Archive | August 2019

QUOTE FOR THE WEEKEND:

“For the last four years or so,  Andrew Luck – Former Quaterback for the Colts-29 yrs old stated this month he’s been in this cycle of injury, pain, rehab, injury, pain, rehab — and it’s been unceasing, unrelenting, both in-season and offseason,” he said after a preseason game over the weekend. “I felt stuck in it, and the only way I see out is to no longer play football. It’s taken my joy of this game away.”

ESPN

Continual Concussions can cause permanent brain damage!

concussion 4concussion 1

concussion 2concussion 3a

A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.  Continue this injury over and over again can lead to high potential of brain damage.

Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don’t realize it.

Concussions are common, particularly if you play a contact sport, such as football. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Most concussive traumatic brain injuries are mild, and people usually recover fully.

******Remember the key to a brain concussion fully recovering is not to have impact to the head happening over and over again. Based on the same concept if you get hit in the same spot over and over again anywhere in the body bruising to actual injury will happen whether it be muscle or bone. Well get hit in the head over and over again like in sports especially boxing but now the big conversation with football even with a helmet on you will cause a permanent damage to the brain.  A perfect example of this is a boxer that gets hit over an over again to the head in a boxing ring. The head is just another area of the body and no different than other areas of our body.******

What actually happens is this a concussion is most often caused by a sudden direct blow or bump to the head.

The brain is made of soft tissue. It’s cushioned by spinal fluid and encased in the protective shell of the skull. When you sustain a concussion, the impact can jolt your brain. Sometimes, it literally causes it to move around in your head. Traumatic brain injuries can cause bruising, damage to the blood vessels, and injury to the nerves.

The result? Your brain doesn’t function normally. If you’ve suffered a concussion, vision may be disturbed, you may lose equilibrium, or you may fall unconscious. In short, the brain is confused. That’s why Bugs Bunny often saw stars after getting whacked in the head in his cartoon by some other character.

The new uptake with football is being concerned with players getting concussions from getting hit by their opponent players whether it be defense or offense while playing the game. Concussions have become big business in the football world. With 1,700 players in the NFL, 66,000 in the college game, 1.1 million in high school and 250,000 more in Pop Warner, athletes and families across the country are eager to find ways to cut the risks of brain injury, whose terrifying consequences regularly tear across the sports pages. And a wave of companies offering diagnostic tools and concussion treatments are just as eager to sell them peace of mind.

That’s actually a slogan for one company. ImPACT, the maker of the world’s most popular concussion evaluation system, offers a 20-minute computerized test that players can take via software or online to measure verbal and visual memory, processing speed, reaction time and impulse control. The idea behind ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) and similar batteries is that doctors or athletic trainers can give a baseline test to a healthy athlete, conduct follow-up tests after an injury and then compare the results to help figure out when it’s OK to return the athlete to play. Selling itself as “Valid. Reliable. Safe,” ImPACT dominates the testing market and has spread throughout the sports world: Most NFL clubs use the test, as do all MLB, MLS and NHL clubs, the national associations for boxing, hockey and soccer in the U.S., and nine auto racing circuits.

A total of 87 out of 91 former NFL players have tested positive for the brain disease at the center of the debate over concussions in football, according to new figures from the nation’s largest brain bank focused on the study of traumatic head injury.

Researchers with the Department of Veterans Affairs and Boston University have now identified the degenerative disease known as chronic traumatic encephalopathy, or CTE, in 96 percent of NFL players that they’ve examined and in 79 percent of all football players. The disease is widely believed to stem from repetitive trauma to the head, and can lead to conditions such as memory loss, depression and dementia.

In total, the lab has found CTE in the brain tissue in 131 out of 165 individuals who, before their deaths, played football either professionally, semi-professionally, in college or in high school.

Forty percent of those who tested positive were the offensive and defensive linemen who come into contact with one another on every play of a game, according to numbers shared by the brain bank with FRONTLINE. That finding supports past research suggesting that it’s the repeat, more minor head trauma that occurs regularly in football that may pose the greatest risk to players, as opposed to just the sometimes violent collisions that cause concussions.

But the figures come with several important caveats, as testing for the disease can be an imperfect process. Brain scans have been used to identify signs of CTE in living players, but the disease can only be definitively identified posthumously. As such, many of the players who have donated their brains for testing suspected that they had the disease while still alive, leaving researchers with a skewed population to work with.

