A Visual Guide to Hepatitis A, B, C

Medically Reviewed by Gabriela Pichardo, MD on September 05, 2021

Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it’s caused by a virus. This is known as viral hepatitis, and the most common forms are hepatitis A, B, and C.

Sometimes there are no symptoms of hepatitis in the first weeks after infection — the acute phase. But when they happen, the symptoms of types A, B, and C may include fatigue, nausea, poor appetite, belly pain, a mild fever, or yellow skin or eyes (jaundice). When hepatitis B and C become chronic, they may cause no symptoms for years. By the time there are any warning signs, the liver may already be damaged.

Hepatitis A is highly contagious and can spread from person to person in many different settings. It typically causes only a mild illness, and many people who are infected may never realize they’re sick at all. The virus almost always goes away on its own and does not cause long-term liver damage.

It usually spreads through food or water. Food can be tainted when it’s touched by a person with hepatitis who did not wash their hands after using the bathroom. This transfers tiny amounts of infected stool to the food. Raw shellfish, fruits, vegetables, and undercooked foods are common culprits in hepatitis A outbreaks. The virus can also spread in daycare centers if employees aren’t careful about washing hands after changing diapers.

A prime risk factor for hepatitis A is traveling to or living in a country with high infection rates. You can check the CDC’s travel advisories to learn about recent outbreaks. Eating raw foods or drinking tap water can raise your risk while traveling. Children who attend daycare centers also have a higher risk of getting hepatitis A.

Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.

You can get it through contact with the blood or body fluids of an infected person. In the U.S., it’s most often spread through unprotected sex. It’s also possible to get hepatitis B by sharing an infected person’s needles, razors, or toothbrush. And an infected mother can pass the virus to their baby during childbirth. Hepatitis B is not spread by hugging, sharing food, or coughing.

Anyone can get hepatitis B, but people who have multiple sex partners or inject illegal drugs have a higher risk. Other risk factors include being a health care worker who is exposed to blood, or living with someone who has chronic hepatitis B.

About 25% of people who get hepatitis C defeat the virus after a short-term infection. The rest will carry the virus in their body for the long term. Chronic hepatitis C can cause very serious complications, including liver failure and liver cancer. There are effective treatments for the virus, though. 

It spreads through infected blood. In the U.S., sharing needles or other items used to inject drugs is the most common cause of infection. Getting a tattoo or body piercing with an infected needle is another means of exposure. A mother may pass the virus to their child at birth. In rare cases, unprotected sex spreads hepatitis C, but the risk appears small. Having multiple sex partners, HIV, or rough sex seems to raise risk for spreading hepatitis C.

People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.

Chronic hepatitis can quietly attack the liver for years without causing any symptoms. Unless the infection is diagnosed, monitored, and treated, many of these people will eventually have serious liver damage. Fortunately, blood tests can determine whether you have viral hepatitis, and if so, which kind.

Testing is important for anyone with the risk factors we’ve mentioned, particularly injected drug users and people who have had multiple sex partners. Health advocates are also urging people of Asian heritage to get tested. Stanford University’s Asian Liver Center estimates that 1 in 10 Asians living in the U.S. has chronic hepatitis B. Many of them have probably had the virus since birth.

Also, the U.S. Preventive Services Task Force recommends that health care providers offer a one-time hepatitis C screening for anyone born between 1945 and 1965.   

If a test says you have viral hepatitis, you can take steps to protect the ones you love. For hepatitis A, wash hands frequently. For hepatitis B and C, avoid sharing nail clippers, razors, or toothbrushes. Hepatitis B, and sometimes hepatitis C, can be passed through sexual contact. Make sure everyone in your household gets the hepatitis B vaccine. An important step is to see a specialist to discuss treatment options.

Hepatitis A almost always goes away on its own, and no medication is needed. If nausea is a problem, try eating several small meals throughout the day instead of three large ones. Drink water, juice, or sports drinks to stay hydrated. And avoid hard exercise until you’re feeling better.

