Hepatitis B

Overview

HBV infection is parenterally transmitted i.e.:

1. Firstly, In babies born to HBV infected mothers, after transfusion of blood and blood products.
2. Secondly, IV drug use
3. Thirdly, Sexual contact
4. Lastly, HDV infection only in HBV-infected individuals

The hepatitis B virus consists of a core containing DNA and a DNA polymerase enzyme needed for virus replication. The core of the virus is surrounded by surface protein (Fig. 23.23). The virus, also called a Dane particle, and an excess of its surface protein (known as hepatitis B surface antigen) circulate in the blood. Humans are the only source of infection.

Spread of infection

Hepatitis B is one of the most common causes of chronic liver disease and hepatocellular carcinoma worldwide. Approximately one-third of the world’s population have serological evidence of past or current infection with hepatitis B and approximately 350–400 million people are chronic HBsAg carriers.

Hepatitis B may cause an acute viral hepatitis; however, acute infection is often asymptomatic, particularly when acquired at birth. Many individuals with chronic hepatitis B are also asymptomatic.

Indian epidemiology then other

Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus pass from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.

• Injection drug use
• Infected unscreened blood products
• Tattoos/acupuncture needles
• Sexual (homosexual and heterosexual)
• Close living quarters/playground play as a toddler (may contribute to high rate of horizontal transmission in Africa)
• HBsAg-positive mother

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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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Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you’ve infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms.

Hepatitis B signs and symptoms may include:

• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)

On exposure to Hepatitis B virus, the spectrum of clinical presentation depends on the immune status of the individual.

Acute hepatitis B—

appropriate immune response in majority of adults leads to acute hepatitis within 5 weeks to 5 months of exposure to infection but resolves within 6 months after the onset. No treatment require as the body is able to clear the virus with the resolution of hepatitis, and clearance of virus markers and development of immunity.

Acute and sub acute

liver failure is a severe form of acute hepatitis that complicate by liver failure. Paradoxically hepatitis B virus may present in extremely Low quantity or undetectable due to profound and inappropriate immune response. Antiviral therapy indicate but liver transplant may require if the condition does not stabilise.

Chronic hepatitis B—

Persistence of Hepatitis B infection for more than 6 months seen when the body has either inadequate or no response to HBV and is unable to clear the virus resulting in chronic inflammation of the liver of variable intensity.

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Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain.

Tests that can help diagnose hepatitis B or its complications are:

• Blood tests- Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it’s acute or chronic. A simple blood test can also determine if you’re immune to the condition.
• Liver ultrasound- A special ultrasound called transient elastography can show the amount of liver damage.
• Liver biopsy- Your doctor might remove a small sample of your liver for testing (liver biopsy) to check for liver damage. During this test, your doctor inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.

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

Investigation

Interpretation of various serological markers in hepatitis B, clinical situations in hepatitis B infection and serological markers and transaminase levels.

HBV contains several antigens to which infected persons can make immune responses, these antigens and their antibodies are important in identifying HBV infection, although the widespread availability of polymerase chain reaction (PCR) techniques to measure viral DNA levels in peripheral blood means that longitudinal monitoring now also frequently guide by direct assessment of viral load. Hepatitis B surface antigen (HBsAg).

HBsAg

HBsAg is an indicator of active infection, and a negative test for HBsAg makes HBV infection very unlikely. In acute liver failure from hepatitis B, the liver damage mediate by viral clearance and so HBsAg negative, with evidence of recent infection shown by the presence of hepatitis B core IgM. HBsAg appears in the blood late in the incubation period, but before the prodromal phase of acute type B hepatitis; it may present for a few days only, disappearing even before jaundice has developed, but usually lasts for 3–4 weeks and can in the illness and rapidly reaches a high titre, which subsides gradually but then persists.

Anti-HBc is initially of IgM type, with IgG antibody appearing later. Anti-HBc (IgM) can sometimes reveal an acute HBV infection when the HBsAg has disappeared and before anti-HBs has developed. Hepatitis B e antigen (HBeAg). HBeAg is an indicator of viral replication. In acute hepatitis B it may appear only transiently at the outset of the illness; its appearance follow by the production of antibody (anti-HBe). The HBeAg reflects active replication of the virus in the liver.

Chronic HBV infection mark by the presence of HBsAg and anti-HBc (IgG) in the blood. Usually, HBeAg or anti-HBe is also present; HBeAg indicates continued active replication of the virus in the liver. The absence of HBeAg usually implies low viral replication; the exception is HBeAg-negative chronic hepatitis B, in which high levels of viral replication, serum HBV-DNA and hepatic necroinflammation seen, despite negative HBeAg.

