Hepatitis By Dr. Dick Stockley
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Welcome To The Eye Magazine Directory
Hepatitis By Dr. Dick Stockley
Again, pretty much any infection can inflame your liver too, from amoeba, to bacteria and any virus if you’re unlucky. But must people when they speak about viral hepatitis they mean one of the 5 specific viral hepatitises. Cunningly called hepatitis A, B, C, D and E. I’m going to ignore hepatitis D it’s too complicated: if your interest is piqued, google it and perhaps get a new job, you’re obviously bored.
When we first came out to Africa the preferred prevention was to get an injection of gamma globulin, the idea being that exposure was inevitable but the circulating antibodies prevented overt disease while infection gave us natural post recovery immunity. It doesn’t seem to have worked in everybody. Andy McNab describes getting it in Iraq. Rosie picked it up in Kitale in the 80’s. We were back in Kotido, she turned yellow and we realised what it was, so she had to give me a dose of gamma globulin.
It’s about 10 mls, has to go in a nice big muscle, and very painful. Rosie was rather unwell and wobbly: I can remember standing at the end of the bed, trousers down, trying to pick up the courage to bend over.
Now there’s a vaccine which protects for about 10 years. It’s often given with hepatitis B as a combined vial.
I disagree. Hep b needs 3 doses and A only 2.
Most cases infected as children will develop chronic hepatitis B as adults, with cirrhosis and high risk of liver cancer. It’s often associated with hiv but more transmissible. It was a common problem in short term visitors to Africa in the days when behaviour was more reckless.
WHO estimates that globally 250 million are living with chronic hepatitis B. Anti virals can suppress it and give prolonged periods of inactivity but cannot cure it. Like true love, hep B is for life. Often a short one.
Now there’s a vaccine. It’s a legal requirement for doctors in most countries as they could pass it on during surgery. In endemic countries pregnant women should be tested to see if they have chronic infection and the vaccine given immediately after birth. Otherwise it’s an essential part of routine infant vaccination. I know vaccine hesitation is on the rise but please if you don’t give hepatitis b vaccination to your children at least tell them so they can read about this disease and make their own decision.
Hepatitis C is again different. It’s also spread by blood but less transmissible and less common. It’s not considered an STD. There’s no vaccine but antivirals can cure it.
Hep E is like A: spread by faecal oral route, common in Africa and Asia. It causes minor disease just like A, with no effective treatment. It’s different in that there’s no vaccine.
A is an acute disease, faecal oral transmission, not fatal, everyone recovers, no treatment, but there is a vaccine.
B is spread as an std and blood borne, can be fatal, often causes life-long chronic disease, leads to cirrhosis and a fatal liver cancer. Antiviral treatment suppresses it and makes it inactive but not cured. Vaccine very effective C is serious, blood borne, can be fatal and gives chronic hepatitis and cirrhosis. No vaccine but antivirals can cure it.
D is a complicated disease in people with B. E is similar to A, no treatment, no vaccine.
But! And it’s a big but. Infectious hepatitis is not the most common cause of hepatitis. That distinction used to belong to alcoholic hepatitis and alcoholic cirrhosis. But no more
Alcohol liver disease is decreasing and has been overtaken and left miles behind by steatohepatitis, also called steatotic liver disease, or hepatic steatosis. Or to its friends fatty liver disease. The Americans call it NAFLD non alcoholic fatty liver disease, leading to NASH nonalcoholic steatohepatitis. In simple English, fat building up in the liver causes inflammation, and like other causes of chronic hepatitis leads to cirrhosis, liver cancer, liver failure and oesophageal varicose veins. It’s estimated that in western countries and rich countries world wide 30% of adults suffer from fatty liver. About 800 million to 1 billion worldwide.
So yes indeed it’s a big butt. I saw only one child with steatohepatitis with deranged liver function in all my 42 years working in Uganda. Now 10% of children in USA have steatohepatitis. Causes are alcohol with an overlap with alcoholic fatty liver disease, but NAFLD is entirely due to diet. Excess calories. It overlaps with diabetes and metabolic syndrome. Steatohepatitis is a serious disease and the only cure is to lose weight and stay thin. Eat less move more, if you eat it, you have to burn it, or your body will store it. If it stores it as yellow fat under your skin you can be fit, fat and happy.
If your body stores it as white fat in your abdomen then you get diabetes, hepatitis, and a shorter miserable life.
The good news is that losing 7kg will almost certainly remove the white abdominal fat first, with immediate reversal of symptoms and disease. And in most cases if you don’t put it back on, actual permanent cure.
Fat contains the most calories, 9 calories per gram. Carbohydrate and protein 4.5 cal per gram. Refined sugar stands alone: it’s carbohydrate but causes instant high blood sugar. Cucumber is carbohydrate too but almost entirely water and complex carbohydrates have to be metabolised to get sugar. So cut fat and sugar from your diet and weight loss is pretty much inevitable. 100 grams of fat and 100 grams of sugar is about 1,200 calories. Cut just that small amount every day and you can lose 7kg in 7 weeks.
Walking and jogging as a general rule burns 1 calorie per kg per km. So I’m 73 kg and if I run 5km I burn 73 x 5 calories that’s 365 calories. More than a chocolate bar! I’m trying not to lose weight because then I’d have to run further to earn my chocolate. Thats the simple easy cheap way of curing or preventing steatohepatitis. Alternatives are gastric surgery, Ozempic or of course just ignore it and pretend it’s not happening.
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