The goal of treating chronic hepatitis B is to control the virus and keep it from damaging the liver. This begins with regular monitoring for signs of liver disease. Antiviral medications may help, but not everyone can take them or needs to be on medication. Be sure to discuss the risks and benefits of antiviral therapy with your doctor.

The latest drug to be approved by the FDA is glecaprevir and pibrentasvir (Mavyret). This medication offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.

There are several other combination drugs available, as well as some single drugs that may be used in combination. Your doctor will choose the right one for you depending on the type of hepatitis C you have, how well your liver is functioning and any other medical problems you may have. Also be sure to discuss your insurance coverage since these medications are expensive.

To manage chronic hepatitis B or C, your doctor will order regular blood tests to check how well your liver is working. Ultrasounds and CT scans can also reveal signs of damage. If the virus is not causing any liver problems, you may not need treatment. But it’s important to have regular tests to watch for changes. Complications are easiest to treat when found early.

One of the most common complications of chronic hepatitis is cirrhosis. This is a scarring of the liver that can be found with a biopsy. Cirrhosis makes it difficult for the liver to do its job and can lead to liver failure, a life-threatening condition. Symptoms include fatigue, nausea, weight loss, and swelling in the belly and legs. In severe cases, patients may experience jaundice and confusion.

Viral hepatitis is the top cause of liver cancer, so people with chronic hepatitis B or C need monitoring even if they feel healthy. Blood tests can detect proteins that suggest the presence of liver cancer. Ultrasounds, CT scans, and MRIs can reveal abnormal lesions in the liver (seen here in green). A biopsy is needed to determine if these areas are cancerous. Tumors that are found early may be surgically removed. But most liver cancers are difficult to treat.

The liver is a vital organ that aids in metabolism, digestion, detoxifying, and the production of many proteins needed by the body. If a large part of the liver is damaged beyond repair, it will no longer be able to perform these important jobs. People cannot live without a working liver. In this case, a liver transplant may be the best hope. This option provides the patient with a healthy liver from a donor.

There are vaccines to protect against hepatitis A and B. The CDC recommends hepatitis A vaccination for all children ages 12 to 23 months and for adults who plan to travel or work in areas with hepatitis A outbreaks or who have other risk factors. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don’t already have immunity to the disease. The hepatitis B vaccine is recommended for all infants at birth and for adults who have any of the risk factors we discussed earlier. There is no vaccine for hepatitis C.

If you have chronic hepatitis, there are steps you can take to keep your liver resilient. Avoid alcohol, which can cause additional liver damage. Check with your doctor before taking any medications or supplements, because some are tough on the liver or may not be safe in people with liver disease. Most importantly, keep your appointments for regular monitoring. By watching for any changes in your liver, you and your health care provider can stay one step ahead of the virus.

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SOURCES:

Allegheny General Hospital Liver Cancer Network.
American Cancer Society web site.
American Liver Foundation web site.
Centers for Disease Control and Prevention web site.
Hepatitis Foundation web site.
John W. Ward, MD, director, division of viral hepatitis, CDC, Atlanta.
Melissa Palmer, MD, clinical professor of medicine, New York University School of Medicine, New York City.
National Digestive Diseases Information Clearinghouse.
Pediatrics, published online Feb. 1, 2011.
The Nemours Foundation.
World Health Organization web site.
FDA. “FDA approves Mavyret for Hepatitis C.” “Mavyret Prescribing Information.”
Hepatitis C Online. “Hepatitis C Treatments.”

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Vitamin A (Retinoid) Benefits for Vision and Health

Written by R. Morgan Griffin

Medically Reviewed by Jennifer Robinson, MD on May 02, 2023

• Why do people take vitamin A?
• How much vitamin A should you take?
• Can you get vitamin A naturally from foods?
• What are the risks of taking vitamin A?

Vitamin A is key for good vision, a healthy immune system, and cell growth. There are two types of vitamin A. This entry is primarily about the active form of vitamin A — retinoids — that comes from animal products. Beta-carotene is among the second type of vitamin A, which comes from plants.

