Hepatitis A

Overview of Hepatitis A

Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), the HBV-associated delta agent or hepatitis D virus (HDV), and hepatitis E virus (HEV). All these human hepatitis viruses are RNA viruses, except for hepatitis B, which is a DNA virus but replicates like a retrovirus.

Although these agents can be distinguished by their molecular and antigenic properties, all types of viral hepatitis produce clinically similar illnesses. These range from asymptomatic and inapparent to fulminant and fatal acute infections common to all types, on the one hand, and from subclinical persistent infections to rapidly progressive chronic liver disease with cirrhosis and even hepatocellular carcinoma, common to the bloodborne types (HBV, HCV, also HDV), on the other. [2]

Acute viral hepatitis may be asymptomatic, marked only by an increase in aminotransferase levels, or symptomatic with or without jaundice or sub fulminant or fulminant depending on the causative agent.

Though the natural history of acute hepatitis can vary according to the etiological agent, it can be divided as follows depending on clinical features and laboratory findings:

1. Prodromal period

• Bilirubinuria appears earlier than a rise in serum bilirubin.
• Serological viral markers help in arriving at a diagnosis.
• Urobilinogen and total bilirubin rise occur before clinical jaundice.
• Liver enzymes AST and ALT are > 500 units
• Leucopaenia may be observed with onset of fever.

2. Acute icteric stage

• Bilirubin rises, plateaus and then gradually decreases.
• Serum AST and ALT rise and fall rapidly and reach normal range in 2 to 5 weeks.
• ESR is raised initially and falls during convalescence

3. Defervescent stage

• Diuresis occurs at onset of convalescence.
• Bilirubinuria disappears, serum bilirubin is still increased.
• Urine urobilinogen increases.
• bilirubin becomes normal after 3 to 6 weeks [1]

Indian epidemiology then other

Transmission of Hepatitis A

The main route of transmission is faeco-oral, occasionally, HAV is transmitted by blood products or through illicit use of injectable drugs [1]

Causes of Hepatitis A

• Antibodies to HAV (anti-HAV) can be detected during acute illness when serum aminotransferase activity is elevated and fecal HAV shedding is still occurring.
• This early antibody response is predominantly of the IgM class and persists for several (~3) months, rarely for 6–12 months. During convalescence, however, anti-HAV of the IgG class becomes the predominant antibody.
• Therefore, the diagnosis of hepatitis A is made during acute illness by demonstrating anti HAV of the IgM class. After acute illness, anti-HAV of the IgG class remains detectable indefinitely, and patients with serum anti-HAV are immune to reinfection.
• Neutralizing antibody activity parallels the appearance of anti-HAV, and the IgG anti-HAV present in immune globulin accounts for the protection it affords against HAV infection.
• Liver injury is immune mediated by natural killer cells, virus-specific CD8+ cytotoxic T lymphocytes and nonspecific cells recruited at the site of inflammation.[2]

Classification of Hepatitis A

1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D
5. Hepatitis E

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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Sign & Symptoms of Hepatitis A

Acute viral hepatitis occurs after an incubation period that varies according to the responsible agent Incubation period 2–6 weeks, related to the infecting dose.

Prodromal symptoms consist of i.e.

• Malaise
• Loss of appetite
• Nausea, Vomiting
• Fever also Headache
• Dark urine
• Pale stool
• Fatigue, Malaise
• Arthralgias
• Photophobia
• Pharyngitis, cold, cough
• Anorexia

Age is the most important determinant of the severity of hepatitis A as also presence of chronic liver disease [1]

• Generally, incubation periods for hepatitis A range from 15–45 days (mean, 4 weeks), for hepatitis B and D from 30–180 days (mean, 8–12 weeks), for hepatitis C from 15–160 days (mean, 7 weeks), and for hepatitis E from 14–60 days (mean, 5–6 weeks).
• Additionally, The prodromal symptoms of acute viral hepatitis are systemic and quite variable.
• Constitutional symptoms of anorexia, nausea also vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza may precede the onset of jaundice by 1–2 weeks. The nausea, vomiting, and anorexia are frequently associated with alterations in olfaction and taste.
• Besides this, A low-grade fever between 38° and 39°C (100°–102°F) is more often present in hepatitis A and E than in hepatitis B or C, except when hepatitis B is heralded by a serum sickness–like syndrome; rarely, a fever of 39.5°–40°C (103°–104°F) may accompany the constitutional symptoms.
• All in all, Dark urine and clay-colored stools may be noticed by the patient from 1–5 days before the onset of clinical jaundice.[2]

