Hepatitis: Information& Hepatitis specialistsThere are millions of people around the world who have hepatitis. Hepatitis is an inflammation of the liver, the term is derived from the Greek: hepar or hepatos means liver, the suffix -itis stands for inflammation. The causes of the inflammation can be different, for example, viral infections with hepatitis A, B, C, D, or E. Also a metabolic disorder (z.B. the fatty liver), autoimmune diseases, or excessive alcohol consumption over a long period of time can trigger hepatitis. Here you will find further information as well as selected hepatitis specialists and centers.
Hepatitis cases in Germany
525 cases in 2019
537 cases in 2022 ( Prognosis )
Hepatitis can therefore viral orr non-viral can be and it is distinguished between a acute and chronic hepatitis differentiated. Chronic variant is when the disease lasts longer than 6 months.
The liver is the largest and most important Metabolic organ of the human. Besides, it is also the largest gland in our body. Located in the right upper abdomen, its surface borders directly on the diaphragm.
Of particular importance is the Portal vein system of this organ. Before substances can spread in the organism, they first enter the liver via the portal vein. This "first-pass effect The hepatitis vaccine is a vaccine that can be metabolized in the body and its effect can be enhanced or weakened.
At the same time, the cells of the body z. B. protected from ingested alcohol. It also passes first from the intestine to the liver for breakdown.
Location of the liver in the human body © yodiyim | AdobeStock
Background information on hepatitis
The metabolic performance of the liver depends very much on the function of the liver cells. However, men can be infected by various viruses via the bloodstream. The consequences are severe inflammation and thus also functional restrictions in the liver metabolism. Such an inflammation of the liver is called hepatitis denoted.
The popularly used term of jaundice is strictly speaking inaccurate. The conspicuous yellowing (= icterus) of the skin and eyeballs does not occur in all cases of liver inflammation. In addition, jaundice can also be the result of an obstruction of the bile ducts. Causes are usually gallstones or tumors.
Regardless of the exact cause, every hepatitis always begins with a Damage and destruction of liver cells. Proteins and enzymes known as transaminases are released from these cells. If these liver transaminases rise in the blood, this is an indication that hepatitis may be present in the diagnosis.
Symptoms of acute viral hepatitis
During acute hepatitis various inflammatory messenger substances are released. They lead to the observed general symptoms such as fever and a flu-like feeling of illness.
In many cases, the liver inflammation only becomes apparent due to the caused Disturbances in liver function noticeable. due to disturbances in hemoglobin-. bile acid metabolism, there is an increase in bilirubin. This is a degradation product of the red blood pigment hemoglobin. Bilirubin in the blood calls
– the typical yellowing of the skin and the whites of the eyes, – the darkening of the urine as well as – the discoloration of the stool and – itching
cause. Since the energy metabolism is disturbed, patients often feel weakened. In the case of very severe liver inflammation, other functions are impaired, e.g., the liver is not functioning properly.B. the production of clotting factors or the detoxification of the blood.
Overview of typical symptoms of hepatitis:
– Fatigue – Headache – Loss of appetite – Feeling of prere in the right upper abdomen – Vomiting – Itching – Fever – Dark coloration of the urine – Light coloration of the stool – Yellowing of the skin, mucous membranes, or. of the eyes (so-called icterus).
Go to Diagnosis can be treated by the doctor with the help of a Blood sample and a subsequent examination can quickly clarify a suspected case of hepatitis. If he can detect specific antibodies against the respective hepatitis virus in the blood, then the diagnosis of liver inflammation is given.
Yellow eye whites are among the symptoms of hepatitis © blackday| AdobeStock
If chronic hepatitis is suspected, further follow-up examinations, for example in the form of a tie sample (Liver biopsy) necessary.
As soon as hepatitis type A, B, C, D, or E is present, the attending physician must report this to the public health department according to § 6 of the Infection Protection Act.
Chronic viral hepatitis
Hepatitis either heals without consequences after the acute phase has been overcome or it progresses into a chronic hepatitis via.
In the long term, chronic progression leads to the development of a so-called shrunken liver (liver cirrhosis). Functional connective tie is irreversibly converted into non-functional tie (fibrosis).
In Final stage of this inflammation of the liver, the liver becomes largely non-functional. As a result, the blood backs up in front of the liver through the entire circulatory system. As a result, bypass circulation is formed, which is manifested in the increased formation of internal varices (varices).
Due to the lack of clotting factors caused by the hepatitis, the patients tend increasingly to bleeding and clotting disorders. In addition, very often body water into the abdomen a phenomenon that the doctor calls ascites (abdominal dropsy).
The liver dysfunction leads to other symptoms such as
– malnutrition, – increased susceptibility to infections, – increased bleeding tendency, – states of confusion (= "hepatic encephalopathy") and .
In addition, cirrhosis of the liver as a result of chronic hepatitis increases the risk of hepatocellular carcinoma.
Hepatitis viruses: causative agent of liver inflammation
Hepatitis goes on quite different causes back, including
– alcohol, – toxins and – backlog of bile due to a tumor or gallstone disease.