Even with those caveats, the latest numbers are “remarkably consistent” with past research from the center suggesting a link between football and long-term brain disease, said Dr. Ann McKee, the facility’s director and chief of neuropathology at the VA Boston Healthcare System.

“People think that we’re blowing this out of proportion, that this is a very rare disease and that we’re sensationalizing it,” said McKee, who runs the lab as part of a collaboration between the VA and BU. “My response is that where I sit, this is a very real disease. We have had no problem identifying it in hundreds of players.”

In a statement, a spokesman for the NFL said, “We are dedicated to making football safer and continue to take steps to protect players, including rule changes, advanced sideline technology, and expanded medical resources. We continue to make significant investments in independent research through our gifts to Boston University, the [National Institutes of Health] and other efforts to accelerate the science and understanding of these issues.”

The latest update from the brain bank, which in 2010 received a $1 million research grant from the NFL, comes at a time when the league is able to boast measurable progress in reducing head injuries. In its 2015 Health & Safety Report, the NFL said that concussions in regular season games fell 35 percent over the past two seasons, from 173 in 2012 to 112 last season. A separate analysis by FRONTLINE that factors in concussions reported by teams during the preseason and the playoffs shows a smaller decrease of 28 percent.

QUOTE FOR THURSDAY:

“In summary, there is a difference between a heart attack and a cardiac arrest. A heart attack occurs when the blood supply to part of the heart stops and thus causes a section of the heart muscle to begin to die; whereas a cardiac arrest occurs when the heart stops beating as a whole.”

American Heart Association

Certain cardiac rhythms can lead to a cardiac arrest & how!

HeartBlocks1

The rhythms above are heart blocks (HB) that occur in the bottom of the upper chambers which can occur in some people. There is 1st degree HB where you can live a completely normal life with but 2nd and 3rd degree HB needs treatment (usually a pacemaker) by cardiologist surgeon.  After treatment with 2nd and 3rd degree HB you can live a completely normal life with follow up with your cardiologist and yearly pacemaker checks.

In this rhythm below the Ventricular Tachycardia is with a point on the top but than flips upside down (commonly called Torsedes Pointes).  This is commonly due to Magnesium Level low and IV Magnesium in the hospital is given 1 to 2 gm.

ventrhy4

This  rhythm above with a pulse=also a rhythm pulsating in different areas of the heart in the ventricles only causing the rhythm not to look identical throughout the tele strip above = Polymorphic V- Tac- meaning the stimulus in the ventricles to make the heart beat is coming from different areas of the ventricles for each beat.  Each jagged tooth is a beat that makes up the whole strip shown above for Ventricular Tachycardia.

Than when the atriums aren’t working as the natural pacemaker that took over for the sinus node but now they don’t work so now the ventricles take over and the rhythms of all ventricle rhythms are with NO p waves since the atriums are not working so no p wave is involved but we have QRS waves but their wide in measurement because the rhythm starts in the ventricles. The rhythms are PVC (Premature Ventricular Contractions), Idioventricular Rhythm, Ventricular tachycardia (Monomorphic and Polymorphic-rhythm getting more irregular. When regular and monomorphic=looking identical with every ventricular beat or contraction as opposed to polymorphic=not looking identical each contraction but each one is a ventricular contraction), Torsades De Pointes Ventricular Tachycardia (the rhythm starts upright but turns upside down but each contraction without a p wave and a wide contraction meaning a ventricular contraction), and Ventricular Fibrillation, to asystole.

Here’s what they look like:

 Accelerated Idioventricular Rhythm

Accelerated idioventricular rhythm occurs when three or more ventricular escape beats appear in a sequence. Heart rate will be 50-100 bpm. The QRS complex will be wide (0.12 sec. or more).

A regular QRS measures less than 0.12 which is with all atriums rhythms.

 Asystole

Asystole is the state of no cardiac electrical activity and no cardiac output. Immediate action is required.

Idioventricular Rhythm

Idioventricular rhythm is a slow rhythm of under 50 bpm. It indicates that then ventricules are producing escape beats.

Premature Ventricular Complex (above 1st strip)

Premature ventricular complexes (PVCs) occur when a ventricular site generates an impulse. This happens before the next regular sinus beat. Look for a wide QRS complex, equal or greater than 0.12 sec. The QRS complex shape can be bizarre. The P wave will be absent.