The American Heart Association recommends obtaining antioxidants, including beta-carotene, by eating a well-balanced diet high in fruits, vegetables, and whole grains rather than from supplements until more is known about the risks and benefits of supplementation.

High doses of antioxidants (including vitamin A) may actually do more harm than good. Vitamin A supplementation alone, or in combination with other antioxidants, is associated with an increased risk of mortality from all causes, according to an analysis of multiple studies.

Topical and oral retinoids are common prescription treatments for acne and other skin conditions, including wrinkles. Oral vitamin A is also used as a treatment for measles and dry eye in people with low levels of vitamin A. Vitamin A is also used for a specific type of leukemia.

Vitamin A has been studied as a treatment for many other conditions, including cancers, cataracts, and HIV. However, the results are inconclusive.

Most people get enough vitamin A from their diets. However, a doctor might suggest vitamin A supplements to people who have vitamin A deficiencies. People most likely to have vitamin A deficiency are those with diseases (such as digestive disorders) or very poor diets.

The recommended dietary allowance (RDA) includes the vitamin A you get from both the food you eat and any supplements you take.

The tolerable upper intake levels of a supplement are the highest amount that most people can take safely. Higher doses might be used to treat vitamin A deficiencies. But you should never take more unless a doctor says so.

* There is no upper limit for vitamin A from beta-carotene.

Getting enough vitamin A can easily be obtained through a healthy diet.

Good food sources of retinoid vitamin A include:

• Eggs
• Whole milk
• Liver
• Fortified skim milk and cereals

Plant sources of vitamin A (from beta-carotene) include sweet potatoes, carrots, spinach, and apricots.

• Side effects. Symptoms of vitamin A toxicity include dry skin, joint pain, vomiting, headaches, confusion.
• Interactions. If you take any medicines, ask your doctor if vitamin A supplements are safe. Vitamin A supplements may interact with some birth control pills, some blood thinners,  some oral acne medicines, cancer treatments, and many other drugs.
• Risks. Don’t take more than the RDA of vitamin A unless your doctor recommends it. High doses of vitamin A have been associated with birth defects, lower bone density, and liver problems. People who drink heavily or have kidney or liver disease shouldn’t take vitamin A supplements without talking to a doctor.

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preparation, table of normal values, interpretation

Biochemical blood test is a detailed study of the patient’s venous blood, conducted to assess the functioning of internal organs, detect deficiency of vitamins, enzymes, macro- and microelements, as well as to diagnose metabolic pathology. Blood biochemistry is more indicative than a general clinical analysis; the results of the analysis make it possible to detect many diseases at an early stage. That is why this study is recommended to be carried out not only as prescribed by a doctor, but also for preventive purposes at least once a year. The results of a biochemical blood test include many interconnected indicators and a doctor should be involved in their interpretation – self-medication is dangerous for your health!

How to prepare for the procedure?

• Blood sampling for biochemistry is always performed on an empty stomach, most often between 8 and 11 am. On the day of the procedure, non-carbonated water is allowed, and the day before the procedure, heavy food, carbonated drinks, strong coffee, tea and alcohol should be excluded from the diet.
• Do not smoke during the last hour before donating blood.
• Immediately before the procedure, try to avoid physical and emotional stress, the last 10-20 minutes it is better to just sit near the manipulation room.
• If the date of the biochemical blood test falls on the period of taking a course of drug treatment or a course of physiotherapy, then it is worth consulting with your doctor – he may recommend rescheduling the study to another time or interrupting the course of treatment for several days.

Interpretation of the results of a biochemical blood test

New generation laboratory analyzers are able to provide results of the study within two hours after blood sampling. As a rule, the patient receives the results within 2-3 days in the form of a printed or electronic table, which lists the studied indicators, their values ​​and reference (average) normal ranges. Different laboratories offer different amounts of data, in the same article the most commonly studied blood parameters will be described.