In addition, especially Viruses plays a major role. Those that cause inflammation of the liver are currently five groups are classified:
– Hepatitis A viruses (HAV), which are mainly ingested through contaminated food. (HBV), which, as a sexually transmitted infection, uses the blood pathway to infect new hosts. – Closely related to hepatitis B is hepatitis D virus (HDV). This defective virus is a frequent concomitant infection of hepatitis B and requires its envelope to infect new cells. Hepatitis C virus (HCV) caused by the. Is probably the most dangerous hepatitis from this series. If left untreated, it always leads to chronic hepatitis with cirrhosis of the liver and finally culminates in liver cancer. – Hepatitis E viruses (HEV) are predominantly transmitted through drinking water contaminated with feces. They are especially in Africa. Asia widespread.
A transmission of hepatitis viruses therefore takes place via the Blood path (B, C and D) or by so-called Smear infections (A and E). That is, in the case of a viral infection, there has been oral or fecal contact. This can be achieved by sexual contacts happen or, however, with the contact in the common Household through articles of daily use.
In general, contaminated sanitary facilities are a danger zone. Contaminated food Can be sources of epidemic infection. This includes vegetables or shellfish fertilized with fecal matter. Occasionally also drinking or bathing water. Here then many people fall ill at the same time.
In general, the countries of the Third World Risk areas for hepatitis are. Travelers in particular should therefore always bear in mind the following saying: "Boil it, peel it or leave it". This means avoiding all foods that have not been cooked or peeled.
However, special caution is also required in the case of hepatitis B and C with regard to Sexual contacts and fleeting vacation acquaintances. If left untreated, both diseases can develop into a permanent form of liver inflammation and have a massive impact on life.
However, in addition to the general rules of conduct, in the case of some hepatitis viruses, there is also the possibility of the Vaccination. The following section will therefore deal with ways of infection and preventive measures.
Hepatitis A: mussels as carriers of the disease
Hepatitis A (HAV) is widespread worldwide. However, especially in southern countries, infections can occur more frequently. The virus is characterized by its extreme resistance also outside the human body.
Due to this property, the hepatitis A virus survives if it is washed into the sea via fecal matter. Mussels and other marine animals absorb it from the water and accumulate it unintentionally via filtration mechanisms. Those who then enjoy their seafood pizza on vacation can easily contract the virus in the process.
Therefore the hepatitis A today is also one of the classic diseases that can occur during a trip ("travel hepatitis").
The duration until the outbreak of the disease after infection (Incubation period) is very long at 15 to 50 days. In many cases, the vacation is then already over again. This is how hepatitis A is more difficult to detect. To make matters worse, children in particular are usually asymptomatic, d.h., they show no signs of disease at all.
If there is Symptoms, mainly found for a diagnosis:
– gastrointestinal complaints – feeling of fullness – nausea – general feeling of illness – slight fever – yellowing (= icterus, "jaundice") of skin and eye white
Hepatitis A is always acute and, unlike hepatitis B and C, does not develop chronic diseases.
After surviving an infection immune for a lifetime, so that re-infection is impossible.
However, this liver inflammation can be completely prevented by prior vaccination. Travelers to southern Europe or Africa in particular should be aware of this. Asia before travel note.
One such Vaccination depending on the health insurance, it is even reimbursed as a precautionary measure for travel protection. In any case, however, children up to age 18 receive. If you are under the age of 18, the vaccination in combination with the hepatitis B vaccination is free of charge.
Hepatitis B: A sexually transmitted infection (STI)
Transmission of the hepatitis B virus (HBV) occurs through the bloodstream as well as other bodily fluids, including
– semen, – tear fluid, – saliva and foremilk/colostrum.
Therefore, the disease is one of the sexually transmitted infections (STI).
In the case of acute disease, after 60 to 120 days, it first occurs to
– nausea, – vomiting, – joint pain, – fever and – fatigue.
Later, hepatitis B also develops into a chronic form characteristic yellow coloration to. About one percent of those with the disease die from acute hepatitis, especially if the organ is already damaged by cirrhosis or other pre-damaged is. Another ten percent eventually develop chronic liver inflammation.
Vaccination offers reliable protection against hepatitis B © Sherry Young | AdobeStock
At Children The situation is different for patients with hepatitis C, where 90 percent of infections become permanent. Chronically infected individuals are a source of infection throughout their lives. May not work in the hospitality or health care industry, for example. Thus, hepatitis B also brings deep cuts in the lives of those affected.
Between 0.7 and one percent of people living in Germany are chronically infected. The best protection is offered by Triple vaccination, which, if carried out in childhood, is free of charge.
If you are unsure whether you should be vaccinated or not? The following list shows you those groups of people who are currently at risk of developing a vaccination recommended will:
– All infants and young children can receive the hepatitis B vaccination. In addition, all previously unvaccinated adolescents between the ages of 9 and 17 should be immunized. – If the mother is infected with hepatitis B, newborns should also be vaccinated (passively immunized) immediately after birth as a precautionary measure. – Persons who are already weakened by other persistent diseases should also be vaccinated. This group of persons includes people z.B. – with chronic kidney disease, , – people with frequent transmission of blood or blood components, – patients before major surgery, and – people who live or work primarily in psychiatric or other care facilities and in workshops for the disabled.
