What
is acute Hepatits?
It is the acute inflammatory reaction of the liver.
What are its causes?
a. Viral hepatitis (A,B,C,D,E & G)
b. Non viral hepatitis
c. Drug induced hepatitis (Mostly Paracetamol, Anti-tuberculous drugs)
d. Alcoholic Hepatitis - excess alcohol intake.
What are its common symptoms ?
Loss of appetite nausea, vomiting.
Fever- mild fever usually 1030-1040 F.
General weakness.
High coloured urine, yellow colouration of sclera & skin.
Some
advice for you
Avoid heavy & strenuous
work. No need to lie down in the bed continuously. You can walk within
the house.
Food - should take usual food.
Drink - should drink about 3 litres of pure drinking water in 24 hrs.
No need to drink excess water, it may be harmful for you.
Should avoid all kinds of non medical treatment like Jhar- Fuk, Tabiz,
Malapara, Panipara and other medications by traditional healers.
Consult the nearest medical personal in earliest possible time.
Remember :
Acute hepatitis subsides
spontaneously in most of the time. But in some cases may lead to acute
Fulminant Hepatic failure & chronic Hepatitis.
Take appropriate measure in due time.
It is a chronic inflammatory process in the liver continuing without improvement for at least 6 months.
What are common causes?
1. Continuing Hepatitis B virus infection (HBV +/- HDV).
2. Chronic hepatitis C viral infection (HCV).
3. Auto immune hepatitis characterized by positive serum auto antibodies. It may be associated with disease like diabetes mellitus, arthalgia, nephritis, haemolytic anaemia.
4. Drug induced - Paracetamol,Anti tuberculous (INH), Antithyroid, etc.
5. Alcoholic hepatitis - due to long continued excess alcohol intake.
6. Metabolic disorder of iron (Haemochromatosis)
7. Familial disease - Wilson's disease.
8. Any acute disease persisting for long time may lead to chronic hepatitis.
What are its common symptoms?
1. Most of the time chronic hepatitis remain asymptomatic & detected during blood test for other purposes.
2. Anorexia & loss of appetite, low grade fever.
3. Feeling of a mass in the upper abdomen (enlarged liver).
4. Previous attack of jaundice is also absent in many cases.
5. Long continued hepatitis may lead to liver cirrhosis and liver cancer.
Some advise for you.
Make sure that whether you have HBV, HCV infection or any other cause of chronic hepatitis.
If you have any of the virus, you should take personal precaution against the spread of the virus to other members of the family.
Screen the family members for the virus & vaccinate the Hepatitis B vaccine.
Don't donate blood to any person.
Personal protection - plate, glass, spoon, shaving kit, towel, tooth brush to be kept separated.
Use safe sex (protected & barrier method) avoid homosexuality.
Don't share same needle for injection.
It you need any surgery, you should inform your attending doctor that you have Hepatitis B or Hepatitis C infection.
Remember :
You need proper evaluation & and management of the cause of your chronic hepatits. You should consult qualified medical personal, he may refer to a specialist.
Hepatitis B and some informations
It is the type of inflammation of liver caused by hepatitis B virus. It is the most common cause of chronic hepatitis.
Incidence of Hepatitis-B in Bangladesh.
About 7%-10% (9.1 to 13 million) population have hepatitis B infection.
About 3%-5% of pregnant mothers in Bangladesh are carrying the hepatitis B virus. Those who have HbeAg, about 90% of them will transmit the virus to their offspring.
Symptoms of Hepatitis B.
There may be no symptoms in many patients.
Non-specific symptoms like tiredness, aches, nausea and loss of appetite.
Manifestations of chronic hepatitis, liver cirrhosis & liver cancer in advanced stage.
How hepatitis B spreads.
From infected mothers to the foetus and child.(vertical transmission)
Transfusion of unscreened blood & blood product,
Parentral drug abuse.
Medical & dental treatment due to use of unsterile equipments and accidental injuries.
Saliva and other body fluids.
Unprotected homosexuals & heterosexuals.
How to prevent it.
Personal measures : use of disposable syringe & needles, transfuse screened blood, not to share utensils and use safe sex.
Vaccination (Hepatitis B vaccine)
Universal childhood vaccination, hepatitis B negative persons, babies born to HBsAg positive mothers, Surgical, medical & dental stuff. Hospital & laboratory staff who come in contact with blood and blood products frequently.
Passive immunization : Hepatitis B immunoglobulin (HBIG)- after exposure at high risk personnals or sources.
Some advise for you :
Don't receive unscreened blood.
Don't donate blood, organ if you are Hepatitis-B positive.
Don't use any one's toothbrush, razor, scissors or other personal items.
Don't make tattoos with unclean materials.
Take precautions against needle stick (prick) injury and blood spillage in medical, surgical, dental and nursing practice.