Premature Ventricular Complex – Bigeminy a QRS after every 2 regular beats

Premature Ventricular Complex – Trigeminy a QRS after every 3 regular beats

Premature Ventricular Complex – Quadrigeminy a QRS after every 4 regular beats

 Ventricular Fibrillation (in above strip-3rd one)

Ventricular fibrillation originates in the ventricules and it chaotic. No normal EKG waves are present. No heart rate can be observed. Ventricular fibrillation is an emergency condition requiring immediate action.

Ventricular Tachycardia  (in above strip-2nd one)

A sequence of three PVCs in a row is ventricular tachycardia. The rate will be 120-200 bpm. Ventricular Tachycardia has two variations, monomorphic and polymorphic. These variations are discussed separately.

Ventricular Tachycardia Monomorphic

Monomorphic ventricular tachycardia occurs when the electrical impulse originates in one of the ventricules. The QRS complex is wide. Rate is above 100 bpm.  Each V tac beat looks identical like in the strip above.

Ventricular Tachycardia Polymorphic

Polymorphic ventricular tachycardia has QRS complexes that very in shape and size. If a polymorphic ventricular tachycardia has a long QT Interval, it could be Torsade de Pointes.  The strip shows the pulses are not identical=polymorphic since the pulse beats are coming from all different areas of the ventricles.

Torsade de Pointes  (the rhythm strip at the top under Heart Blocks)

Torsade de Pointes is a special form of ventricular tachycardia. The QRS complexes vary in shape and amplitude and appear to wind around the baseline.  This is an example or polymorphic ventricular tachycardia.

Ventricular ending line needs to be treated stat to be switched back to atrial rhythm since the heart is missing ½ of the conduction it’s to normally receive from the atriums and if not reversed the heart will go into failure to heart attack or to asystole flat line and go into a cardiac arrest.

With PVCs=Premature Ventricle Contractions asymptomatic we just closely monitor the pt and telemetry the pt is on. Now a pt with PVCs and symtomatic usually meds with 0xygen (sometimes 02 alone resolves it but other times with meds) but if it gets worse into V Tachycardia the treatment is below.

Idioventricular Rhythm (IVR)is usually with a slow brady pulse and needs meds.   Accelerated IVR (AIVR) is usually hemodynamically tolerated and self-limited; thus, it rarely requires treatment.

Occasionally, patients may not tolerate AIVR due to (1) loss of atrial-ventricular synchrony, (2) relative rapid ventricular rate, or (3) ventricular tachycardia or ventricular fibrillation degenerated from AIVR (extremely rare). Under these situations, atropine can be used to increase the underlying sinus rate to inhibit AIVR.

Other treatments for AIVR, which include isoproterenol, verapamil, antiarrhythmic drugs such as lidocaine and amiodarone, and atrial overdriving pacing are only occasionally used today.

Patients with AIVR should be treated mainly for its underlying causes, such as digoxin toxicity, myocardial ischemia, and structure heart diseases. Beta-blockers are often used in patients with myocardial ischemia-reperfusion and cardiomyopathy

With Ventricular rhythms with fast pulse over 100 with symptomatic signs for the patient we may use as simple as valsalva pressure on the neck that medical staff only do but when pt is in asymptomatic (no symptoms) Ventricular Tachycardia (V-Tac) to even medications but when symptomatic if in V-Tac start cardioversion with a pulse if no pulse called pulseless V-Tac we use a defibrillator since there is no pulse there is no QRS to pace with in having the shock hit at the R wave, why? NO PULSE.

Treatment for Torsade de Pointes is Magnesium deficiency and Mag. Supplement given IV 2gms. Usually effective but if necessary the same as above as directed for it with a pulse or the other V Tac. (without a pulse)-See above.

Ventricular Fibrillation is when the ventricles are just quivering and the atriums in any ventricular rhythm doing nothing. The pt needs CPR and ASAP a defibrillator in hopes the shock will knock the rhythm back to a normal sinus or some form of a real rhythm.

Asystole which is a straight line, no pulse and this is CPR with epinephrine or Vasopressin 40 for only the replacement of the 1st or 2nd dose of Epinephrine 1mg. This is given 3-5 minutes (epinephrine). No defibrillation since no pulse. A rhythm may come back and if not the MD will call when CPR stops. Asystole is hard to resolve in most cases highier probability of resolution if in a hospital where close monitoring is done and its detected quicker.

