Hepatitis B Diagnosis

  • Diagnosis

    Hepatitis B is a viral infection of the liver that can be serious. The hepatitis B virus is carried in the blood and attacks the cells of the liver. Once inside a liver cell, the virus makes the cell produce more virus particles that are then released into the bloodstream. People who cannot clear the virus from their systems face an increased risk of cirrhosis as well as liver cancer.

    Hepatitis B infection can cause both short-term (acute) and long-term (chronic) illness. The acute form of the disease usually begins between one month and six months after exposure to the virus. The flu-like illness of acute hepatitis usually clears up within weeks to months. In some cases, however, acute hepatitis can be serious enough to cause hospitalization and rarely, death.

    Hepatitis B that persists becomes chronic. A person with chronic hepatitis will have harbored the virus for at least six months, sometimes only with vague symptoms. But the virus continues to be active and can be detected in the blood. Damage to the liver during this state may also continue, eventually causing cirrhosis or liver cancer. The disease can also flare into acute hepatitis.

    Many people who have hepatitis B do not show signs of disease. Only about 30% of adults who are infected with hepatitis B will develop an acute episode; 30% of adults will clear the virus without showing any symptoms at all. Among children under the age of four, only about 10% develop symptoms of acute hepatitis. Although children are less likely to show the symptoms of acute hepatitis, they are more likely to develop chronic hepatitis--the chronic state occurs in about 25% of children under the age of four and in about 80% of infants. About 10% of adults infected with hepatitis B will develop chronic disease. But in general, most adults will clear the virus from their system without medical therapy. Many people with chronic infections will clear the virus from their system over time. But doctors will treat these people in an effort to speed up the clearance of the virus, preventing ongoing harm to the liver.

    Hepatitis B is spread by contact with bodily fluids; usually blood. It is commonly passed on through sexual contact, intravenous drug use, and use of contaminated blood products. The virus can also be passed from mother to infant during birth.

    People can have hepatits B without obvious symptoms. Even without physical symptoms, though, hepatitis B can cause liver damage. A doctor can detect this damage through a blood test that looks for specific viral proteins in the blood. Also, routine laboratory tests for proper liver function may alert your doctor to the possibility of a disguised infection. Liver sampling (biopsy) can usually detect microscopic evidence of damage.

    In the acute form, hepatitis B causes sudden liver inflammation and a flu-like illness. Symptoms can include:

    • fatigue
    • lack of appetite
    • joint pain
    • yellowing of the skin and eyes (jaundice)
    • nausea and vomiting.
    • right-sided tenderness under the ribs.

    Symptoms may persist for some time, but they usually resolve in less than six months.

    In the chronic form, hepatitis B can eventually cause serious liver damage. Symptoms of chronic hepatitis B include:

    • fatigue
    • ongoing loss of appetite
    • muscle and joint pain
    • tenderness in the upper right abdomen.

    An estimated 10% per year of people with chronic infections do clear the virus from their systems over time. Others do not, and face an increased risk of cirrhosis as well as liver cancer. While it is possible to "carry" the hepatitis B virus for years without serious problems, some carriers relapse into an active infection. This active infection may not cause symptoms, but may cause liver damage anyway.

    Sharing needles for injection drug use helps spread the disease. Needles used to create tattoos, if unclean, can also spread the virus. Unprotected sexual intercourse can spread hepatitis B. Both semen and vaginal secretions can spread the hepatitis virus. The hepatitis virus has also been found in saliva. Kissing on the cheek or dry lip kissing will not spread the virus.

    People who have day-to-day contact with those who have chronic hepatitis B are at risk for the disease, and should get a hepatitis B vaccine. For example, anyone living with a person with chronic hepatitis B is more likely to come in contact with that person’s blood, a razor, a toothbrush, or any other item that may contain bodily fluids harboring the disease.

    Health care workers who have contact with blood are at risk for getting the disease. A needlestick from an infected needle, for example, can spread the virus.

    Babies born to mothers with an active hepatitis B infection are at risk for getting the disease. Spread of the virus from mother to child during birth is called vertical transmission, and carries a risk of infection to the newborn that can approach 90%, depending on how active the virus is in the mother.