Use disposable blades in private haircutting saloon instead of traditional razor.
Practice safe sex.
The incidence is many times than that of AIDS.
Remember :
If you remain infected more than 6 months regular monitoring is needed for your liver functions & viral status.
Hepatitis
C and some informations
What is hepatitis C infection?
It is the type of hepatitis caused by hepatitis-C virus. It is one of
the common causes of chronic hepatitis. It takes long time to produce
its full blown effect i.e. liver cirrhosis & its complications.
Incidence of Hepatitis C in Bangladesh.
About 2%-3% (2.6 to 3.9 million)of population of Bangladesh have Hepatitis-C
infection.
Symptoms of Hepatitis-C:
In most of the patients there may be no symptoms,
The following symptoms may be either individual or in combination
Fatigue, loss of appetite, feeling sick & weight loss, flue like fever,
chills, headache.
Mild pain in the liver area.
Jaundice, ascites, bleeding, loss of consciousness in advanced stage.
How hepatitis C spreads.
Contact with blood and other body fluids--- most common causes are.
Transfusion of blood & blood products.
Contact of infected blood with cut surface or open wound.
Surgeons specially dental surgeons, nurse, dialysis unit workers.
Parenteral drug abusers
About 50%-80% of present and past drug abusers & those shared needle..
Tattoo, acupuncture, ear, nose & body pricking
Use of unsterile infected needles & sharp materials for pricking purposes.
Social contact.
By sharing scissors, towels and shaving with common razor in the hair
cutting saloon.
Transmission through sex.
Sexual transmission through unprotected sex is less but it occasionally
occur.
Breast feeding & saliva
It is less but possible if there is crack nipple.
Mother to baby transmission
The risk of transmitting the baby from mother is about 6%, which may occur
within the womb, during delivery or after birth.
How to prevent it:
It should be kept in mind that there is no vaccine currently available
against hepatitis-C virus. So awareness & personal protection is the
best way to avoid this disease.
Some advise for you :
Strict screening of blood and blood products for Hepatitis-C before any
transfusion.
Use of own toothbrush, razor, scissors & other personal items.
Practicing of safer sex.(Barrier method)
HCV positive should never donate blood and register as organ donor.
Ensuring the use of sterile needles, syringe for various purposes.
Extreme precautions by medical,surgical dental & nursing staff against
needle stick injury or blood spillage.
Remember:
Regular assessment is needed to detect whether liver damage is progressing
and to plan the appropriate treatment in due time.
Hepatitis
What is hepatitis.
It is a kind of infection of liver. Common causes of hepatitis are viral.
Non viral causes include drug induced, alcoholic and auto immune.
Types of hepatitis virus :
There are several types of Hepatitis virus Hepatitis A, B, C, D &
E. They spread & affect the liver in different ways.
Viral Hepatitis is of two kinds.
Acute hepatitis - short duration of illness.
Chronic hepatitis - lasts long time, subside & relapse.
Acute Hepatitis is usually caused by Hepatitis A, B & E and chronic
Hepatitis is due to Hep B & C viral infection.
Hepatitis A virus (HAV) - It spreads through contaminated food & drink.
More in children, usually complete recovery occurs.
Hepatitis B virus (HBV) - it spreads through contaminated blood &
body fluids. Most of the time it recovers without any treatment but chronic
hepatitis & cirrhosis may develop in some cases.
Hepatitis C virus (HCV) - this virus also spreads through contaminated
blood and body fluids. It usually does not cause jaundice, but in most
cases it causes chronic hepatitis and its complications. It takes long
time to cause irreversible damage of liver (liver cirrhosis & its
complications)
Hepatitis-D virus (HDV) it also spreads through contaminated blood &
body fluids. It needs the presence of Hepatitis B virus for its infections.
Hepatitis-E virus (HEV) It also spreads through contaminated food &
drink like A virus. Usually affects elderly persons. It also recovers
completely but during pregnancy it may cause Acute Fulminant Hepatic Failure.
Some advise for you.
Personal hygiene in daily life is essential for prevention of all kinds
of viral infection in liver.
You should avoid contaminated food & drink which is the main source
of faecal & oral route of transmission of Hepatitis A & Hepatitis
E viral infections.
Don't receive or donate blood & blood products without screening Hep
B & Hep C virus.
Take precaution of needle stick, blood or fluid spillage by medical, surgical,
dental & nursing staff.
Precaution in jaundice during pregnancy due to Hepatitis E virus.
Take Hepatitis B vaccine yourself, your child & other members of the
family.
Remember :
Acute Hepatitis may lead to Fulminant hepatic failure.
No vaccine yet available for Hepatitis C. Personal protections are the
only methods of its prevention.
Don't rely on nonprofessionals & traditional healers.