Proteins

	Designation	Norma (women)	Norma (men)	Units
Albumin	ALB	< 14 years: 38-54 14-60 years: 35-50 > 60 years: 34-38		g/l
Glycated hemoglobin	HbA1c, A1c, glycosylated hemoglobin	< 5. 7		%
Total protein	TP, TProt, Serum	< 1 year: 47-72 1-4 years: 61-75 5-7 years: 52-78 8-15 years: 58-76 > 15 years: 64-83		g/l
C-reactive protein	CRP, SRP	< 0.5		g/l
Iron-binding capacity of serum	TIBC, IBC, OJSS	45.3–77.1		µmol/l
Myoglobin	Myoglobin	12-76	19–92	µg/l
Transferrin	Tf	2.2-2.4	2–4	g/l
Ferritin	Ferritin	13-150	30-400	µg/l

Total protein characterizes the state of protein metabolism and reveals dysproteinemia (change in the quantitative ratio of protein fractions in blood serum). Decreased values ​​may indicate malnutrition, liver disease, burns, trauma, and surgery, while elevated values ​​may indicate an infectious disease, non-infectious hepatitis, autoimmune disease, dehydration, or may be caused by diarrhea and vomiting.

Protein albumin occupies up to 65% of the blood plasma volume, is produced by the liver and performs the most important function of transporting many biologically active substances. The reasons for the decrease in albumin concentration coincide with those for the total protein. The value increases quite rarely, for example, with dehydration, hemoconcentration, or as a result of taking anabolic steroids.

The iron protein myoglobin is being investigated primarily for the early diagnosis of myocardial infarction. A high concentration of myoglobin may indicate myocardial infarction, heart failure, acute kidney injury, the effects of thermal burns, electric shock. Low myoglobin accompanies the course of rheumatoid arthritis and poliomyelitis.

The value of glycated or glycosylated hemoglobin is very important for patients with diabetes mellitus, and is also used for its diagnosis. Glycated hemoglobin gives an idea of ​​the average level of glucose in the blood over a long period of time (1–2 months). If the concentration of this protein fraction does not exceed 5.7% of the total volume of hemoglobin in the blood, then we can speak of a compensated state. Values ​​in the range of 5.7–6.4% indicate a risk of developing diabetes mellitus, above 6.4% indicate severe decompensated diabetes.

C-reactive protein acts as an indicator of the inflammatory process in the body. Exceeding the threshold of 0.5 g/l indicates acute inflammation or malignancy. Also, this parameter is important for evaluating the effectiveness of antibacterial and anti-inflammatory therapy.

Investigated values ​​of transferrin , ferritin and iron-binding capacity of serum allow diagnosing the pathology of iron metabolism in the blood. Transferrin is the main carrier of iron, an increase in its concentration, as a rule, indicates the development of iron deficiency anemia, and a decrease indicates infections, cirrhosis of the liver, anemia of a different etiology, or protein starvation. With iron deficiency anemia, ferritin, on the contrary, decreases, and its increase indicates inflammatory processes, liver disease, or oncopathology.

Lipids

	Designation	Norma (women)	Norma (men)	Units
Triglycerides	TRIG	< 15 years old: 0.40–1.48 15–30 years old: 0.4–1.63 30–55 years old: 0.44–2.63 > 55 years old: 0.62–2.71	< 15 years old: 0.34-1.41 15-30 years old: 0.45-2.81 30-55 years old: 0.56-3.61 > 55 years old: 0.65-3.29	mmol/l
Total cholesterol	CHOL	5.2		mmol/l
HDL cholesterol	HDL, HDL-C	1. 03–1.55		mmol/l
LDL cholesterol	LDL, LDL-C	0–3.3		mmol/l

Total cholesterol is used to detect primary and secondary disorders of lipid metabolism, assess the likelihood of developing atherosclerosis, and also to evaluate the effectiveness of the treatment of atherogenic disorders of lipid metabolism. A decrease in the value is caused by cachexia, starvation, malabsorption, severe acute diseases, liver failure, hyperthyroidism, and an increase is caused by primary and secondary dyslipoproteinemia. Dangerous consequences of low cholesterol are psychophysiological disorders and reproductive dysfunction, high – diabetes mellitus and atherosclerosis. Biochemical blood test for triglycerides (products of carbohydrate metabolism in the liver) pursues the same tasks, the reasons for the increase and decrease in their concentration also coincide with total cholesterol.

