Hepatitis is the inflammation of the liver. Like any other term used in medicine, the suffix “itis” indicates that we are dealing with an enlargement, an inflammation, in the size of the component cells. For example, bronchitis is the inflammation of the lining of the bronchial tubes of the lungs, while appendicitis means the inflammation of the appendix. Hepatitis has many causes; some are related while other causes are not. However, the greatest problem in properly discussing this condition is not that people are not aware of it but that the level of misinformation about hepatitis is particularly deep. While many people frequently believe that hepatitis is contracted as a result of promiscuous conduct, others believe that it is related to having some kind of illicit drug usage. Sadly, these notions often cause a delay in making the diagnosis because the sufferers end up presenting late in the hospital as a result of the stigma they face. It is not everyone who is found to be positive to the virus that goes on to develop the disease. The severity of any infection is deducible by being able to determine the viral load of the carrier.

However, this is the hepatitis awareness month and even though this condition has other causes, the focus in this essay will be the various viruses that also cause the disease. The three most common strains of the disease are caused by hepatitis A; hepatitis B and hepatitis C.

Hepatitis A is spread from the anus to the mouth, called the fecal-oral route. It is believed that there are about 3,500 new infections of hepatitis A every year in the United States. As usual, no figures are available in our dear country. An infected person will shed it in their stool and pass it on to someone else because of poor sanitation. As a result, poor hand-washing practices often without any soap, leads to new infections in others through contaminated water and food. The handling of objects by people who have been contaminated with the virus helps to propagate the infection and sex with an infected person can also help it along. Hepatitis A is usually a mild disease with certain associated features like fatigue, loss of appetite, body pains, stomach upset, abdominal pain all of which predate the appearance of the jaundice. Most cases will resolve within several weeks. Those people at the extremes of life and those with a previous liver condition tend to suffer from complications.

Hepatitis B by contrast is a worldwide infection. More than 1.3 million people are thought to have it in the chronic form in the United States while there is an estimated 20,000 new infections every year in that country. The virus is far more difficult to eliminate than HIV and it is 50 to 100 times more contagious than HIV. It is considered a sexually transmitted disease which is spread through blood, semen and vaginal secretions. Nigeria and South Africa are the two largest reservoirs of hepatitis B in sub-Saharan Africa. For the former, the large population means it is a significant health burden with up to 67 per cent of all carriers of the virus not even aware that they have it. Many have had their own infection for decades and the discovery is only made at the very end of life when they present with liver cancer, cirrhosis of the liver and sometimes, while being investigated for some unrelated ailment. The recent inclusion of the hepatitis B vaccine in the immunisation programme of several states in Nigeria has already shown promise as a potent force to reduce further new infections. They are also prevented by screening pregnant women who are immunised within 24 hours of delivery in order to protect their newborns if they are found to be positive.  For those who already have the chronic phase of the disease, there is the chance that they could progress to the stage at which the liver is grossly scarred, known as cirrhosis with liver failure a constant risk. At other times in countries that have the requisite infrastructure, liver transplantation is often an undertaking of last resort.

The last of the major viruses is hepatitis C which affects about three million Americans with some 30,000 new infections per annum. That even makes it more common than hepatitis B and more than half of all patients do not know that they have the virus. The typical risk factors for this particular virus are a past history of intravenous or intranasal drug use, body piercing and tattooing. Homosexual men, people on dialysis especially in the period before universal blood screening and healthcare workers were all particularly exposed. It is very poorly spread sexually but the common symptoms are as for hepatitis A and B above.  While it is possible to successfully treat hepatitis C in more than 90 per cent of all cases, the case is somewhat different in the case of hepatitis B where various formulations are available to control the progression of the disease but not its elimination. In both cases, the consumption of alcohol especially in a heavy and sustained fashion tends to worsen the prognosis and also seems to ensure that cirrhosis occurs in about 25 per cent of cases.

The liver is the largest laboratory in the body and is one of the only few organs that can regenerate itself. However, when the liver is sick, the rest of the body knows it even though for a considerable length of time, the liver can actually suffer in silence. Often, by the time symptoms of liver disease manifest, as you might see in hepatitis, the damage to the organ might have been very extensive. For example, some of the disease conditions that damage the liver so extensively are autoimmune hepatitis, a cruel form of liver disease also seen in systemic lupus erythematosus in which certain cells in the body fail to see the liver as part of the same person and therefore attack it. This is not contagious and is often seen in women. It can be treated with medications such as steroids. If it is not treated, progression to liver failure and cirrhosis will occur.

Finally, another cause of non-contagious hepatitis is alcohol. This cause of liver disease is often provoked by chronic alcoholism that permanently induces certain liver enzymes to become unduly active to the level that liver damage occurs. Another possible cause of this sort of hepatitis is medicines used to treat various ailments including hypertension. Excessive iron and copper loads in the body are also possible causes. Of them all, perhaps the most surprising cause of hepatitis is obesity-associated fatty liver, which is probably the most common cause of hepatitis today in affluent nations.

