spread to others. General therapy is necessary, for at present there is no universal cure. It is treated symptomatically.
A specific immunoglobulin has been produced overseas and it is highly likely this will be used in persons who have been exposed and will probably greatly help in reducing the severity of symptoms. But this is not yet universally available and it will probably take some time before it is.
A vaccine has also been produced and this is given to those at special risk. It is said to be very effective. It is readily available in Australia via your own family doctor.
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