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Diagnosis of Hepatitis A

• Raised serum bilirubin
• Serum AST also ALT levels remain high
• Alkaline phosphatase level is only mildly elevated, though if it remains persistently high, it suggests hepatitis-associated cholestasis
• Hepatitis A specific IgM antibody can be detected at the onset of symptoms and at the first rise in serum ALT.
• IgG anti HAV becomes positive at onset of illness and is detectable for many years.
• Nucleic acid-based tests like PCR performed on stool. [1]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment of Hepatitis A

• Unlike other types of viral hepatitis, hepatitis A rarely causes long-term liver damage and doesn’t become a long-term (chronic) illness.
• There isn’t a specific treatment for hepatitis A, and most people will recover fully within one to two months.
• Usually, symptoms are managed at home
• Plenty of rest
• Painkillers and medication to help with itchiness, nausea or vomiting.

Occasionally hepatitis A can last longer and, in rare cases, it can be life-threatening if it causes the liver to stop working properly (liver failure).[2]

Prophylaxis of Hepatitis A

Hepatitis A Vaccine: –

Dose primary course of 2 doses (1 mL each) one month apart. Booster Dose—One dose of 6–12 months after first dose for active immunization which provides long-lasting immunity.

Apart from individuals at high risk, hepatitis A vaccination is recommended in patients with chronic hepatitis C. Post-exposure Prophylaxis For intimate contacts (household, sexual, institutional) of persons with hepatitis A.

Dose: Immunoglobulin 0.02 mL/kg is recommended as early after exposure as possible; it may be effective even when administered as late as 2 weeks after exposure [1]

Homeopathic Treatment of Hepatitis A

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Hepatitis A:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Arsenicum album

• In general, Great exhaustion after the slightest exertion; septic infections and low vitality;
• Headaches, Relieved especially by cold
• Intense photophobia; hay-fever also coryza; face yellow.
• Cannot bear the sight also smell of food; nausea, retching, vomiting.
• Liver and spleen enlarged and painful; additionally abdomen swollen and painful; high temperature.
• Worse – after, midnight, from cold, cold drinks or food, right side. On the other hand, Better – with heat, warm drinks, head elevated.

Bryonia

• Liver region swollen, sore, tensive. In detail, Stitching pain, tenderness of abdominal walls.
• Furthermore; Aching muscles, irritable, oppressive headache.
• Dry lips, mouth, excessive thirst, bitter taste, stools large, dry hard, red brown urine, dry cough.
• Weakness, apathy,
• Coryza, dark coated tongue, abnormal hunger, loss of taste.
• Vomiting of bile and water immediately after eating, constipation.
• Worse – pressure, coughing, breathing, warmth, warm drinks, motion, morning, eating, exertion, touch, stooping, opening eyes, sitting up. whereas Better – lying on painful side, rest, cold things.

Calcarea carbonica

• Headache from over-‘lifting, mental exertion, with nausea; eyes sensitive to light; coryza.
• Abdomen sensitive to slightest pressure; additionally liver region painful when stooping; dark brown urine.
• Tickling cough, troublesome at night; pain between shoulder blades.
• Worse – exertion, ascending, cold, standing. whereas Better – dry weather, lying on painful side.

Cinchona officinalis

• Basically, Yellowish sclera; photophobia; coryza, sneezing, watery discharge.
• Pain in right upper abdomen; liver and spleen swollen also enlarged; jaundice; intermittent fever.
• Worse – slightest touch, draughts, night, after eating, bending over. on the other hand Better – bending double, pressure, open air, warmth. 

Chelidonium manjus

• Heavy, lethargic; drowsiness very marked; right-sided headache down behind ears also shoulder blade; face yellow.
• In detail, Nausea, vomiting; jaundice due to hepatic obstruction; liver enlarged; dark turbid urine; clay-colored stools, float in water.
• Short exhausting cough; spasmodic cough; pain in right side of chest also shoulder.
• Besides this, Fixed pain under inner and lower angle of right shoulder blade; yellow skin.
• Worse – especially right side, motion, touch, change of weather, early morning. whereas Better – after dinner, pressure.