    Patients who are undergoing hemodialysis--a process whereby a person's blood is fed into a machine that filters and purifies it, and then returns it to the body— are at greater risk of catching the virus. Infants and children who emigrate to the US from areas where the disease is common are at risk for chronic infection. According to the Center for Disease Control, chronic hepatitis B infection rates are high (>8%) in all of Africa; Southeast Asia, including China, Korea, Indonesia, and the Philippines; the Middle East, except Israel; south and western Pacific islands; the interior Amazon River basin; and Haiti and the Dominican Republic. The prevalence of chronic hepatitis B infection is intermediate (2% to 7%) in South Central and Southwest Asia, Israel, Japan, Eastern and Southern Europe, Russia, most areas surrounding the Amazon River basin, Honduras, and Guatemala. It is recommended that travelers to these areas be vaccinated for hepatitis B if they will be staying for longer than six months, or if they anticipate having daily physical or sexual contact with the local population. Anyone traveling to such an area who may require medical or dental care should also be vaccinated.

    A diagnosis of hepatitis B is based on the history and on blood tests. Doctors will perform a physical exam and ask questions to develop a history. Possible exposure to the virus may prompt blood testing.

    Laboratory tests look for elevated levels of liver enzymes. They also look for a variety of blood markers linked to the virus itself and to the body’s attempt to fight it. These can tell physicians which stage of disease a person has reached--acute infection, chronic infection, chronic active infection, or past infection (and hence immunity).

    A safe and effective vaccine is available. The vaccine has been in use since the early 1980s. It is given in series of three injections into the muscle. Smoking, obesity, chronic illness, or immune compromise (such as advanced HIV infection) may weaken the effect of the immunization. A combined vaccine (Twinrix) for both hepatitis A and hepatitis B is also available.

    Childhood vaccination is now routine in the US. Vaccination is also recommended for the following groups:

    • Those at occupational risk. This includes medical, dental and, laboratory workers, as well as others whose jobs entail exposure to blood.
    • People such as those with hemophilia, who take clotting factor concentrates to control bleeding.
    • People who live with or have sex with hepatitis B carriers.
    • Men who have sex with men and injection drug users and their sexual partners.
    • People with multiple sex partners and those diagnosed with a sexually transmitted disease.
    • Hemodialysis patients.

    Pregnant women should be tested for the hepatitis B virus. Testing infants immediately after birth can prevent transmission. Hepatitis B immune globulin, a protein that targets the virus for elimination by the body’s immune system, can help prevent the spread of hepatitis B to infants if it is given soon after birth.

    Post exposure use of immunoglobulin (HBIG) in combination with the vaccine is indicated for susceptible sexual contacts of individuals with acute hepatitis B.

    If you are sexually active, use a latex condom. The US Centers for Disease Control and Prevention recommend the following:

    • Use a new condom with each act of intercourse.
    • Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects.
    • Put the condom on after the penis is erect and before any genital contact with your partner.
    • Ensure that no air is trapped in the tip of the condom.
    • Ensure adequate lubrication during intercourse, possibly requiring use of lubricants such as K-Y Jelly or glycerine. Never use oil-based lubricants such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
    • Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.

    Don’t share your toothbrush, razor, or any other personal item that might have blood on it.

  • Prevention and Screening

    A safe and effective vaccine is available. The vaccine has been in use since the early 1980s. It is given in series of three injections into the muscle. Smoking, obesity, chronic illness, or immune compromise (such as advanced HIV infection) may weaken the effect of the immunization. A combined vaccine (Twinrix) for both hepatitis A and hepatitis B is also available.

    Childhood vaccination is now routine in the US. Vaccination is also recommended for the following groups:

    • Those at occupational risk. This includes medical, dental and, laboratory workers, as well as others whose jobs entail exposure to blood.
    • People such as those with hemophilia, who take clotting factor concentrates to control bleeding.
    • People who live with or have sex with hepatitis B carriers.
    • Men who have sex with men and injection drug users and their sexual partners.
    • People with multiple sex partners and those diagnosed with a sexually transmitted disease.
    • Hemodialysis patients.

    Pregnant women should be tested for the hepatitis B virus. Testing infants immediately after birth can prevent transmission. Hepatitis B immune globulin, a protein that targets the virus for elimination by the body’s immune system, can help prevent the spread of hepatitis B to infants if it is given soon after birth.

    Post exposure use of immunoglobulin (HBIG) in combination with the vaccine is indicated for susceptible sexual contacts of individuals with acute hepatitis B.

    If you are sexually active, use a latex condom. The US Centers for Disease Control and Prevention recommend the following:

    • Use a new condom with each act of intercourse.
    • Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects.
    • Put the condom on after the penis is erect and before any genital contact with your partner.
    • Ensure that no air is trapped in the tip of the condom.
    • Ensure adequate lubrication during intercourse, possibly requiring use of lubricants such as K-Y Jelly or glycerine. Never use oil-based lubricants such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
    • Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.

    Don’t share your toothbrush, razor, or any other personal item that might have blood on it.

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