Jaundice during pregnancy
A pregnant mother might have jaundice due to various causes. Some of them are related to pregnancy itself and others are the usual causes of jaundice developed during pregnancy. It may effect the health of the mother and also the child in different ways.The common causes are .
Different kinds of viral hepatitis
The viruses are hepatitis A, B, C, D,E & G. Among them, the hepatitis E viral infection may be serious. It causes about 50% of hepatitis during pregnancy It may cause sudden severe impairment or stoppage of liver function of the mother in about 20% cases (Acute Fulminant Hepatic failure).
Hepatitis B virus may be transmitted to the neonate leading to serious liver disease and its carrier state.
Other causes.
Accumulation of bile inside the Biliary channels (Intrahepatic cholestasis). It causes jaundice and itching.
Acute fatty liver.
Biliary obstruction by stone or other causes.
Toxaemia of pregnancy. (Eclampsia & pre-eclampsia is a serious problem in which the pregnant women might develop convulsion, fit, finally hepatic coma and multiorgan failure.)
Jaundice in pregnant condition should be considered seriously. Both the mother & the child at risk. Maternal mortality is about 10%-45%. There may be both still birth, premature and low birth weight baby, kernicterus and chances of foetal abnormality.
Some advise for you :
The cause of the jaundice should be evaluated. Prompt & adequate measure to be taken to save the life of both mother and the child.
Incase of hepatitis B (HBV) virus positive mother and especially those with HbeAg positive. The neonate should receive hepatitis B immunoglobulin (HBIG) along with the 1st dose of hepatitis B vaccine as soon as possible after birth. The child also should receive additional two doses of vaccine subsequently. The WHO recommended dose schedule is 1st day, 1st month & 6th month.
Hepatitis E virus positive mothers should be under strict follow up & measures be taken to prevent acute liver failure.
Remember :
Pregnant mother should be under care of gynaecologist and hepatologist.
Jaundice
in new born
(neonatal jaundice)
This is the jaundice in new born. A child may born with jaundice or the jaundice may develop within a few days of birth.
Causes of neonatal jaundice :
There are many causes of this jaundice. One type of jaundice appears within 2nd or 3rd day of birth and usually subsides automatically within two weeks. It is called physiological jaundice. Another type of jaundice starts with severe jaundice or the severity of jaundice increases gradually, it is called pathological jaundice.
The common causes of pathological jaundice are.
Mismatch blood of Rh & ABO type between mother and the neonate (Blood group incompitability)
Viral & other infection during pregnancy (intrauterine infection).
Excessive break-down of red blood cells (Congenital Haemolytic Anaemia).
Infection & application of dirty clothes in the umbilicus of the neonate. (umbilical sepsis).
Enzyme deficiency in the liver. (enzyme deficiency).
Defective development of liver & Biliary tree. One of the condition is Biliary Atresia in which the Biliary channel is not properly developed. The bile flow is obstructed leading to jaundice and destruction of liver.
Some advise for you :
The cause of the jaundice should be determined.
Exposure to the sunlight is needed for physiological jaundice (phototherapy).
Exchange transfusion for blood group incompitability.
Surgery may be needed for Biliary atresia. The best time is within two months of birth.
Don't apply dirty materials, dressings in the umbilicus.
Proper antenatal examination of mother's blood for haemolytic disease, mental & physiological impairment.
Kernicterus (Bilirubin encephalopathy) may develop in the neonate if the jaundice is severe.
Remember :
Child specialist, specially a neonatologist should be consulted at the earliest possible time.t is the yellow colouration of sclera, skin, mucous membrane, urine & other body fluids due to the excess amount of bilirubin the body.
Common causes.
1. Hepatitis-acute & chronic hepatitis.
a. Viral hepatitis (A,B,C,D,E & G)
b. Non viral hepatitis
c. Drug induced hepatitis (Mostly Paracetamol, Anti-tuberculous drugs)
d. Alcoholic Hepatitis - excess alcohol intake.
2. Developmental defects of the liver & Biliary system (Biliary atresia).
3. Jaundice in newborn (Neonatal Jaundice).
4. Haemolytic jaundice - due to excess breakdown of red blood cells.
5. Obstructive jaundice - due to obstruction of the passage of bile from liver to intestine.
Some advise for you.
Arrange to make diagnosis and to treat the cause of your jaundice early. Don't waste time.
Don't rely on traditional healers and non medical treatment.
Remember :
Jaundice is not a disease, it is a sign of a disease.
The cause of every jaundice is not the same.
Tumour and cancer of the liver, gallbladder bile duct, duodenum & pancreas may be the cause jaundice.
Liver cirrhosis
It is a diffuse process with fibrosis and nodule formation. The smooth & soft liver is changed to firm or hard shrunken liver with micro or macro nodular appearance. The functional capacity also reduces.
What are its common cause?
