Hepatitis B

IND Version

Hepatitis B is an infection of the liver that can cause chronic liver damage. Its uniqueness found in the ability to survive long in the liver without causing symptoms (career), when the patient’s durability decrease the hepatitis B will appear again. It spread through the blood, and the incidence of new illness can be reduced through prevention mechanism.

CAUSES (ETIOLOGY)

Hepatitis B is infection of the liver cell caused by type B hepatitis virus (HBV = Hepatitis B Virus). This virus is a DNA virus. Excellence of being a DNA-strain provides an easy to fit in human DNA contained in the cell nucleus) and multiply.

This virus will enter into the human body through the blood. Sores on the skin or any action that facilitates the opening of skin protection make virus to enter the bloodstream easily. Infected blood  will flow to the liver. In the liver, the virus will infiltrate the liver cell (hepatocyte) and  enter into the cell nucleus. Liver cells which had infiltrated would be "ordered" to form a new virus component. When the components are formed and assembled to form a series of new viruses, the viruses will come out through the cell wall and infect the next cell. So many new viruses are formed in the liver cells that have been infected, until finally the liver cells will be damaged and die. Cell died not only caused by viral replication, but also the body's defense mechanism that destroys the infected cells.

Function of damaged liver cells will be replaced by rest of liver cells or new liver cells. However, if the liver cell damage occurs in large quantities, then the heart will form the connective tissue to fill the "space" from cells death. This connective tissue is such as scar tissue in the wound in the skin. Unfortunately, these connective tissues do not have a function like liver cells. In the long term, liver function can not get the support of well-functioning liver cells, but mostly liver filled by connective tissue. This situation will lead to the onset of liver stiffness, known as liver cirrhosis. On the next process it can lead to liver cancer (HCC = Hepato Cellular Carcinoma)

DATA & STATISTICS 

Hepatitis B remains one of the major problems in the world. It is estimated, 1/3 of the world's population suffering from Hepatitis B either with or without clinical symptoms. Incidence of Hepatitis B has no time pattern such as Hepatitis A, because the infection can occur through contact with bodily fluids at any time. If adults are infected with HBV, then chances are 5-10% of people are going to the chronic phase of his career. Whereas, in children, the possibility to enter into chronic phase of 25-90%. Of the number who experience chronic phase of this career, 25% will have liver cirrhosis or liver cancer.

Hepatitis B virus is transmitted through contact with blood or body fluids, in contrast to his hepatitis A. Factors increasing the risk of hepatitis B infection include:

1. Blood contact during wound

2. Unprotected sexual intercourse with patients with hepatitis

3. Babies born per-vaginally in women with hepatitis

4. Blood transfusions are not getting adequate supervision.

Medical staff / health provider are at greater risk for hepatitis infection. Sex workers and men / women with promiscuous behavior also have a greater risk than the general population, in addition to the problem of sexually transmitted infections. The development of the use of needles to drug users turn also increases the risk of hepatitis B infection and transmit to any user of the syringe.
Until recently, hepatitis B transmission from pregnant mothers to their babies has not been found. However, to prevent infection while passing through the birth canal, it is hoped the baby was born by Cesarean Section operation (SC).

SYMPTOMS & SIGNS

The common symptoms shown by patients with hepatitis in general are a decreased appetite due to feeling uncomfortable in the right upper abdomen. Patients also experience decreased stamina. Fever may occur, but rarely show a high temperature.

The patient's body will arise the changes are generally a sign of hepatitis. Signs include:

ORGANS	FOUND
Eye	eye sclera (white part of the eye) image shows a yellowish
Abdomen	Enlarged abdominal circumference
	Palpable enlarged liver. Sometimes, in the case of liver cirrhosis, liver palpable  enlarged with rough surface texture.
skin	color of the skin will appear yellow
feces	whitish-pale (putty color)
urine	yellowish to dark yellow

EXAMINATION

To further increase the certainty of the diagnosis of hepatitis B compared to other liver disorders, required investigation. Damage to the liver needs to be known through laboratory examination of liver function, including by looking at levels of SGOT, SGPT, alkaline phosphatase, albumin, globulin, prothrombin time.

The virus that infects liver cell causes reactions in the body in the form of self defense by forming specific antibodies against the virus. Because of its specific antibody may be a marker of hepatitis virus infection. These antibodies are generally named after the disease that resisted, such as for hepatitis B known as the Anti-HBs.

In addition to checking the antibodies, examination of virus particles (HBs Ag, HBe Ag and HBc Ag) is also a marker of "trace" a virus that infects the liver. Antibody and antigen is providing interpretation when the occurrence of infection and at what stage of infection lasts.
Examination of the above requires some cc (usually 5 cc) of blood taken from patients with venous blood.

THERAPY

 
After knowing the cause and mechanism of liver damage in short time, then the following things into consideration in providing therapy in patients with hepatitis B.

1. The cause of infection in the liver is a virus, so antibiotics will not be able to eliminate the virus that has infected. Provision of antiviral treatment needed to Hepatitis B.

2. Antibodies are known to suppress the virus that infects. Body with good stamina will produce a good antibody. For the treatment of patients with hepatitis principle is to maintain and increase endurance. In the case of an acute infection that requires immediate antibodies, immunoglobulins can be administered to suppress the virus and minimize damage to liver cells.

 

3. Remaining liver cells must be maintained to keep the overall liver function. Giving hepatoprotector still considered reasonable in this case. Some drugs can be found in the market such as Curcuma, Curliv, Hepatin. Consume turmeric and ginger drink can be an alternative treatment to maintain liver function. Reduction in liver weight by reducing the toxins in the blood (free radicals) derived from food (high fat foods), beverages (alcohol, as well as lifestyle habits (smoking) will greatly help improving liver function.

4. In the case of chronic hepatitis B infection, treatment is much more complex. Giving antivirus will be combined with interferon-a (Interferon Alfanative example). Interferon is a protein compound produced by infected cells, the aim to suppress the virus / infected organism.

LET’S PREVENT!

Prevention is a wise step in reducing the incidence of hepatitis B. As explained above, HBV is spread through contact with body fluids injured area. Some of these steps is expected to reduce the risk of infection with hepatitis B.

1. Any action that interacts with human body fluids should we prepare ourselves by wearing protective devices.

2. The tools are used in medicine to deal with wounds, injections, or acupuncture should be immediately discarded. If the device is reusable, the action should have been done aseptically.

3. Always use tools that are new / sterile when they want to shave or make tattoos.

4. Do a blood donor at a place that has been trusted. Similarly, donors receive blood only from a reliable place.

5. Did Hepatitis B vaccination early on. Hepatitis B vaccination has become mandatory in the national immunization program in Indonesia, so expect the protection of human Indonesia has been started since childhood. If you have a job with a high risk factor for developing hepatitis B, it is advisable to check HBs antibody titer. If it is not known to have antibodies to HBs, hepatitis B vaccination can be performed (eg Hepavax-Gene). Boster action procedure is not mandatory because if it had been through three times and evaluation of vaccination 1-2 months show protection against hepatitis B is positive, then the body's defense will last a lifetime.

6. Consider the use of Hepatitis B Immunoglobulin (otherwise known as passive immunization) when exposed to blood exposure to patients with hepatitis. Hepatitis B Immunoglobulin (HBIG) provides protection to the body for 3-6 months and should be given immediately if exposed to HBV (within <48 hours="hours" span="span">