Treatment

In hepatitis B, among previously healthy adults who present with clinically apparent acute hepatitis, recovery occurs in ~99%; therefore, antiviral therapy is not likely to improve the rate of recovery and not require. In rare instances of severe acute hepatitis B, treatment with a nucleoside analogue at oral doses used to treat chronic hepatitis B has attempted successfully.

Although clinical trials have not done to establish the efficacy or duration of this approach, most authorities would recommend institution of antiviral therapy with a nucleoside analogue (entecavir or tenofovir, the most potent and least resistance-prone agents) for severe, but not mild–moderate, acute hepatitis B. Treatment should continue until 3 months after HBsAg seroconversion or 6 months after HBeAg seroconversion.

Fulminant hepatitis

In fulminant hepatitis, the goal of therapy is to support the patient by maintenance of fluid balance, support of circulation and respiration, control of bleeding, correction of hypoglycemia, and treatment of other complications of the comatose state in anticipation of liver regeneration and repair. Protein intake should restrict, and oral lactulose or neomycin administered. Glucocorticoid therapy has shown in controlled trials to ineffective.

Likewise, exchange transfusion, plasmapheresis, human cross-circulation, porcine liver cross-perfusion, hemoperfusion, and extracorporeal liver-assist devices have not proven to enhance survival. Meticulous intensive care that includes prophylactic antibiotic coverage is the one factor that does appear to improve survival. Orthotropic liver transplantation is resort to with increasing frequency, with excellent results, in patients with fulminant hepatitis.

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Homoeopathic Treatment:

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. Now 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 improve with homeopathic medicines.

Homeopathic Medicines

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, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines of Hepatitis B:

ACONITE [ACON]:

Sudden inflammation of liver, first attack Violent, rending, tearing pains: bursting. Additionally, Restlessness; tortures of anxiety: moving constantly: fear of death:" great thirst.

BELLADONNA [BELL]:

More sensitive to jar and more sensitive to motion, than almost any other remedy. Severe pain right hypochondrium on a small spot near and above umbilicus. Worse motion: very sensitive to touch. Acute pain, liver, worse lying especially right side; pains go to shoulder also neck: or spread to back and kidneys. Get rapidly worse. All in all, thirst for cold water: or thirst for water changed into thirst for beer.

CHAMOMILLA [CHAM]:

In general, Excessive sensibility of nerves: so excessive that few remedies can equal it Intense irritability: and its consequences. Hepatitis after vexation, or taking cold. Stitching pain in liver with vomiting also chilliness: after vexation. Vomiting of bile also food.

CORNUS CER [CORN]:

Chronic hepatitis and bilious derangements. Jaundice. Additionally, Constant working of bowels, as if they were all in motion Sensation as if they would break in two at waist.

CHINA [CHIN]:

Swollen, hard liver: sensitive to least pressure or Sensation of subcutaneous ulceration. Moreover, Obstruction of gall-bladder with colic: periodic recurrence: jaundice. Biliary calculi. Nerves in a fret", feeble, sensitive, anaemic, chilly. Lastly, Periodicity in regard to pains, and complaints.

NITRIC ACID [NIT-AC]:

Liver enormously enlarged. Jaundice. Urine scanty also strong smelling chronic hepatitis: "argue cake." In detail, Stitches in liver region.

KALI CARB [KALI-C]:

In brief, Heat, burning, pinching in liver: wrenching pain on stooping. Painful stitches right lumbar and liver: worse motion: sits stooped forward, stopped forward, elbows on knees and face in hands. Besides this, Must walk stooped forward, hands on knees, to steady body against motion. Lastly, Sprained pain, liver; can only lie on right side.

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.

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[1]Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set

[2] Medicine Golwala

[3] Davidsons Principles and Practice of Medicine (PDFDrive.com)

[4] Encyclopedia of Diets – A Guide to Health and Nutrition (PDFDrive)

[5] Pointers to Common Remedies by Dr.M.L.Tyler.

Frequently Asked Questions

What is Hepatitis B?

Hepatitis B is a viral infection caused by Hepatitis B virus affecting Liver. HBV is a DNA virus with a remarkably compact genomic structure; despite its small, circular, 3200-bp size, HBV DNA codes for four sets of viral products with a complex, multiparticle structure.

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

• Aconite
• Belladonna
• Chamomilla
• Cornus cer
• China
• Nitric Acid
• Kali carb

What causes Hepatitis B?

Hepatitis B virus (HBV)

What are the symptoms of Hepatitis B?

• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea also vomiting
• Weakness also fatigue
• Yellowing of your skin and
• Whites of your eyes (jaundice)