On World Hepatitis Day (28 July), a specialist explains why you need to be alert for signs of this serious condition.

It has been described as a “silent killer” that lurks undetected until it’s too late. While this might sound dramatic, it is true, says Dr Werner Coetzee, a hepatopancreatic biliary surgeon at Mediclinic George and Mediclinic Geneva, who specialises in diseases of the liver, pancreas, and biliary tree. 

“Hepatitis is a word referring to a number of conditions characterised by inflammation of the liver,” he explains. “Rather than a specific disease itself, it encompasses different diseases with similar clinical effects.” 

Infectious viral hepatitis is caused by viruses and is named using letters of the alphabet – hepatitis A, B, C, D and E. “The letters A to E indicate different types of viruses that are all associated with hepatitis states of the liver,” Dr Coetzee explains.

Toxic hepatitis can be due to pharmaceutical medications, alcohol, or other drugs.  

Ischaemic hepatitis is caused by low blood pressure during acute illness. 

However, the most common cause of hepatitis in Western countries is fatty liver disease. This kind of liver inflammation is often associated with obesity and other metabolic illnesses.

How you get infectious hepatitis 

Viral hepatitis is usually transmitted by person-to-person contact, says Dr Coetzee. But there are other ways of getting infected, depending on the type of virus.  

“You can get hepatitis A by ingesting a substance that’s carrying the virus – usually contaminated water. Hepatitis B and C can be transmitted through contact with body fluids and are often passed on as a sexually transmissible disease – hepatitis B is especially transmissible,” Dr Coetzee explains. “However, it is also possible to contract these viruses through other means of contact with infected fluid, such as direct contact with blood or serum.”

How to tell if you have hepatitis

Symptoms of hepatitis vary. “In viral hepatitis, patients may complain of flu-like symptoms such as fatigue, body aches and pains, right upper abdominal discomfort and, in more severe forms, jaundice, confusion and abdominal swellingdistention,” says Dr Coetzee. Hepatitis A is a diarrhoeal illness and symptoms are similar to gastroenteritis – abdominal cramps, vomiting, fever, and diarrhoea. It only causes liver failure in a small minority of cases. But other causes of hepatitis may have few or no symptoms, making them even more dangerous.

Silent killer 

Unlike hepatitis A, which may feel like a nasty tummy bug that gets better without treatment, hepatitis B can be lethal. “And when acute liver failure develops, this is most definitely not a ‘silent killer,’” says Dr Coetzee. That said, in cases where your body doesn’t have a strong immune response to the virus, it can linger undetected, progressing to a chronic disease which, while asymptomatic, is quietly causing damage to the liver due to inflammation and subsequent scarring. “In this case, you may only develop symptoms when there is irreparable damage to the liver. Liver cancer may sometimes form in this damaged environment,” Dr Coetzee adds.

Vaccination is crucial

Not being vaccinated against hepatitis B is the biggest risk factor for contracting the disease, says Dr Coetzee. “The vaccination has already saved millions of lives,” he adds. Other pPeople at elevated risk include those who practise unsafe sex and intravenous drug abusers. Other lifestyle factors can also increase your risk. “Excessive alcohol use causes toxic hepatitis. And obesity, uncontrolled diabetes and hypertension are all associated with fatty liver disease and resulting hepatitis,” says Dr Coetzee. As mothers carrying the virus can pass it on to their babies during birth, it’s important to get a blood test for hepatitis during pregnancy.  

Treatment options 

Treatment for infectious hepatitis is on a case-by-case basis. Some people won’t need treatment, as they’re able to fight off the infection themselves. In other cases, the disease may only be picked up at the chronic stage, when it’s too late for treatment to be effective. However, there are antiviral treatments available for those with acute liver failure, or extremely high levels of circulating virus, says Dr Coetzee. As for non-infectious causes, such as fatty liver disease, the aim of treatment is to manage the disease and prevent it from progressing and causing further complications. “It is also very important to monitor those with established chronic hepatitis for the development of liver cancer.”

The best way to combat hepatitis is through vaccination, says Dr Coetzee. “There is no more important message to get across: Get vaccinated!”

Disclaimer: The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.