Hepatitis B is a notifiable inflammation of the liver caused by a viral infection that may be manifested by pain in the upper abdomen, a characteristic yellowing of the skin, poor performance, fatigue, nausea, vomiting, or diarrhea. The liver may become enlarged and reacts painfully to pressure impulses.
What is hepatitis B?
In most cases, hepatitis B is not recognized as such immediately after the first symptoms appear. Diagnosis must also distinguish between chronic and acute hepatitis B disease and how far the inflammation has progressed or healed. 90% of infected persons suffer from an acute infection with hepatitis B, which heals and can be overcome within six months. 10% of cases of the disease are chronic and can develop either from a previous acute infection with hepatitis B or right at the beginning. In this case, the disease outlasts the six-month period. The younger a patient infected with hepatitis B, the greater the risk that the disease will become chronic.
Causes
Hepatitis B is many times more contagious than HIV, the virus that causes AIDS. It can be transmitted when open skin or body orifices come into contact with bodily fluids such as blood or saliva from an already infected person; a large number of hepatitis B infections are transmitted through sexual intercourse. Even a small amount of body fluid contaminated by the virus carries a high risk of infection. Worldwide, about five to seven percent of people chronically infected with hepatitis B are believed to be infected to date, and newborns can contract hepatitis B from their mothers at birth and are also likely to suffer a chronic course of the disease due to their young age.
Symptoms, complaints, and signs
The symptoms of infection with hepatitis B are not clearly outlined in the majority of cases. The majority of those who contract the disease – about two-thirds – either have no symptoms at all or experience an indeterminate feeling of illness. After an incubation period of about two to four months, symptoms include fatigue, joint pain, headache, loss of appetite, weight loss or muscle complaints. Many patients complain of fever. A more obvious sign of infection with hepatitis B is a feeling of pressure in the area of the right upper abdomen. Only about one-third of patients develop symptoms of jaundice after an outbreak of hepatitis B. In these cases, the color of the skin turns yellow. In these cases, the urine turns dark to very dark in color. The stool, on the other hand, takes on a light coloration. The most obvious sign, however, is a yellowing of the skin and the white areas of the eye. Only in very rare, particularly severe cases does hepatitis B take a particularly severe course. Then the liver is so severely damaged by the infection that liver failure occurs and the patient falls into a coma. In chronic courses of hepatitis B, which are also rare, the liver values are permanently elevated, which can lead to bleeding in the throat area, among other things.
Course
Hepatitis B has a relatively long incubation period of at least one and up to six months after transmission of the viral pathogen. When hepatitis B is contracted, the symptoms described previously may occur, but in some cases acute disease progresses without specific symptoms. If the disease is acute, it heals on its own after a period of no more than six months; if it is chronic, the symptoms last longer and the disease is referred to as chronic hepatitis B. Hepatitis B can be diagnosed when the virus is transmitted to the patient. This can be diagnosed if, after the six-month period, there is no relief of symptoms, no healing, and no formation of antibodies against hepatitis B recurrence. In some cases, chronic hepatitis B can cause cirrhosis or other serious diseases of the liver, such as cancer; the liver tissue is attacked and destroyed in the long term in this case.
Complications
Hepatitis B may or may not heal spontaneously. In some cases, about five percent of those with hepatitis B develop chronic hepatitis, which can end in cirrhosis of the liver. The probability of developing cirrhosis is also increased if there is an additional infection with the hepatitis D virus.This leads to a more than 90 percent probability of a severe course of the disease. Liver cirrhosis caused by a hepatitis B virus increases the risk of developing liver cancer more than 100-fold. Life expectancy is greatly reduced. In cirrhosis of the liver, all functions of the liver fail, including the synthesis function as well as the detoxification function of the liver. As a result, the necessary proteins for the blood are no longer produced, so that no oncotic pressure can be built up, resulting in edema. Coagulation proteins are also absent, and bleeding time is prolonged. Furthermore, the lack of detoxification means that ammonia is no longer properly broken down, which can transfer to the brain and thus lead to a life-threatening hepatic encephalopathy. The virus is also dangerous for expectant mothers, as the pathogen can be transmitted to the child. This leads to a high probability of chronic hepatitis in the child.
When should you go to the doctor?