– Trainee or. students, – laboratory and cleaning staff, – staff in psychiatric institutions, asylum seekers' homes and workshops for the disabled, and – other persons at risk of infection through blood contact (e.g. B. first responders, police officers, garbage disposers)
Vaccination provides long-lasting protection against infection with hepatitis B viruses. Nevertheless, regular booster vaccinations after 15 years indicated depending on antibody titer in blood. After high-risk contacts or for people who work in health services, booster vaccinations can be useful after only 10 years.
Hepatitis C: Blood is the number one source of risk
Hepatitis C (HCV) is the most insidious of all hepatitis infections in humans. After a rather short acute phase, the hepatitis progresses into a persistent form of progression about. The acute phase is often symptom-free. Within 15 to 30 years, cirrhosis of the liver slowly develops, which can turn into liver cancer.
The incubation period until the first symptoms appear is usually six to eight weeks here. Very often, flu-like symptoms occur, which eventually culminate in jaundice. Chronic hepatitis C is usually silent and is therefore often not noticed.
However, there are a number of other symptoms that may indicate such ongoing infection:
– fatigue – loss of performance – upper abdominal discomfort – itching of the skin – joint problems and other rheumatic diseases
A Vaccination as against hepatitis B, D and A is unfortunately not possible with hepatitis C. Thus, the only protection is to avoid blood-to-blood contact, because blood is still the main route of infection.
Particularly at risk are therefore
– Injecting drug addicts – Tattoo lovers who get a new tattoo abroad, as well as – People who tend to engage in risky sexual practices.
Until the early 1990s, contaminated blood supplies or blood products were the main cause of new infections. The virus was not identified until 1989. Since then, blood supplies can be checked for hepatitis viruses by means of a test.
In general, however, hepatitis C is now considered to be curable. This is thanks in particular to new drugs approved in 2014 that inhibit viral replication in the liver.
The Prognosis for a complete cure is between 60 and 95. Influencing factors for this are
– the viral genus (1-6), – the degree of cirrhosis of the liver, – the presence of concurrent infections with other agents, such as.B. HIV or hepatitis B.
Therefore, always a early diagnosis and therapy are sought.
Hepatitis D: Two variants often occur simultaneously
Hepatitis D virus (HDV) is a so-called defective virus. This means that it cannot multiply in liver cells alone. For its multiplication cycle, hepatitis D requires a simultaneous infection of cells with hepatitis B. It practically uses the envelope of the B virus as a helper virus to infect new liver cells.
Transmission is analogous to hepatitis B. Thus, with frequently changing sexual intercourse Double infections occur with both viruses. Such co-infections with hepatitis B and D are usually even more severe than infections with hepatitis B alone.
Thus, when a D variant is developed, it is important for the patient to know whether or not it is
– simultaneous infection with B and D has occurred (simultaneous infection) or – the D variant develops later (Superinfection).
The liver suffers significantly more in the case of a superinfection. However, the course of the disease is also much slower compared to the B variant. Liver cirrhosis. can lead to liver cancer. Therefore, especially in the case of double infections with hepatitis B and D, it is very important to start treatment early on with antiviral drugs to treat. Then there is the best chance to slow down the progression of the disease or to reduce the viral load.
The best protection against infection with Hepatitis D is also ensured by hepatitis B vaccination.
Hepatitis E: Contaminated drinking water or meat as a source of infection
This form of inflammation of the liver with hepatitis E (HEV) is a disease that occurs worldwide. It occurs mainly in Asia, Africa and countries of the Third World. Similar to hepatitis A, it is transmitted to humans via contaminated water.
In the European area, the risk of infection lies in the consumption of uncooked Pork or contaminated wild boar meat. The Federal Institute for Risk Assessment recommends scrupulous hygiene when preparing wild boar meat. Anyone who cuts up a wild boar or parts of it themselves should always wear gloves.
Contaminated wild boar meat can transmit hepatitis E © photocrew | AdobeStock
People with acute or chronic immunodeficiency include the Residual risk groups. In them, a hepatitis E virus is more likely to trigger hepatitis E disease.
About 40 days after infection, typical symptoms appear with yellowing of the skin and eyes. As the disease is usually asymptomatic in children, there is a lack of reliable evidence in this age group.
After about two to three weeks, hepatitis E is usually over. Persistent forms of progression are not known. There is no treatment for the infection, nor is there a vaccine approved for use in Europe.
Protection against infection and preventive hygiene
What can be done in principle to avoid infection with hepatitis? Here are some tips that are particularly useful for long-distance travel and potentially risky everyday situations:
– When traveling in faraway countries, peel or cook vegetables and fruits before eating them. – Do not use ice cubes in Asia, Africa, South America (water should be boiled). – Consume meat products and especially offal from pigs, wild boar, deer or roe deer only fully cooked. – Protect yourself with a condom during sexual intercourse, especially when changing partners. – Pay attention to good hygienic conditions when using sharp objects such as scissors, needles or knives (in nail salons, hand and foot care and tattoo stores).