High-density lipoprotein cholesterol and low-density lipoprotein (HDL-C and LDL-C, respectively) are examined and interpreted in combination with total cholesterol and triglycerides for a more accurate diagnosis. HDL-C increases with primary biliary cirrhosis, hepatitis, alcoholism, or its increase may be genetically determined. In patients with atherosclerosis, decompensated diabetes mellitus, chronic kidney disease, cholestasis, the value of HDL-C decreases. Low-density lipoproteins are involved in the processing and excretion of fats, a decrease in their concentration may indicate the development of chronic anemia, Raynaud’s syndrome or myeloma, and an increase in hypothyroidism, nephrotic syndrome, diabetes mellitus, porphyria, Cushing’s syndrome, the risk of atherosclerosis.

Carbohydrates

	Designation	Norma (women)	Norma (men)	Units
Glucose	GLUC	3. 3-5.5		mmol/l
Fructosamine	FRA	0–285		µmol/l

Glucose is the main source of energy for all cells and tissues of the human body and, in particular, its only source for the brain. The value of glucose in the results of biochemical analysis reflects the level of sugar in the blood. If this value is increased, then there is a risk of developing diabetes mellitus, damage to the central nervous system, and hormonal disorders. Glucose “falls” with the formation of tumors in the pancreas, with liver and adrenal insufficiency, hypothyroidism, malnutrition, or due to insulin intake.

The value of fructosamine reflects the fluctuation in blood glucose levels during the 2-3 weeks prior to the test. If its concentration exceeds 280–285 µmol / l, then the doctor considers the likelihood of developing diabetes.

Inorganic substances and vitamins

	Designation	Norma (women)	Norma (men)	Units
Vitamin B12		208–963. 5		pg/ml
Iron	Fe, IRON	< 2 years: 7-18 2-14 years: 9-22 > 14 years: 9-30	< 2 years: 7-18 2-14 years: 9-22 > 14 years: 11-31	µmol/l
Potassium	K	3.5–5		mmol/l
Calcium	Ca	2.25–2.5		mmol/l
Magnesium	Mg	0.75–1.25		mmol/l
Sodium	Na	136–145		mmol/l
Phosphorus	P	< 2 years: 1.45–2.16 2–12 years: 1.45–1.78 12–60 years: 0.87–1.45 > 60 years: 0.90–1.32	< 2 years: 1.45–2.16 2–12 years: 1.45–1.78 12–60 years: 0.87–1.45 > 60 years: 0.74–1.2	mmol/l
Chlorine	Cl	98-107		mmol/l

Vitamin B12 in the human body is involved, in particular, in the production of red blood cells. High levels of this vitamin can indicate liver disease, kidney disease, or leukemia. Diseases of parasitic etiology, inflammatory processes in the gastrointestinal tract and adherence to a vegetarian (vegan) diet, on the contrary, lead to a decrease in the level of vitamin B12 in the blood.

In one of the previous paragraphs it was mentioned that iron takes part in the process of transporting oxygen. Its deficiency is usually explained by malnutrition or metabolic disorders, and its excess – by functional disorders of the intestine.

Potassium is responsible for the regulation of water balance and normalizes the heart rhythm. Potassium deficiency occurs due to malnutrition or malnutrition, vomiting, renal failure, Cushing’s syndrome, osmotic diuresis, chronic kidney disease, and also accompanies long-term use of steroid drugs. Potassium also increases with acute dehydration, extensive injuries and burns, chronic adrenal insufficiency, diabetic coma, or as a result of taking potassium-sparing diuretics.

Calcium is involved in the formation of bone tissue, it is extremely important for the normal functioning of muscles, nerves, heart muscle and blood vessels. Low blood calcium values ​​indicate vitamin D deficiency, functional kidney disease, pancreatitis, impaired magnesium metabolism, or hypoparathyroidism. An increase in calcium levels accompanies hyperparathyroidism or is a symptom of oncopathology.

