How do I get infected with hepatitis?
The possibility of infection is more dangerous for certain groups of people than for others. As already mentioned, there are different ways of transmission of the individual virus diseases. Hepatitis A and hepatitis E, for example, can be transmitted mainly through contaminated food such as food or water.
This is most likely to occur in tropical or developing countries, but sewage workers can also become infected. Faecal-oral in this context means that poor hand hygiene can lead to infection, or if food is not consumed in a clean state or water is not boiled. Other hepatitis viruses, such as the hepatitis B or C virus, can be transmitted via needlestick injuries in the health sector or in drug addicts who share the injecting equipment.
Even during a natural vaginal delivery, there is a high probability that the viruses are transmitted from mother to child, which in most cases means chronicity for the child. Furthermore, in the past it was possible to obtain hepatitis C, for example, via blood products. Before 1992, blood donations were not serially tested for this virus, so it was possible to get hepatitis C through a blood transfusion.Nowadays, there is still a risk of transmission, but at 1:1.
000. 000 it is very low. The transmission paths of the hepatitis viruses already described can essentially be summarized to a few.
First, transmission through food and water, then needle-stick injury, transmission through sexual intercourse and finally transmission from mother to child at birth. The virus concentration (also known as viral load) plays a role in all infection pathways. This is directly higher during sexual intercourse or needlestick injuries than during kissing.
A certain virus load can also be detected in saliva. Infection through kissing is therefore possible in principle, but is considered to be very low. In the patient interview (anamnesis), path-breaking symptoms and causes of the hepatitis can often already be determined or narrowed down.
For example, the possible causes of hepatitis can be narrowed down by asking specific questions about alcohol and drug consumption and about vaccinations against hepatitis A and hepatitis B. This is followed by questions about taking medication (drug-toxic hepatitis? ), stays abroad (infectious hepatitis?
), etc. During the physical examination, an acute hepatitis often reveals a painful pressure in the right upper abdomen and a palpable enlargement of the liver. When liver cells are destroyed, e.g. in the course of an inflammation, they are released from the liver cells and are therefore detectable in the blood in increased concentrations.
Depending on the constellation of the enzymes, the extent of the liver cell damage can be traced. In the case of slight liver cell damage, the enzymes GPT and LDH (lactate dehydrogenase) initially increase because these can diffuse rapidly through the membrane of the damaged cell. In case of a strong cell death, the enzymes GOT and GLDH (glutamate dehydrogenase), which are located in the mitochondria (cell organelles) of the cells, are also released in increased amounts.
In case of bile stasis, bilirubin, gamma-glutamyl transferase (γ-GT) and alkaline phosphatase (AP) may also be elevated. In the case of viral hepatitis, antibodies against viral components or directly the DNA of the virus can be detected in the blood. In an ultrasound examination, the abdominal organs are visualized with the help of ultrasound waves.
The transducer emits ultrasound waves which are absorbed or reflected by the various tissues it encounters. The transducer receives the reflected waves, which are converted into electrical impulses and displayed on a screen in different shades of grey. In acute hepatitis, the liver is enlarged and slightly less echo (i.e. darker) due to an accumulation of fluid in the liver (edema).
Chronic hepatitis often shows a fatty liver-like structure, which appears more echoic and offers an almost smooth transition to the signs of liver cirrhosis. Liver puncture allows in most cases a reliable diagnosis by histological examination of the tissue under the microscope. There are different ways in which liver tissue can be obtained: The simplest type is liver blind puncture, in which, as the name suggests, the liver is punctured “blind”, i.e. without the assistance of an imaging procedure, with a hollow needle.
A cylinder of tissue is removed, which is then examined by a pathologist for fine tissue. The targeted puncture of the liver is performed with the help of an imaging procedure such as sonography or computer tomography. The needle is inserted into the liver under visual control, so to speak, in order to avoid complications such as bleeding as much as possible.
The targeted puncture of the liver must be carried out especially in the case of diseases that affect only a part of the liver, such as tumors (liver cancer), cysts and other unclear foci of the liver (e.g. metastases). Finally, if hepatitis is diagnosed, the liver can also be biopsied during a laparoscopy. In this procedure, which is performed under general anesthesia, the liver is examined in a minimally invasive manner. Through small incisions in the abdominal skin, the liver surface can be inspected by inserting a rod camera and a piece of tissue can be removed from the organ.
