Hepatitis B

What is hepatitis B?

Hepatitis B is a viral infection of the liver. The liver becomes inflamed and tender. It may also become swollen. Areas of liver tissue may be destroyed by the inflammation. Hepatitis B is a serious, sometimes severe and even fatal type of hepatitis.

How does it occur?

Hepatitis B is caused by the hepatitis B virus. You get hepatitis B by direct contact with the blood or body fluids of an infected person. For example, you can get it from:

• having unprotected sex with someone infected with hepatitis B
• sharing needles for drug injection with an infected person
• your mother if she had hepatitis B at the time she gave birth to you
• getting a body part pierced or a permanent tattoo with nonsterile equipment.

The disease can be spread by people who do not have any symptoms and may not know they carry the virus. These people are called asymptomatic carriers.

What are the symptoms?

You may not have any symptoms of hepatitis until several weeks or months after you are infected with the virus. Or you may never have any obvious symptoms.

If you have symptoms, the illness usually begins with these flulike symptoms:

• loss of appetite
• fever
• general aching
• tiredness.

Other early symptoms may include:

• itching, sometimes with hives
• painful joints
• loss of taste for cigarettes if you are a smoker.

After several days you may also have these symptoms:

• nausea and vomiting
• foul breath and bitter taste in the mouth
• dark brown urine
• yellowish skin and eyes (jaundice)
• pain just below the ribs on your right side, especially if you press on that part of your abdomen
• bowel movements that are whitish or light yellow and may be looser than normal.

Some people develop a chronic form of the disease without having any obvious symptoms, even though damage to the liver may be occurring. The symptoms of chronic hepatitis may be persistent fatigue, weakness, and loss of appetite, as well as some of the other symptoms listed above.

How is it diagnosed?

Your health care provider will ask about your medical history and symptoms. Especially important is your history of hepatitis risk factors such as IV drug abuse.

Your provider will examine your skin and eyes for signs of hepatitis. Your provider will check your abdomen to see if the liver is enlarged or tender.

You will have blood tests. If blood tests show that your liver is not working normally, your provider will do tests to see if you are infected with the hepatitis B virus.

If your provider thinks you may have chronic hepatitis or serious liver damage, or if the diagnosis is uncertain, you may have a liver biopsy. A biopsy is a procedure in which a needle is used to remove a small amount of tissue. This is done through the skin over the liver after the area is numbed with an anesthetic. The sample of tissue is sent to a lab for tests to check for damage to your liver.

How is it treated?

The usual treatment is rest. In addition, your health care provider will recommend that you avoid alcohol for at least 6 months. Usually it is not necessary to stay at the hospital. If you become severely dehydrated from nausea and vomiting, you may need to go to the hospital to receive intravenous (IV) fluids.

If you develop chronic hepatitis B, you may need treatment with medicines. The types of drugs used are interferon and other antiviral drugs.

How long do the effects last?

The symptoms generally last several weeks and are usually followed by a slow but complete recovery. It may take 6 months before tests of your liver show that it is working normally again.

Some people who have hepatitis B develop the chronic form of the disease. This means the virus continues to affect their liver for several months. The continued inflammation can damage the liver, resulting in cirrhosis (scarring of the liver) and possible liver failure. Your health care provider may check your blood every few months for signs of chronic liver disease.

Infection with the hepatitis B virus increases your risk for liver cancer.

How can I take care of myself?

• Follow your health care provider's instructions for taking medicine to relieve your symptoms. When you have hepatitis, you need to avoid taking certain medicines (for example, acetaminophen). Ask your provider which medicines you can safely take for your symptoms (such as itching and nausea).
• Follow your provider's advice for how much rest you need and when you can return to your normal activities, including work or school. As your symptoms improve, you may gradually increase your level of activity. It is best to avoid too much physical exertion until your provider tells you it is OK.
• Eat small, high-protein, high-calorie meals, even when you feel nauseated. Sipping soft drinks or juices and sucking on hard candy may help you feel less nauseated.
• Do not drink alcohol unless your provider says it is safe.

What can be done to help prevent the spread of hepatitis B?

Hepatitis B is highly contagious for 2 to 6 weeks before symptoms appear. It continues to be contagious for some time after you start having symptoms. After you have been diagnosed, your health care provider will want to see you for a follow-up. Your provider may test your blood to see if you are still contagious. Some people who get hepatitis B become chronic carriers of the virus. A blood test can determine whether you are a chronic carrier.

To avoid spreading the disease to others:

• Always wash your hands thoroughly with soap and very warm water, especially after you use the restroom and before you eat or prepare food. Bathe often.
• Do not allow your body fluids, including saliva, to contact others.
• Do not share food or drink with others.
• Clean any blood stains with a disinfectant.
• Do not share needles, toothbrushes, or razor blades with others.
• Avoid sexual contact with others until your provider tells you that you are no longer contagious.
• Do not donate blood.

Three shots of a hepatitis B vaccine can prevent infection with the hepatitis B virus. The second shot is given 1 month after the first shot. The third shot is given 6 months after the first shot.

People in the following categories have a high risk of getting hepatitis B and should get shots of the hepatitis B vaccine:

• health care workers
• public safety workers who work with drug abusers
• volunteers and employees at homeless shelters
• sexual partners of people who carry the virus
• male homosexuals.

In addition, the American Academy of Pediatrics and the American Academy of Family Physicians now recommend that all children get hepatitis B shots. As the cost of the shots decreases, more people, especially teenagers and young adults, are also being encouraged to get the shot to prevent sexually transmitted hepatitis B. Ask your health care provider if you should be immunized against hepatitis B.

For more information, contact:

American Liver Foundation
Phone: 800-GOLIVER (465-4837)
Web site: http://www.liverfoundation.org
Printed information about liver disease and hepatitis, information specialists