The PURPOSE in treating any rhythm abnormal to the human heart is to reach the goal of a optimal or healthiest rhythm (a normal sinus rhythm , the best rhythm the heart can be in) and if not reaching an atrial rhythm.  We the medical field aim to reach a heart rhythm the patient can live with and hopefully reaching the best NSR-Normal Sinus Rhythm.  Normal sinus rhythm that is a rhythm starting from the upper right chamber extending to the left one and continues down on both sides to the bottom of the ventricles.  This rhythm is giving the most effective oxygen perfusion to the heart to allow it to do its function (pumping good oxygenated blood flow out of the left ventricle at the same time pumping highly carbon dioxide blood from the right side of the heart to the lungs to get more oxygen).   Doing this it allows the human body to get good amounts of oxygen to all our tissues=good overall oxygen perfusion to all tissues.  At the same time what happens is red blood cells from all tissues with mostly used up oxygen from the cell and more carbon dioxide in the cell are also being pumped by the heart to return to the right side  to the lungs to go through this whole process again in getting more oxygen in the RBCs which keeps us alive. A human without oxygen or low oxygen to their tissues or any tissue is going to reach cellular starvation which in turn causes starvation to the tissues (in general) or to a tissue (Ex. Diabetic the foot to lack of 02 to cyanotic purple tissue to necrotic black tissue=dead to amputated since the tissue is dead.).

Cardiac Arrest or Heart Attack are more likely to occur in  a irregular rhythm especially making the heart work to hard being RVR afib in the atriums that can lead easily to ventricular tachycardia to ventricular fibrillation and not treated immediately.

Cardiac Arrest is an electrical problem with the conduction of the heart whereas a Heart Attack is caused by a blockage of blood (Ex. coronary artery) to the heart that can lead to a bad rhythm due to lack of 0xygen that leads to worse rhythms as the heart gets more stressed out.

QUOTE FOR WEDNESDAY:

“ParryRomberg syndrome is a rare disorder characterized by slowly progressive deterioration (atrophy) of the skin and soft tissues of half of the face (hemifacial atrophy), usually the left side. It is more common in females than in males.”

National Institute of Neurological Disorders and Stroke.

Parry-Romberg Syndrome!

Parry-Romberg syndrome is a rare disorder characterized by slowly progressive deterioration (atrophy) of the skin and soft tissues of half of the face (hemifacial atrophy), usually the left side. It is more common in females than in males. Initial facial changes usually involve the tissues above the upper jaw (maxilla) or between the nose and the upper corner of the lip (nasolabial fold) and subsequently progress to the angle of the mouth, areas around the eye, the brow, the ear, and the neck. The deterioration may also affect the tongue, the soft and fleshy part of the roof of the mouth, and the gums. The eye and cheek of the affected side may become sunken and facial hair may turn white and fall out (alopecia). In addition, the skin overlying affected areas may become darkly pigmented (hyperpigmentation) with, in some cases, areas of hyperpigmentation and patches of unpigmented skin (vitiligo). Parry-Romberg syndrome is also accompanied by neurological abnormalities including seizures and episodes of severe facial pain (trigeminal neuralgia).  Cranial neuropathies involving cranial nerves III, V, VI, and VII, have also been described in patients with PHA. Secondary trigeminal neuralgia has been reported due to impingement of the nerve by destruction of bony structures, as well as vascular inflammation and damage resulting in facial pain that can be chronic and poorly responsive to treatment. Additionally, speech may be affected in PHA patients resulting in dysarthria or aphasia. Cognitive impairment and an increase in behavioral disorders have also been noted. Depending on the degree of atrophy, changes to intracranial tissue and vessels may also result in hemiparesis, dysesthesias, and paresthesias.

The onset of the disease usually begins between the ages of 5 and 15 years. The progression of the atrophy often lasts from 2 to 10 years, and then the process seems to enter a stable phase. Muscles in the face may atrophy and there may be bone loss in the facial bones. Problems with the retina and optic nerve may occur when the disease surrounds the eye.

The prognosis for individuals with Parry-Romberg syndrome varies. In some cases, the atrophy ends before the entire face is affected. In mild cases, the disorder usually causes no disability other than cosmetic effects.

