The functions of the liver include breaking down nutrients into forms that are easier to utilize by the body, ridding the body of toxic or foreign substances, storing vitamins, minerals, glucose and iron, controlling the collection of fat, utilizing cholesterol, regulating blood clotting, and producing energy, immune factors, hormones and proteins for blood plasma. If the liver becomes infected (hepatitis) liver cells will be destroyed, affecting all the various functions of this organ.

A common cause of hepatitis is infection by a virus. Other causes of hepatitis include alcohol, bacterial infection, protozoan infection, leptospirosis, parasites, and certain medications and chemicals.

1. Hepatitis A virus (HAV)

Infection occurs more often in older children and adults rather than small children. When infected the body produced antibodies to fight the virus and the infection goes away on its own and does not lead to chronic infection or chronic liver disease. A vaccine to prevent hepatitis A virus infection is available.
 

2. Hepatitis B virus (HBV)

Persons infected often have no symptoms and the infection usually disappears on its own. In 1-2% of cases the infection can become chronic and in 10% of cases the infected person will become a carrier of the disease. A vaccine to prevent an hepatitis B virus infection is available.
 

3. Hepatitis C virus (HCV)

Persons infected often have no symptoms and acute infection is uncommon. Infection can lead to cirrhosis and liver cancer. There is no vaccine available to prevent hepatitis C virus infection.
 

4. Hepatitis D virus or delta hepatitis (HDV)

This virus can only propagate in the presence of the hepatitis B virus and can cause severe hepatitis.
 

5. Hepatitis E virus (HEV)

Though propagation of this virus has not occurred in Thailand, it is widely prevalent in neighboring countries like Myanmar, India and Bangladesh.
 

6. Hepatitis G virus (HGV)

It is transmitted through blood and intercourse.
 
 

The most common symptoms of hepatitis are fatigue, body aches, muscle pain, joint pain, nausea, vomiting, loss of appetite, fever, and headaches. These symptoms are similar to those of the flu, making it easy to mistake one for the other. Some infected persons may experience abdominal tenderness, pain in the right ribs, pale stools, dark urine, or jaundice, characterized by yellow skin and/or eyes. The jaundice usually disappears in one to four weeks, but in some persons may be severe and causing itching, which can last two to three months. Most patients will recover completely, except for those who develop hepatitis B infections. Approximately 5-10% cases will become carriers of the disease while more than 85% will develop a chronic infection.
 

A diagnosis is reached by considering the symptoms mentioned above, a physical examination, and the following blood tests:

1. Liver function test (LFT) which usually reveals levels of the enzymes SGOT (serum glutamic-oxaloacetic transaminase), SGPT (serum glutamate pyruvate transaminase) and bilirubin that are higher than normal
2. Test for the type of hepatitis virus, as follows:

• For the hepatitis A virus, patients can be tested for the anti-HAV IgM (anti-hepatitis A virus immunoglobulin M) that are created in the first stage of infection.
• For the hepatitis B virus, patients can be tested for HBsAg (hepatitis B surface antigen), which is a sign of infection of the hepatitis B virus or of the status of carriers of the virus. Patients can also be tested for the anti-HBs (anti-hepatitis B surface antibody), which means the body has begun creating antibodies to fight the virus or the patient has been vaccinated against the hepatitis B infection, and the anti-HBc IgM (anti-hepatitis B core immunoglobulin M), which indicates a past or present infection.
• For the hepatitis C virus, patients can be tested for the anti-HCV (anti-hepatitis C virus) that indicate either acute or chronic infection.
• For the hepatitis D virus, patients can be tested for the anti-HDV IgM (anti-hepatitis D virus immunoglobulin M) that indicates acute infection and the anti-HDV total ab (anti-hepatitis D virus total antibodies) that indicates acute and chronic infection.
• For the hepatitis E virus, patients can be tested for the anti-HEV IgM (anti-hepatitis E virus immunoglobulin M) that indicates acute infection and anti-HEV IgG (anti-hepatitis E virus immunoglobulin G) indicates that you have had a hepatitis B viral infection and the body has begun creating antibodies to fight the virus.
• There is currently no test for the hepatitis G virus antibodies.

There is no specific treatment for hepatitis; only the symptoms can be managed. Rest is important in managing fatigue and it is recommended that patients eat foods that are easy to digest and low in fat to prevent nausea, bloating and abdominal fullness. The doctor may prescribe medication to treat excessive vomiting or for severe itching. Avoid substances that are harmful to the liver, such as alcohol and certain medications.
 

Some carriers of the hepatitis B virus and most carriers of the hepatitis C virus will develop chronic hepatitis that may last more than six months. If left untreated, it can progress into cirrhosis and finally liver cancer (hepatocellular carcinoma).

There are many types of medications that can be used to treat chronic hepatitis B and a gastroenterologist and/or hepatologist will determine which medication is most appropriate for each patient’s condition and medical history.

As for hepatitis C, since it may progress into cirrhosis and liver cancer, it is important that the strain of the virus is determined and an appropriate length of treatment is planned to suit each patient to guarantee highest efficacy. Furthermore, the patient may need a special blood test, a FibroScan (to check for adhesions in the liver to gauge severity of cirrhosis) or a liver biopsy to assess the status of the infection before treatment is started.

1. Avoid behaviors that may put you at risk of being infected. Wash your hands regularly, eat food that is cooked well, drink clean water, avoid contact with other people’s bodily fluids, do not share personal objects and practice safe sex.
2. Build immunity by getting vaccinated. Currently there are vaccines for infections of the hepatitis A and hepatitis B viruses.

In the cases of infections of the hepatitis A and E viruses, these will go away on their own and never recur. In the case of infection of the hepatitis B virus, more than 90% of patients will recover and have immunity against recurrence. There isn’t enough information on the hepatitis C virus and hepatitis D virus antibodies so it is unclear if recurrence of these infections is possible.

Furthermore, while symptoms may improve or disappear entirely, the patient may still be infected with the virus, which may attack the liver at any time. They are simply suppressed or controlled by antibodies created once the symptoms have improved and the patient feels stronger.