HEPATITIS B!?

Frankly speaking, only a minority of us know that Hepatitis B is actually a disease that’s becoming more serious in Malaysia. Did you know that Malaysia is ranked number 5 for the prevalence of hepatitis B in South East Asia? (quoted from Dr. Gamal Shiha, a committee member of APSL [Asia Pacific Study of the liver disease]) Yes believe it or not. Number 5. We even beat Thailand to it!



So what’s so important that you have to know about this disease?

Because of its high incidence, we, as future doctors, have to know how to prevent the disease so that the morbidity & mortality rate would be decreased, what the aetiologies are and how serious this disease could actually affect a person.

Transmitted parentally, ventrally (mother to foetus) and sexually, hepatitis B virus (HBV) (a.k.a Hepadnavirus) is a hepatotrophic virus, which means its main target is the liver. If not treated in the early stage, hepatitis B can lead to severe chronicity where the whole body is affected too.

“Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact. About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection. The hepatitis B virus is 50 to 100 times more infectious than HIV.” – WHO

The figure itself is a shocker. 2 BILLION and 350 MILLION..600 000 world wide..!! and most of the cases involve Asians.

Hepatitis B gets serious when it enters the stage of chronicity, where the patient will develop cirrhotic liver (50%), and worse, hepatocellular carcinoma (HCC). The condition may be asymptomatic or may present as a mild, slowly progressive hepatitis. What happens next?


Symptoms

Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including:

• yellowing of the skin and eyes (jaundice)
• dark urine
• extreme fatigue
• nausea
• vomiting and
• abdominal pain

People can take several months to a year to recover from the symptoms.


And this is only the early stage of infection. In the chronic stage, there’s a feminizing effect of the body (for male) where patient will develop gynaecomastia, loss of body hair, and testicular atrophy (due to reduced oestrogen metabolism by the liver). Other physical signs of chronic liver disease can be seen in the image below.


Other complications of chronic liver disease are portal hypertension and hepatic encephalopathy.

I think most of us are familiar with portal hypertension, right? But what is hepatic encephalopathy (HE)? If you go to the Specialized Medical Hospital (beside the ophthalmology centre) level 4 and 5, there you will see many patients suffering from HE. Some of them are laughing and some are just irritable and tied up to the bed. HE is a disease with an unknown exact cause but it is believed to be caused by ammonia (NH3) that crossed the blood brain barrier. NH3 is supposed to be metabolized by the liver and excreted in the urine. But in chronic hepatitis B, the liver has lost its function. Therefore the NH3 travels to brain and starts to disturb the normal brain function.


Prevention

How do you prevent yourself from getting infected by this silent-but-deadly disease?

• Vaccination
• Avoid injury by contaminated objects
• Avoid illegitimate sexual relations
• Safe medical procedures
• Supervision of blood banks
• Treatment of patients

Future doctors are definitely more prone to get infected; inevitably we have to deal with patients with Hepatitis B. If you accidentally prick yourself with the patient’s blood, you are now infected! Therefore, get the HB vaccine now! Go to our kuliyyah tibb, level 2, near the parasitology department, there’s a small room (first door on the left), enter and ask for “hepatitis B vaccination” and there you’ll be given 3 courses of injection (of course not all 3 at once, there’s a time gap obviously) and don’t miss the scheduled doses (it’s not free, but students are given discount!). If you do,

If the delay is less than a year: The missed doses only are given
If the delay is more than a year: Begin the vaccination from the beginning!!

In conclusion, even though there are treatments for Hepatitis B (Interferon, lamivudine, adenovir, entecavir) but PREVENTION IS BETTER THAN CURE.


Wallahu ta’ala a’lam.


Reference:

1. Clinical Medicine Kumar and Clarks
2. Viral Hepatitis (Dr.Gamal Shiha)
3. Macleod’s Clinical Examination