Fulminant Hepatitis
Fulminant hepatitis is a severe but very rare form of acute hepatitis, it may begin with fatigue and nausea, but within a few weeks the signs and symptoms are pronounced (see acute hepatitis signs and symptoms listed above). About 2 weeks after jaundice develops encephalopathy develops. Encephalopathy is a state of impaired or altered mental status. In its mild form there may be some short term memory loss, forgetfulness, slurring of speech, small behavioral personality or behavioral changes, changes in sleep patternIn its severe form severe loss of memory i.e. not knowing the date, year, their name or address, confusion, inappropriate behavior, poor coordination, asterixis- uncontrollable flapping of the hands, fetor hepaticus- foul smelling breath, and coma. Up to 85 per cent of people with this type of rare hepatitis will die without a liver transplant.
Diagnostic tests for Hepatitis B
Blood Tests for Hep B
Blood tests will show the presence of the disease and what is affected. A hepatitis B serology blood test will give an accurate diagnosis of the type of hepatitis present as there are different strains of the virus.
Blood Test-Liver Function Tests for Hepatitis B
These blood tests show how well the liver is functioning but it does not accurately access all of the many and varied functions that the liver is responsible for in our bodies. They do check the level of liver enzymes, transaminases and cholestatic enzymes, bilirubin and liver protein levels, all of which can be affected by the liver virus.
High levels of transaminases in the blood do not always reveal how badly the liver is inflamed or damaged. Elevations of them can also occur in genetic liver disease, liver tumours, heart failure. The normal ranges of AST and ALT transaminases are around 0 to 40 IU/L and 0 to 45 IU/L respectively. In chronic hepatitis B the levels are usually two to three times above the normal range.
Blood Test-Liver Proteins and Hepatitis B
Albumin, prothrombin, and immunoglobulins, proteins made by the liver are checked and abnormal levels are indicative of severe liver disorder. Prothrombin times, because the liver produces many of the clotting factors required to stop bleeding, needs to be determined.
Liver Biopsy
Liver biopsy is one of the main and most accurate diagnostic procedures that can determine what is wrong with the liver and how badly it has been damaged. As most liver diseases affect the entire organ uniformly, the small sample obtained by biopsy, generally performed under a local anaesthetic, will show any abnormalities.For most people the guided liver biopsy is a safe and efficient diagnostic tool.
Treatment of Acute Hepatitis B
Acute hepatitis B is treated conservatively, rest and plenty of fluids. Bed rest is not needed by all people who have the virus, it just depends on how ill you feel. If you are up to it then there is no reason why you should not go to work. It is important to lead a healthy life, so stop smoking (try hard!), definitely give up alcohol for a few months as the liver needs time to recover, and eat a healthy diet.
Treatments Available for Chronic Hepatitis B
For those people whose bodies are unable to clear the virus hepatitis B will go on to become a chronic condition. Not so long ago there was no treatment for hepatitis B, however there are now a number available that are proving very effective. The future is looking a lot brighter. Scientists and drug companies are hoping that within the next few years a treatment will be discovered that will offer a cure for everyone with chronic hepatitis B.
Current treatments for Hepatitis B
Treatment with antiviral therapy is available for people with chronic hepatitis B although it is not recommended for all infected individuals. Treatment is aimed at suppression of the hepatitis B virus and stopping active liver disease. The FDA (Food and Drug Administration) has approved two drug types, alpha interferon and lamivudine. Alpha interferon, given by injection, stimulates the body’s immune system and is administered for 16 weeks. It is very expensive and does have a number of side effects, a few of them serious. Lamivudine, taken orally for 52 weeks, although it has few side effects, is not as long lasting as interferon. Relapse is a common feature and its use can lead to antiviral resistance.
Response rates to the drugs i.e. successful treatment programmes are variable. The FDA reports (Oct. 2002) that it is ‘above 50% in patients with ALT levels greater than 5 times the upper normal limit of normal, but lower (20%-35%) in patients with ALT levels less than 2 times the upper limit of normal. In patients with ALT levels less than 2 times the upper limit of normal, response rates are poor and therapy should be deferred’.
A new drug type is offering a possible third option, the neucleotide analogue adeforir dipivoxil, Hepsera which is currently being evaluated.