In the case of hepatitis B, a doctor or hospital must be consulted immediately. This can prevent further infection. As a rule, early diagnosis has a very positive effect on the course of the disease. A doctor should be consulted if the affected person suffers from jaundice. This is the main symptom of the disease. Furthermore, jaundice is accompanied by high fever and severe weakness and fatigue. A doctor should also be informed if the affected person has been in an area affected by hepatitis B in recent months, as the incubation period is at least one month. Furthermore, weight loss also indicates hepatitis B and must be examined by a physician. In the worst case, the disease can lead to the death of the affected person or cause cancer. In this case, treatment and examination take place in a hospital. Since the disease cannot be completely cured, those affected are dependent on permanent therapy.
Treatment and therapy
In acute form, hepatitis B usually does not need to be treated with medication and heals on its own after a period of up to six months. If acute hepatitis B disease poses a long-term damaging threat to the liver, liver transplantation may be necessary in rare cases. Chronic hepatitis B can be treated either by boosting the immune system with weekly injections of interferons or by taking nucleoside tablets daily to reduce viral replication in the body. Both forms of therapy cannot cure chronic hepatitis B, but they can counteract many late effects and symptoms. Only in rare cases is the body’s immune function reactivated in such a way that it can induce a late cure for chronic hepatitis B.
Outlook and prognosis
Most patients with hepatitis B have a good prognosis. More than ninety percent of those affected experience a favorable course of disease and recovery if diagnosed early and therapy is started quickly. After a few weeks of medical care, the disease usually heals completely and without further sequelae. The likelihood of a chronic course of the disease is given with hepatitis B. Complications and further illnesses occur in up to ten percent of patients. As late sequelae, liver cirrhosis and liver cancer are possible diseases after about ten years, contributing to a worsening of the favorable prognosis. In about twenty percent of cases, a shrunken liver is diagnosed. The patient is at risk of a life-threatening condition. Often, only an organ transplant can help alleviate the symptoms and death. Without medical treatment, the risk of chronic disease progression is very likely. If children are born with hepatitis B or become infected at birth, chronic liver inflammation develops in almost all patients. In very rare cases, infection with hepatitis D occurs in addition to hepatitis B. This increases the likelihood of severe disease progression. This increases the likelihood of severe disease progression and liver organ failure.
Prevention
Hepatitis B can be prevented by means of a vaccine, the administration of which is now one of the standard vaccinations recommended as early as infancy or early childhood and prevents hepatitis B infection. If the vaccination was given in childhood, the immune protection against hepatitis B pathogens lasts into adulthood. If the vaccination is given at an advanced age, three injections are required to ensure a long-lasting protection of up to ten years. In addition to vaccination protection, adequate contraception can also be an important factor in preventing possible infection with hepatitis B during sexual intercourse and protecting oneself and others from transmission.
Follow-up
Among other things, follow-up care aims to prevent recurrence of hepatitis B. Patients generally achieve this through vaccination. After initial infection, no further treatment is usually necessary. This is because hepatitis B heals completely in 90 percent of those affected. Some patients do not even notice the disease. The prognosis is therefore extremely favorable. The situation is different for adults with a weakened immune system and children. In almost all cases, the disease takes a chronic course. This requires long-term treatment. Medical support is aimed at enabling those affected to lead a symptom-free life. Medications must be taken daily for this purpose. They reduce the amount of virus in the blood. This eliminates the risk of cirrhosis of the liver or the development of liver cancer. The treating physician arranges regular check-ups during which blood samples are taken. The sample allows a conclusion to be drawn from direct and indirect indications. Furthermore, an ultrasound examination and a biopsy may be ordered. The imaging procedure can determine the structure of the liver. The liver biopsy records the extent of tissue damage. Doctors can thus clearly document the progression of hepatitis B disease.
Here’s what you can do yourself
Hepatitis B can be effectively treated by prompt medical examination. In addition to medical treatment, affected individuals should inform friends and family members to reduce the risk of infection. Immediate vaccination reduces the risk of spread and often counteracts possible late effects of the viral infection. Drinking plenty of fluids and using liver compresses are recommended for liver symptoms. An effective natural remedy is the milk thistle cure, in which appropriate capsules are taken regularly or milk thistle tea is drunk. Dandelion, bloodroot, burnet, wormwood and club moss are also said to have a soothing effect. Acute pain can be counteracted by dark chocolate and foods that contain many bitter substances. An effective acupressure grip for the liver: place fingers inside each other and rub the heels of the hands until they become hot. Chronic hepatitis B disease can be self-treated by strengthening the immune system. Regular exercise and and a healthy, balanced diet can effectively counteract the symptoms and late effects, but cannot completely cure the disease itself. Therefore, medical treatment is always required as well, which complements the aforementioned self-measures and enables those affected to live with the disease without symptoms.