Unfortunately there is no cure and there are no treatments that can stop the progression of Parry-Romberg syndrome. Reconstructive or microvascular surgery may be needed to repair wasted tissue. The timing of surgical intervention is generally agreed to be the best following exhaustion of the disease course and completion of facial growth. Most surgeons will recommend a waiting period of one or two years before proceeding with reconstruction. Muscle or bone grafts may also be helpful. Other treatment is symptomatic and supportive.

 

 

 

QUOTE FOR MONDAY:

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmiss-ion from mother to baby at birth, from family member to child, and also by sexual contact.

WHO World Health Organization

Part II Hepatitis C,D, & E

 

Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure, liver cancer, or life-threatening esophageal and gastric varices.

HCV is spread primarily by blood-to-blood contact associated with intravenous drug use, poorly sterilized medical equipment, and transfusions. An estimated 150–200 million people worldwide are infected with hepatitis C. The existence of hepatitis C – originally identifiable only as a type of non-A non-B hepatitis – was suggested in the 1970s and proven in 1989.  Hepatitis C infects only humans and chimpanzees. It is one of five known hepatitis viruses: A, B, C, D, and E.

The virus persists in the liver in about 85% of those infected. This infection of the liver is caused by the hepatitis virus. About 3.2 million people in the U.S. have the disease. But it causes few symptoms, so most of them don’t know.

There are many forms of the hepatitis C virus. The most common in the U.S. is type 1. None is more serious than any other, but they respond differently to treatment.

Jaundice (a condition that causes yellow eyes and skin, as well as dark urine), Stomach pain, Loss of appetite, Nausea, and Fatigue.

HOW IT’S TRANSMITTED

The virus spreads through the blood or body fluids of an infected person.

You can catch it from:

-Sharing drugs and needles

-Having sex, especially if you have an STD, an HIV infection, several partners, or have rough sex.

-Being stuck by infected needles

-Birth — a mother can pass it to a child

Hepatitis C isn’t spread through food, water, or by casual contact.

HOW IT’S DIAGNOSED

You can get a blood test to see if you have the hepatitis C virus.

Are There Any Long-Term Effects?

Yes. About 75% to 85% of people who have it develop a long-term infection called chronic hepatitis C. It can lead to conditions like liver cancer and cirrhosis, or scarring of the liver. This is one of the top reasons people get liver transplants.

WHAT’S THE TREATMENT:

Hepatitis C treatments have changed a lot in recent years. The latest is a once-daily pill called Harvoni that cures the disease in most people in 8-12 weeks. It combines two drugs: sofosbuvir (Sovaldi) and ledipasvir. In clinical trials, the most common side effects were fatigue and headache. However, the medicine is expensive.  Interferon and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression,nausea, and diarrhea.

THOSE AT HIGHEST RISK:

Certain things may increase your risk of becoming infected with the hepatitis C virus. Just because you are at risk for getting hepatitis C does not mean that you have the virus.

Many people do not know how they became infected with hepatitis C.

Recommended Related to Hepatitis

Tips to Deal With Hepatitis C Fatigue

When you have hepatitis C, being tired — really tired — can be a fact of life. But there are ways you can boost your energy. Here, three people who have experience with fatigue from the disease share their tips.

You can get hepatitis from:                                                           

Sharing needles and other equipment (such as cotton, spoons, and water) used to inject drugs.              

-Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.                          

-Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.

HEPATITIS D

Hepatitis D (hepatitis delta) is a disease caused by the hepatitis D virus (HDV), a small circular enveloped RNA virus. This is one of five known hepatitis viruses: A, B, C, D, and E. HDV is considered to be a sub-viral satellite because it can propagate only in the presence of the hepatitis B virus (HBV).

Transmission of HDV:  Most already are with Hepatitis B.  How can it transmit from one to another?  Well similar to that of Hepatitis B including:

Spread through infected Hepatitis B or D needles shared since one of the users blood is infected with the infection.

Spread through a sex partner infected with Hepatitis B or D via the semen

****both spreads infected through the blood and fluids in the body****

Spread through a infected mother to her newborn.

Remember it can occur either via simultaneous infection with HBV (coinfection) or superimposed on chronic hepatitis B or hepatitis B carrier state (superinfection).

Both superinfection and coinfection with HDV results in more severe complications compared to infection with HBV alone. These complications include a greater likelihood of experiencing liver failure in acute infections and a rapid progression to liver cirrhosis, with an increased chance of developing liver cancer in chronic infections. In combination with hepatitis B virus, hepatitis D has the highest fatality rate of all the hepatitis infections, at 20%.