Chronic hepatitis
May be viral or non viral causes. Chronic Hepatitis B & Hepatitis C viral infection are the main causes.
Alcoholic Hepatitis, drug induced Hepatitis are the common non viral Hepatitis.
Metabolic disorder like
Haemachromatosis due to excess iron absorption.
Familial disease.
Wilson's disease due to altered copper metabolism.
Any chronic hepatitis state may change to cirrhosis of liver.
Symptoms.
In early or compensatory cirrhosis.
Most of the time remain asymptomatic.
Loss of appetite, anorexia, low grade fever.
In advanced or decompnsatory cirrhosis.
Ascites - Accumulation of fluid in the abdomen.
Oesophageal varices : enlarged tortuous vein in the gullet, which may bleed at any time.
Jaundice - Usually mild and persistent.
Encephalopathy : impaired mental function due to toxic effect of waste product, which are normally destroyed by the healthy liver. The waste products affect the brain. The patient may loss consciousness.
Increased bleeding tendency from tooth, nose, mouth, anus and skin (Bruising).
Liver cancer - may develop in some cases of cirrhosis.
Some advise for you :
You must have to take adequate balanced diet & fluid.
Alcohol should be avoided.
Portal hypertension & its manifestation like ascites, oesophageal varices & encephalopathy may need medical, interventional & surgical management.
You must consult specialist regarding early detection of liver cancer. It may need liver surgery or other treatments.
End stage liver disease may need liver transplantation (replacement of diseased liver with donated liver or its part).
Remember :
The causes of cirrhosis are many, the end result is the same. You may need multidisciplinary management strategies.
Liver tumour
The cancerous (Malignant) one is again of two types, one originates from the liver tissue (Primary) & other is carried to the liver from various malignant tumours of the body (secondary or Metastatic). The secondary tumours of the liver are much more common than primary tumours. Common metastatic tumour is from primary colorectal, pancreatic & breast cancer.
Most common cause of primary liver cancer is liver cirrhosis & commonly due to Hepatitis B & Hepatitis C virus.
Symptoms.
Mostly asymptomatic.
Mild right sided upper abdominal pain.
Anorexia, loss of appetite.
Feeling of a mass in the Rt. side of the abdomen.
Jaundice, ascites, bleeding through mouth (Haematemasis)
Some advise for you :
Regular follow up for primary liver tumour of the liver for those who have liver cirrhosis (due to any cause), chronic Hepatitis- B, Hepatitis - C viral infection.
Follow up for metastatic tumour of the liver after surgery of the primary tumour.
Extent & nature of the tumour should be ascertained.
The main treatment of the liver tumour is planned & safe liver resection. (Removal of tumour & part of the diseased liver).
Consult Hepatobiliary surgeon (Liver Surgeon) in earliest possible time.
If resection is not possible other modalities of treatment should be arranged.
Remember :
Awareness, early diagnosis of liver tumour & adequate surgical treatment should be the goal.
Obstructive Jaundice
Common causes of obstructive jaundice.
1. Stone : the stone (stones) coming from the gallbladder, liver or may be produced within the Biliary system.
2. Tumour : tumours of the bile duct, pancreas, gallbladder and liver are prime causes. 3. Stricture bile duct The calibre of the Bileduct may be narrowed due to
a) accidental injuries during the operation like cholecystectomy (removal of the gallbladder).
b) Operation of the liver, pancreas, stomach & duodenum.
c) Traumatic injuries of the hepatobiliary system.
4. Infections of the Biliary system : round worm in the Biliary system, enlarged lymph nodes, metastatic tumours may also cause Biliary obstruction.
5. Biliary atresia : Developmental defect of Biliary system in new born
Symptoms of obstructive jaundice.
The level of jaundice usually increases gradually. If the jaundice due to stone, it may fall temporarily but later on it increases (Fluctuating jaundice).
High coloured urine (like tea) and whitish coloured stool (like clay) may be passed.
Chills, rigor and fever.
Abdominal mass :
Gallbladder mass & enlarged liver in gallbladder cancer.
Pancreatic mass & distended gallbladder in pancreas cancer.
Some advise for you :
The cause of obstructive jaundice should be diagnosed in earliest possible time.
Treatment of the cause and relief of jaundice should be the gold standard
Consult surgeon preferably hepatobiliary surgeon & interventionist for proper management.
Don't be misdiagnosed by nonprofessional & traditional healers. Avoid all kinds of non medical treatment like Jhar - Fuk, Tabiz, Malapara, Panipara, paste and other medications. It will only waste your valuable time.
Remember :
Delayed diagnosis and treatment of obstructive jaundice is the main cause of liver, kidney & other bodily system (Multiorgan) failure.
BSRS Bhaban (9th Floor), 12 Kawranbazar, Dhaka-1215