Introduction

Hepatitis is simply an inflammatory process taking place in the Liver parenchyma. It is also referred to as acute Parenchymal liver damage or chronic hepatitis when it has a duration of at least 6 months.
Hepatitis could be induced by a long List of aetiologies including :

• Drugs
• Toxins
• Viruses
• Autoimmunity, etc

Among these various causes, alcohol is a Major causative agent of liver disease in many countries followed by hepatitis-causing viruses of which Hepatitis B Virus is the commonet viral agent.
Other viral causes of hepatitis include: Hepatitis A, C, D, E viruses and Other non-hepatotrophic hepatitis-causing viruses like Cytomegalovirus(CMV) and Eptein Barr Virus(EBV).
It's important to note that these viruses named "hepatitis viruses" are so-called because they specifically attack Liver cells(hepatocytes).
It would make much sense if at this point we revise the functions of the Liver as these functions would be deranged in Liver disease.

The Human Liver

The liver is the body's Largest internal organ(1.2-1.5 kg) and is situated in the upper right part of the abdomen known as Right Upper Quadrant(RUQ) or Right Hypochondrium. It is divided into four lobes and eight segments anatomically.

Functions of The liver

Protein metabolism:

This involve both the synthesis and storage of proteins. It is the Major/principal site of protein synthesis of ALL CIRCULATING proteins apart from a few called Gamma-globulins produced by other cells in the body.
Some Important Proteins synthesized by the liver:

1. Albumin(10-12g daily)
   Functions of albumin: It helps to transport substances in the body such as steroid hormones, calcium, fatty acids and drugs. It also maintains fluid in the blood vessels by exerting a pressure known as colloid Oncotic pressure.
   In Liver disease severe enough to affect Albumin synthesis, Hormonal Imbalances , Low calcium Levels, Lipid Imbalances and Ineffective pharmacotherpy may result. Sufferers may also have Body swelling due to decreased Oncotic pressure which causes fluid to accumulate in tissues( especially the legs and abdomen).

2. Other Transport proteins e.g
   Transferrin -Transports Iron
   Ceruloplasmin - Transports Copper
   In Liver disease, These Micronutrients may not reach their destination as the vehicles of transport are deficient of totally absent.

3. All Clotting Factors Are synthesized by the Liver. In their absence, one tends to bleed easily and blood clot formation is difficult. This May even mimick Classical hemophilia

4. Comlement Proteins: A group of proteins needed by the immune system to mount attacks against certain external attacks. In their absence one may easily develop infections especially those of bacterial origin.

Storage Function:

The Liver stores large amounts of vitamins K and Folic acid. Minerals such as Iron and copper are stored in the Iiver too.
Other functions of the Liver are Listed here.

Now, Let's Dive into The Main Meat of the Matter→↓↓↓

Viral Hepatitis:

As earlier mentioned, these are caused by viruses Alone. For the purpose of this post, Viral Hepatitis is caused by only Hepatitis viruses.
Henceforth, We would be dealing with Only Hepatisis B and D which are known to be in a mysterious viral relationship.
Both Viruses are Transmitted by:
•contaminated blood or blood product transfusions,
•Sharing of Sharps
• Unprotected Sex! (Read about Condoms )
All people at risk of HBV infection are at risk of HDV infection as both essentially have the same route of transmission.

Hepatitis Type B

HBV is classified as a hepadnavirus. It is known to establish Chronic infections, especially in those infected as infants; it is a major factor in the eventual development of liver disease and Hepatocellular carcinoma in those individuals. I will later discuss a bit about hepatocellular carcinoma as it is a deadly product of the viral Union.

Some Specific properties of Hepatitis B virus

• Virion: About 42nm in diameter overall
• Genome: One Molecule of double stranded DNA, circular.
• Proteins: Two Major polypeptides(One glycosylated) are present in HBsAg; One polypeptide is Present in HBcAg.
• Envelope: Contains HBsAg and Lipid.
• Replication:
  Diagram: HBV lifecycle

Hepatitis Type D( Delta Hepatitis)

Usually referred to as "the Defective virus", Hepatitis D virus is the smallest known human pathogen and resembles subviral plant pathogens(e.g viroids). It is a defective virus that acquires an HBsAg coat(A protein from Hepatitis B viral envelope) for transmission! It shares no homology with the HBV genome and is often associated with the Most severe forms of Hepatitis in HBsAg positive patients(those Infected with Hepatitis B virus).

Hold On:

I mean that Hepatitis D can only infect a patient who is already Infected by HBV!" This is usually very severe as I have mentioned.

Two ways in which These Viruses May Be Wedded:

1. Co-infection of HDV nd HBV which is clinically indistinguishable from an acute icteric Hepatitis B infection(Ghost Marriage). Occasionally, a biphasic rise of liver enzymes(specifically aminotranferases) may be seen.
2. Superinfection which results in an acute flare-up of a previously quiescent chronic HepatitisB infection. A rise in Serum AST or ALT may be the only indication of Infection.

The Deadly Outcome of This Marriage Pattern.

• While co-infection will most likely lead to fulminant hepatitis with a very Severe, acute and lethal course, Superinfection will take a Chronic course which predisposes to cirrhosis(Scarring) of the Liver with a risk of Chronicity far higher than Hepatitis B virus infection Alone.
This Background of Chronic Liver cirrhosis predisposes to the worst enemy of the Liver, Hepatocellular Carcinoma.
Hepatitis B virus has been associated with up to 80% of cases of Hepatocellular carcinoma as a result of cirrhosis.
How much more damage will these couple cause to the Poor Organ?

Hepatocellular carcinoma, a Feared product of such a cirrhotic union is a deadly cancer responsible for over half a Million deaths worldwide. It is associated with a very bad prognosis. Read More here

Summary/Take home Package

Protection from Hepatitis B does not stop Hepatitis D infection!

•Get your Hepatitis B vaccine Today!
•Use your condoms and Avoid Unsafe sex practices
•Do Not Share Sharps!
• Tell someone about The deadly viral Couple!

Resteem, Follow and upvote.

Image Credits: All Images are of public domain By Wikipedia and Pixabay

Next Article: #Why-Some-of-Us-are-Immune-to-HIV-infection.