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 severe 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.

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

The incubation period for hepatitis E—the time between exposure to the virus and the onset of symptoms—ranges from 2 to 10 weeks. The disease often begins with flu-like symptoms such as fever, fatigue, loss of appetite, nausea, and abdominal pain. Subsequently, typical liver-related symptoms may develop, including jaundice (yellowing of the skin and eyes), dark urine, and pale stools. Hepatitis E is usually an acute illness, and patients make a full recovery within a few weeks to months.

Symptoms of a hepatitis E virus infection include:

• Mild fever
• Fatigue
• Joint Pain
• Loss of appetite
• Nausea or vomiting
• Stomachache
• Your skin or the whites of your eyes turn yellow (jaundice, icterus)
• Light-colored or clay-colored stool
• 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 stool of people with hepatitis E. It is usually spread through drinking water contaminated with the hepatitis E virus or stool containing the virus (contaminated water). You can also become ill from eating contaminated meat or shellfish that is raw or undercooked.
In rare cases, the virus can spread through the following routes:

• From Mother to Baby During Pregnancy
• Through blood contaminated with hepatitis E. This usually occurs when a person receives donated blood (a blood transfusion) that contains HEV.

This condition is diagnosed based on:

• Your symptoms and medical history
• Your history of recent travel to areas where Hepatitis E is common
• A physical examination
• Tests to check for hepatitis E or signs of liver damage: blood tests, stool tests, FibroScan, etc.

Blood Test

The following can be determined through the blood test:

• HEV IgM
• HEV IgG

During a blood test, a small tube of blood is drawn from a vein on the inside of the arm, usually in the crook of the elbow. To make it easier to see and feel this vein, a tourniquet is tightened around the upper arm. A needle is inserted into the vein, drawing the blood into the tube. The needle is used only once and then disposed of.

Fibroscan

A Fibroscan is a test that measures the stiffness of the liver. The more scar tissue there is, the stiffer the liver.

A Fibroscan is a test in which a type of ultrasound transducer is placed between the ribs on the right side of the body (where the liver is located). Small shock waves are sent to the liver. The test takes about 10 minutes and is painless.

Ultrasound

An ultrasound of your abdomen (abdominal ultrasound) will be performed. This allows us to examine the organs inside your body, including your liver. For patients with liver cirrhosis (link to AZ Delta liver cirrhosis webpage) caused by a hepatitis C infection, an ultrasound is required every 6 months for the early detection of liver cancer.

During an abdominal ultrasound, gel is applied to your abdomen, and a transducer is moved across your abdomen. This exam takes about 10 minutes and is painless.

Biopsy

Most patients with hepatitis C do not need a liver biopsy. It is performed only when there is suspicion of a possible underlying liver condition. There are two types of liver biopsy:

• Percutaneous liver biopsy: In this procedure, the doctor inserts a needle through the skin, between the ribs, to remove a small sample of liver tissue.
• Transjugular liver biopsy: When there is too high a risk of post-procedure bleeding (e.g., when the patient is taking a blood thinner that cannot be discontinued, when the patient has a coagulation disorder, etc.), a transjugular liver biopsy is performed. This involves removing a small sample of liver tissue through your blood vessels.

After these two biopsies, the tissue samples will be sent to the lab for further examination. You will receive the results at your next appointment, which will be scheduled shortly thereafter.

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

Until you receive treatment, you can manage your symptoms at home.

Sometimes, antiviral medications are prescribed. These medications help to:

• To reduce the risk of liver damage
• Reduce the risk of passing hepatitis E on to others.

Medication

Food and Drink

Activity

General Instructions

If you are infected with the hepatitis C virus, it is important to avoid other factors that can also damage the liver. For example: avoid excessive alcohol consumption, avoid being overweight, etc.

Prevention of 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 food when traveling to areas where the virus is prevalent.
• Do not drink water that may be contaminated. Hepatitis E can be killed by boiling water or adding chlorine to it. 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 these foods.
• 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.

Read more about hepatitis E here [clinicalkey.com]