Hepar sulphuris calcareum

• Stitching in region of liver when walking, coughing, either breathing, or touching it.
• Must turn in bed constantly; irritable, dejected, sad;
• Furthermore, Craving acids, wine, strong tasting food.
• Aversion to fats; belching without taste or smell.
• Burning in stomach; additionally heaviness and pressure in stomach after slight meal.
• Abdomen distended, tense; soft fetid clay colored stool, difficult to expel; croupy cough, asthma.
• Worse – dry cold winds, cool air, slight draught, touch, lying especially on painful side, evening and night. whereas Better – damp weather, wrapping head up, warmth, after eating, loosening clothing.

Mercuris

• Catarrhal headaches; In detail Coryza with sneezing.
• Liver enlarged and, hard, sore to touch; jaundice; whitish-grey stools; urine dark.
• Cannot lie specifically on right side; generally either gastric or bilious fever.
• Worse – night, wet weather, lying on right side, perspiring, warm room, also warm bed.

Digitalis

• Dull lethargy with slow pulse; excessive nausea not relieved by vomiting; enlarged sore painful liver.
• Moreover, Cough with raw sore feeling in chest.
• Continuous sleepiness; jaundice; additionally sudden flushes of heat followed by great nervous weakness.
• Worse – sitting erect, after meals and music but Better – empty stomach, open air. 

Lachesis

• Sun headaches; coryza, preceded by headache; face jaundiced.
• Liver region sensitive, cannot bear anything around waist; hot flushes also hot perspiration; abdomen sensitive, painful.
• Stools clay colored, light yellow urine, eyes yellow, cough also vomiting together.
• Worse – after sleep, left side, warm bath, pressure, hot drinks, especially closing eyes. On the other hand Better – appearance of discharges, warm applications.

Natrum sulphuricum

• Specifically A liver remedy.
• Duodenal catarrh, hepatitis, jaundice and vomiting of bile; additionally liver sore to touch, with sharp stitching pains; cannot bear tight clothing around waist.
• Coryza, yellow conjunctiva, photophobia, cough, yellow diarrhoea.
• Worse – lying especially on left side, music, damp weather. whereas Better-dry weather, pressure, changing position. [4]    

Diet & Regimen of Hepatitis A

• Stimulating the liver can stress the liver and stimulants such as colas, chocolate, coffee, and tea are restricted.
• Fruit juices also, because they contain high levels of concentrated sugar which stress the digestive process and the pancreas, while feeding the virus. [3]
• Stimulating the liver can stress the liver and stimulants such as colas, chocolate, coffee, and tea are restricted.
• Fruit juices also, because they contain high levels of concentrated sugar which stress the digestive process and the pancreas, while feeding the virus. [3]

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References use for Article Hepatitis A

[1] Medicine Golwala

[2]Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set

[3] Encyclopedia of Diets – A Guide to Health and Nutrition (PDF Drive )

[4]Homoeopathic Body-System Prescribing – A Practical Workbook of Sector Remedies

Frequently Asked Questions

What is Hepatitis A?

Acute viral hepatitis is a systemic infection affecting the liver predominantly caused by five well-characterized hepatotropic viruses, which are designated hepatitis A, B, C, D and E.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Hepatitis A?

• Arsenicum album
• Bryonia
• Calcarea carbonica
• Cinchona officinalis
• Chelidonium manjus
• Hepar sulphuris
• Mercuris
• Digitalis
• Lachesis
• Natrum sulphuricum

What causes Hepatitis A?

Hepatitis A virus [HAV]

What are the symptoms of Hepatitis A?

• Malaise
• Loss of appetite
• Nausea, Vomiting
• Fever & Headache
• Dark urine
• Pale stool
• Fatigue, Malaise
• Arthralgias
• Photophobia
• Pharyngitis, cold, cough
• Anorexia

How to prevent Hepatitis A?

Hepatitis A Vaccine (Dose primary course of 2 doses one month apart. Booster Dose—One dose of 6–12 months after first dose for active immunization which provides long-lasting immunity.)