Ask the doctor

Dear doctor, I have been following your medical articles which has now become my Sunday, Sunday medicine. I am 68 years old and I am almost entirely living on drugs due to various ailments like slipped disc, diabetes, glaucoma, prostate enlargement and high blood pressure. I am tired of daily use of drugs in such a large volume. Can’t I live again without drugs in my life? I now stagger and walk as if I want to fall. Can I stop all the drugs or am I going to die if I stop them?                                                                                                                       0803xxxxxxx

I am sorry about the large number of medications you have to take, sir. It is because your ailments are so varied and are also so interrelated.  If you discontinue the use of those medicines, your health will rapidly deteriorate and death could ensue in a short while. Consequently, my advice to you is to see your doctors, get them to review your medicines with a view to streamlining them and that should help a lot to reduce the number and variety of the medications you take without compromising your overall health.

Dear doctor, thank you for the work you are doing. I am a woman of 59 years. I am having pains in my legs particularly when I walk. I feel stiffness from the buttocks downward to the legs that I will have to stop for some seconds before continuing to walk again.    0803xxxxxxx

The recurrent pain you suffer from when you walk may be due to some nerve injury. It may also be due to a blood vessel disease. Either way, it will be of immense benefit to get to see a physician who will examine you and determine what might be responsible for the pains. Once that has been achieved, it should be easier to offer you the kind of treatment that should work for you.

Dear doctor, whenever I use blood tonic my pant always get soaked with blood the next morning. I stopped using it but someone just told me that there is danger in not using blood tonic to replenish my monthly flow. Please sir, is it advisable to continue using it only to get soaked the next morning? Or is there a better product to use?  0806xxxxxxx

There is no truth in what your friend has told you, that if you do not take a blood tonic to replenish your monthly flow, that there is some danger. There is no danger involved. There are millions upon millions of women around the world who have never ever used any form of blood tonic and that has not harmed them in any way. And for you in particular, who adversely reacts the way you do to the use of a blood tonic, you need to stop using it.

Dear doctor, I saw your number in SUNDAY PUNCH. I am 15 years old and I am very thin and I don’t know what to do. I eat a lot, especially milk and I am still not improving. People look down on me because I am skinny. What do I do to have body and strength sir?  071xxxxxxx

Milk is not the ideal food for you to gain weight and it is not simply by eating a lot either. You have to eat regular meals that are balanced and large and you will gain in weight. In order to understand some of the complex details of weight gain, you must read an article published on this page a month ago about the techniques of gaining weight safely and quickly.

Dear doctor, I am a 14-year-old boy and I have a small penis to the extent that I don’t feel it. I really need your help. Do I need a drug or something else? 0805xxxxxxx

It is important to speak out this early when you notice things like that. At the present time, you will most likely not need drugs. The most important thing now is to verify if your observation is correct with respect to the size of the penis. So you will have to see a doctor for examination. The penis will be examined and its dimensions compared to those of other boys of your age before a judgment can be reached. It is only after that stage that it can be decided whether you will need a drug or not.

Dear doctor, I noticed some thick white blood coming out of my vagina. I hope there is nothing wrong with me. Thank you.                                       0902xxxxxxx

Blood is usually red in colour. If you are now passing out a thick whitish discharge from your vagina, it would be because you have a vaginal infection or more generally, a genital tract infection which will need proper antibiotic treatment after necessary investigations have been done.

Dear doctor, thank you for the health awareness. God bless you.

A lady once asked you that she does not eat until noon to 2pm and blood flow will not stop until she eats.

I was surprised that your response was for her to go to the hospital to run tests

Methinks your first suggestion would be for her to eat breakfast and lunch before 2pm. Every treatment does not require going to the hospital to run tests. And tests will have financial implication because there is no free treatment in any hospital.

Please educate your readers about the importance of breakfast even if it’s cornflakes and milk. But not going about on an empty stomach.

And really, it has been said that behind any diagnosis and treatment, there is the financial gain. I hope this is not playing out at this instance. Thanks.                                                                   xxx@xxx.com

Thank you very much for your comments. My first statement really bothered on a comprehensive attempt to make the reader understand how low blood glucose levels, which is what you get when you skip meals can adversely affect hormone levels. I then explained that such imbalances can cause bleeding but that tests are required to determine what the precise cause is. That is the proper scientific way to tackle the problem. Anything else is sheer guesswork and to rely on that as a template for treatment could lead to more trouble. Lastly, there is no commercial interest involved in asking the woman to go to a laboratory. I don’t know where she resides, not to mention which laboratory she is likely to visit.