Magnesium performs the function of intracellular metabolism and transmission of impulses from nerve endings to muscles. Malnutrition, malabsorption, prolonged diarrhea, colitis, enterocolitis and dyspepsia reduce the concentration of magnesium in the blood. Functional disorders of the kidneys, hypothyroidism, lactic acidosis and neoplasms lead to its increase.

Along with magnesium, sodium , also involved in calcium metabolism, is responsible for the transmission of impulses to the muscles. The reason for the decrease in sodium can be hypothyroidism, Addison’s disease, diabetes mellitus, kidney and gastrointestinal tract diseases, congestive heart failure, taking gentamicin, less often – Parkon’s syndrome or hypercalciuria. High levels of sodium in the results of biochemistry indicate dehydration, oversaturation of the body with salts, diabetes insipidus or kidney disease with oliguria.

Normal functioning of the nervous and musculoskeletal systems is impossible without a sufficient amount of phosphorus in the body. The content of phosphorus in the blood increases with hypoparathyroidism, an excess of vitamin D, rhabdomyolysis, bone diseases or improper diet, less often with acromegaly. On the other hand, hypovitaminosis D, hyperparathyroidism, kidney transplantation, intravenous glucose infusions, respiratory alkalosis cause a decrease in the concentration of phosphorus in the blood.

Chlorine performs the functions of maintaining the acid-base balance of the blood and osmotic pressure. The most obvious causes of a decrease in chlorine levels are profuse sweating, vomiting, diarrhea, incorrect treatment with diuretics, less commonly, a decrease is caused by nephrotic syndrome and hypokalemic metabolic syndrome. An excess of chlorine in the blood can be a consequence of dehydration, swelling, alkalosis and decompensation of cardiac activity.

Example of blood chemistry results

Low molecular weight nitrogenous substances

Urea and creatinine are studied in combination, their values ​​reflect the functional state of the patient’s kidneys, in particular, the degree of impairment of filtration and excretory functions. High values ​​indicate kidney problems, but may be due to excessive exercise, a high-protein diet, prolonged fasting, or thyroid disease. Low urea values ​​may be due to a low protein diet, pregnancy, and liver disease.

The level of uric acid as an auxiliary parameter reflects the body’s ability to remove waste products from the processes of nucleic acid and purine metabolism. It is of particular diagnostic interest in patients with gout. The main causes of increased uric acid are gout and alcoholism, less often – the pathology of the kidneys and liver. Low values ​​of uric acid in the results of a biochemical blood test are much less common and usually indicate malnutrition or malnutrition.

Pigments

	Designation	Norma (women)	Norma (men)	Units
Total bilirubin	BILT	3.4–17.1		µmol/l
Direct bilirubin	BILD, D-BIL	0–7. 9		µmol/l
Bilirubin indirect	ID-BIL	BILT – BILD		µmol/l

Yellow pigment bilirubin begins to accumulate in the blood in diseases and hereditary pathologies of the liver, biliary tract, for example, Gilbert’s syndrome. Indirect bilirubin can also be elevated in some anemias and malaria.

Enzymes

Liver enzyme with an unpronounceable name alanine aminotransferase is involved in amino acid metabolism. The indicator increases with myocardial infarction, acute hepatitis A and B, and other liver diseases.

Enzyme amylase is produced by the salivary glands and pancreas and is responsible for the digestion of carbohydrates. Exceeding the norm by 3-5 times may indicate acute appendicitis, peritonitis, stomach and duodenal ulcers, cholecystitis. In acute pancreatitis or exacerbation of its chronic form, the value of amylase increases by 10–30 times. An increased value of pancreatic amylase allows timely detection of complications of operations on the abdominal organs and diseases of the pancreas.

The concentration of the enzyme aspartate aminotransferase in human blood increases greatly in case of damage to the liver or heart muscle, due to alcohol abuse, the indicators can increase two times relative to the norm.

High values ​​of the enzyme gamma-glutamyltransferase are observed in patients with acute hepatitis, extra- and intrahepatic cholestasis, alcoholism, pancreatic and prostate cancer, primary liver tumors.