The routes of transmission of hepatitis D are similar to those for hepatitis B. Infection is largely restricted to persons at high risk of hepatitis B infection, particularly injecting drug users and persons receiving clotting, and is mostly associated with intravenous drug use. factor concentrates. Worldwide more than 15 million people are co-infected. HDV is rare in most developed countries

TREATMENT:

The vaccine for hepatitis B protects against hepatitis D virus because of the latter’s dependence on the presence of hepatitis B virus for it to replicate.

Low quality evidence suggests that interferon alpha can be effective in reducing the severity of the infection and the effect of the disease during the time the drug is given, but the benefit generally stops when the drug is discontinued, indicating that it does not cure the disease. Interferon is effective only in ~20% of cases.

The drug myrcludex B, which inhibits virus entry into hepatocytes, is in clinical trials as of October 2015

Hepatitis E virus (HEV) is another liver infection.  Hepatitis E is a self-limited disease that does not result in chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. It is transmitted from ingestion of fecal matter, even in microscopic amounts, and is usually associated with contaminated water supply in countries with poor sanitation is a liver infection caused by the Hepatitis E virus (HEV). Hepatitis E is a self-limited disease that does not result in chronic infection.

Hepatitis E is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.  There is no FDA approved vaccination for Hepatitis E.

 

 

 

 

 

QUOTE FOR THE WEEKEND:

Hepatitis” means inflammation of the liver. … Hepatitis A and B can be prevented by vaccination, but not hepatitis C. There are now many good medications available to treat chronic hepatitis B and C. The symptoms of acute hepatitis include yellowing of the skin and eyes, nausea, fever and fatigue.

MAYO CLINIC

Part I Hepatitis and it’s types (A and B):

Hepatitis_Overview       Hepatatis approach-to-evaluation-of-liver-disorders-34-638

Viral hepatitis, including hepatitis A, hepatitis B, and hepatitis C, are distinct diseases that affect the liver and have different hepatitis symptoms and treatments. Other causes of hepatitis include recreational drugs and prescription medications. Hepatitis type is determined by laboratory tests.

HEPATITIS A:

If you have this infection, you have inflammation in your liver that’s caused by a virus. You don’t always get symptoms, but when you do, you might have: Jaundice (yellowing of the skin), Pain in your belly, Loss of appetite, Nausea, Fever, Diarrhea, Fatigue, Loss of weight, fever, sore muscles, **Pain on the right side of the belly, under the rib cage-where your liver is located** (if not a combination of these symptoms).

Children often have the disease with few symptoms.

You can spread the Hepatitis A virus about 2 weeks before your symptoms appear and during the first week they show up, or even if you don’t have any.

How it’s transmitted:

You can catch the disease if you drink water or food that’s been contaminated with the stool of someone with the virus.  You can also get infected if you:

-Eat fruits, vegetables, or other foods that were contaminated during handling.

-Eat raw shellfish harvested from water that’s got the virus in it.

-Swallow contaminated food.

Examples: Sometimes a group of people who eat at the same restaurant can get hepatitis A. This can happen when an employee with hepatitis A doesn’t wash his or her hands well after using the bathroom and then prepares food. It can also happen when a food item is contaminated by raw sewage or by an infected garden worker.

-The disease can also spread in day care centers. Children, especially those in diapers, may get stool on their hands and then touch objects that other children put into their mouths. And workers can spread the virus if they don’t wash their hands well after changing a diaper.

How Is It Diagnosed?

Blood tests allow doctors to diagnose it. **It is important to identify the type of hepatitis virus causing the infection to prevent it from spreading and to start the proper treatment. Since this Hepatitis A virus infection is spread through food or water that has been contaminated by the feces (stool) of an infected person.

Are There Any Long-Term Effects?

Usually the virus doesn’t cause any long-term problems or complications. But according to the CDC, 10% to 15% of people with hepatitis A will have symptoms that last a long time or come back over a 6- to 9-month period. In rare situations, some people may have liver failure or need a transplant.

What’s the Treatment?

No treatments can cure the disease. Your doctor may take tests that check your liver function to be sure your body is healing.

Who is at highest risk for this?

