Hepatitis E

Hepatitis E is a liver disease caused by the hepatitis E virus (HEV). This infection leads to inflammation of the liver and can have both acute and serious consequences. Hepatitis E occurs worldwide, but is particularly widespread in areas with poor sanitation and insufficient access to clean drinking water, such as parts of Asia, Africa, the Middle East and Central America.

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The hepatitis E virus is transmitted primarily by the fecal-oral route, usually by drinking contaminated water or consuming foods that have been in contact with infected water, such as raw or undercooked meat from infected animals. In rare cases, the virus can also be transmitted via blood transfusions or from mother to child during pregnancy.

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The incubation period of hepatitis E, which is the time between exposure to the virus and the onset of symptoms, ranges from 2 to 10 weeks. The illness often starts with flu-like symptoms such as fever, tiredness, loss of appetite, nausea, and abdominal pain. Subsequently, typical liver complaints can occur, including jaundice (yellowing of the skin and eyes), dark urine, and decolorized stools. Most often, hepatitis E is acute and the patient recovers completely within a few weeks to months.

Symptoms of Hepatitis E virus infection include:

• Slight fever
• Fatigue
• Joint pain
• Loss of appetite
• Nausea or vomiting
• stomach ache
• Your skin or the white parts of your eyes turn yellow (jaundice, icterus)
• Light-colored or clay-colored stools
• Dark-colored urine
• Itchy skin or rash

Sometimes, Hepatitis E causes no symptoms.

Hepatitis E is caused by the Hepatitis E virus. This virus is found in the faeces of people with hepatitis E. It is usually spread through drinking water containing Hepatitis E or faeces containing Hepatitis E (contaminated water). You can also get sick from eating contaminated meat or shellfish that is raw or undercooked enough.
In rare cases, the virus can spread by the following routes:

• From mother to baby during pregnancy
• Through blood with Hepatitis E in it. Most commonly, this occurs when a person receives donated blood (blood transfusion) with HEV in it.

This disorder is diagnosed based on:

• Your symptoms and medical history
• Your history of recent trips to places where Hepatitis E is common
• A physical exam
• Tests to check for hepatitis E or signs of liver damage: blood tests, stool test, fibroscan, etc.

Blood tests

The following things can be determined via the blood test:

• HEV IgM
• HEV IgG

A blood test involves taking a tube of blood from a vein on the inside of the arm, usually in the crease of the elbow. In order to see and feel this vein properly, a thrust band is pulled tightly around the upper arm. The vein is pricked with a needle so that the blood is drawn into the tube. The needle is used only once and then destroyed.

Fibroscan

The fibroscan is an examination that measures the stiffness of the liver. The more scar tissue, the stiffer the liver.

A fibroscan is an examination in which a type of ultrasound head is placed between the ribs on the right side of the body (where the liver is located). Tiny shock waves are sent to the liver. The examination takes about 10 minutes and does not hurt.

ultrasonography

An ultrasound will be taken of your abdomen (ultrasound abdomen). That way, we can look at the organs inside your body, and therefore also at your liver. Patients who have liver cirrhosis (link to the AZ Delta liver cirrhosis webpage) due to a hepatitis C infection require an ultrasound every 6 months to detect liver cancer early.

During an ultrasound of your abdomen, a gel is applied to your stomach and rubbed onto your stomach with an ultrasound head. This examination takes about 10 minutes and does not hurt.

Biopsy

Most patients with hepatitis C do not require a liver biopsy. This is only done when there is a suspicion of a possible other underlying liver disease. There are two types of liver biopsy:

• Percutaneous liver biopsy: In this biopsy, the doctor pierces the skin, between the ribs, to remove a piece of liver.
• Transjugular liver biopsy: When there is too much risk of bleeding (e.g. When the patient takes a blood thinner that cannot be stopped, if the patient has a clotting disorder, etc.), a transjugular liver biopsy is chosen. This means that a small piece of liver tissue is removed via your blood vessels.

After both biopsies, the pieces of tissue go to the lab to be further examined. You will receive the results at the next consultation, which will be scheduled shortly afterwards.

Hepatitis E usually goes away on its own within a few weeks or months.

For treatment, you can manage your symptoms at home.
 
Sometimes, antiviral medications are prescribed. These medications help to:

• Reducing the risk of liver damage
• Lower the risk of transmitting hepatitis E to others.

Medication

Eating and drinking

Activity

General instructions

When you are infected with the hepatitis C virus, it is important to avoid other factors that also cause damage to the liver. For example: do not overuse alcohol, avoid obesity, etc.

Preventing Hepatitis C

The best way to prevent an HEV infection is to reduce the risk of exposure to the virus:

• Avoid drinking water, ice cubes made from drinking water, and raw or undercooked foods when traveling to areas where the virus is common.
• Do not drink water that may be contaminated. Hepatitis E can be killed by boiling water or adding chlorine to water. You can also drink bottled water.
• Do not eat fruits or vegetables that have been washed with contaminated water. If the water may be contaminated, use bottled water to wash this food.
• Do not eat raw or undercooked meat or shellfish.
• Use a condom every time you have vaginal, oral, or anal sex. Make sure you use it correctly every time.

Learn more about Hepatitis E here [clinicalkey.com]