-Live with or have sex with someone who’s infected.*

-Travel to countries where hepatitis A is common.*

Remember the people who are also at risk:

-Men who have sex with men*

-People who inject illegal drugs*

-Kids in child care and their teachers*

HEPATITIS B

Hepatitis is a serious disease caused by the hepatitis B virus (HBV). Infection with this virus can cause scarring of the liver, liver failure, liver cancer, and even death. What happens to most cases of Hepatitis patients is the adult cases (up to 95%), hepatitis B causes limited infection. Usually people manage to fight off the infection successfully within a few months, developing an immunity that lasts a lifetime. (This means you won’t get the infection again).  Blood tests show evidence of this immunity, but no signs of active infection. Unfortunately, this is not true in infants and young children in which 90% of infants and 30% to 50% of children will develop a chronic infection.

Symptoms of acute infection (when a person is first infected with hepatitis) include:

-Jaundice (yellowing of the skin or whites of the eyes and/or a brownish or orange tint to the urine)/Unusually light colored stool/Unexplained fatigue that persists for weeks or months/Flu-like symptoms such as fever, loss of appetite, nausea, and vomiting/Abdominal Pain

Often, symptoms occur one to six months after exposure, with an average of three month. An estimated 30% of those infected do not have any symptoms at all.

How it’s transmitted:

Hepatitis B is spread in infected blood and other bodily fluids such as semen and vaginal secretions. It is spread in the same way that the virus that causes AIDS (HIV) is spread but hepatitis B is 50 to 100 times more infectious. Most people who are infected with hepatitis B in the U.S. do not know they have it. If you’re pregnant and you’ve got hepatitis B, you could give the disease to your unborn child. If you deliver a baby who’s got it, he needs to get treatment in the first 12 hours after birth.

How it’s diagnosed:                                                                                                              

If your doctor suspects that you may have hepatitis B, he or she will perform a complete physical exam and order blood tests to look at the function of your liver. Hepatitis B is confirmed with blood tests that detect the virus.

If your disease becomes chronic, liver biopsies (tissue samples) may be obtained to detect the severity of the disease.

Are There Any Long-Term Effects?

Liver damage if the virus is not taken care will happen with multiple organ crash from putting affect on other organs from doing their jobs.

WHAT’S THE TREATMENT:

Treatment depends on whether you:

-Have been recently infected with the virus (treating acute hepatitis B).*

-Have the symptoms of an acute infection. *

-Have chronic infection (Have had the hepatitis B for a chronic period of time).

-Acute vs Chronic=different RX.*

Acute Hep B. you should get a shot of hepatitis B immunoglobulin (HBIG) and the first of three shots of the hepatitis B Vaccine (What is a PDF document?). It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the better the treatment works.

Regarding Chronic Hep B treatment depends on how active the virus is in your body and your chance of liver damage. The goal of treatment is to stop liver damage by keeping the virus from multiplying.

Antiviral medicine is used if the virus is active and you are at risk for liver damage. Medicine slows the ability of the virus to multiply.

Antiviral treatment isn’t given to everyone who has chronic hepatitis B.

Follow-up visits

Whether or not you take medicine, you will need to visit your doctor regularly. He or she will do blood tests to check your liver and the activity of the hepatitis B virus in your body.

Some of the tests can find out whether the virus is multiplying in your liver, which would increase your risk of liver damage.

Liver transplant

If you develop advanced liver damage and your condition becomes life-threatening, you may need a liver transplant. But not everyone is a good candidate for a liver transplant.

If you have not gotten a hepatitis B vaccine and think you may have been exposed to the virus, you should get a shot of hepatitis B immunoglobulin (HBIG) and the first of three shots of the hepatitis B vaccine. It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the better the treatment works.

THOSE AT HIGHEST RISK FOR HEPATITIS B:

-Being born in, or spending more than 6 months in, parts of the world where hepatitis B is common or where a large number of people have been infected for a long time. Such areas include Southeast and Central Asia, the islands of the South Pacific, the Amazon River basin, the Middle East, Africa, Eastern Europe, and China.

-Being a man who has sex with men.

-Being sexually active. This includes having unprotected sex with someone who is infected with the virus or whose sexual history is unknown to you.

-Having more than one yex partner. (Your risk is higher if you have another sexually transmitted infection such as chlamydia.)

-Living with someone who has a chronic hepatitis B infection.

-Getting  or body piercing and tattoos from someone who doesn’t sterilize his or her equipment.

-Sharing needles or other equipment (such as cotton, spoons, and water) to inject illegal drugs.