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Hepatitis B is a viral infection which affects the liver. As the illness progresses, the organ slowly loses its function, which makes certain symptoms emerge.

Hepatitis, inflammation of the liver, can be caused by a number of different factors. Viruses are, however, the most common cause of hepatitis. There are five hepatitis viruses: A, B, C, D, and E. Hepatitis B is a worldwide health problem. It is estimated that 257 million people around the world are living with hepatitis B.

This disease, and the health complications it causes (such as liver failure, cirrhosis and cancer), was responsible for 887,000 deaths in 2015. The virus is more common in some regions than the others. The most affected regions are the Western Pacific Region and the African Region, where it is estimated that around six percent of adult population are infected with the virus. 

Hepatitis B is a virus transmitted through blood and other bodily fluids, such as saliva, vaginal or seminal fluids. The most common ways of getting infected include:

  • Direct contact with the infected blood
  • Having unprotected sex
  • Sharing injection equipment while using IV drugs
  • Sharing razors or other equipment which might contain infected blood
  • Getting a tattoo or a piercing in an unsafe and unsanitary environment.
  • The virus can also be transmitted from an infected mother to her child during childbirth. 
A vaccine exists, and it is highly recommended that all infants get the first dose within the first 24 hours after birth. Hepatitis B can be diagnosed by testing blood and saliva for either antigens produced by the virus, or for antibodies produced by the host. PCR diagnostics are also available.

As the virus spreads from one cell to another, the liver slowly loses the capability to do what it is supposed to do. The loss of function is what makes the symptoms appear. In some cases, the symptoms might be mild to non-existing, while in others, the disease presents itself with a dramatic picture.

1. Abdominal pain

One of the first, and most common symptoms of an infected liver is abdominal pain. The pain is located in the upper right quadrant of the abdomen (which is where the liver is located). While there are nerves in the liver, they lack sensory function, which means that we cannot "feel" the liver, as in if someone somehow managed to touch our liver, we wouldn't be able to feel it. The same goes for pain. But, the liver is surrounded in a thin layer of connective tissue called the Glisson capsule. As the inflammation causes the liver tissue to become enlarged, it pushes and stretches the capsule. The nerves connected to the capsule register the tension, resulting in abdominal pain. 

2. Jaundice

Jaundice, or icterus, is the most noticeable symptom of hepatitis. This is the phenomenon in which skin and the whites of the eyes become yellow as a result of high bilirubin levels. When our red blood cells die, the hemoglobin molecules are processed in the liver and excreted via urine and feces. But, when the liver loses the capacity to metabolize these molecules, blood levels of bilirubin rise. Bilirubin is a yellow pigment and occurs normally during the break down of the hemoglobin molecule. As the molecules aren't excreted from the organism, they travel through the body and accumulate in the tissues, coloring them yellow.

3. Pale stool

Light colored stool is also connected to the hemoglobin metabolism. As the liver processes the hemoglobin, and breaks it down, the by-products of the metabolism are excreted to our intestines via bile, giving the feces a normal, brown, color. Since the levels of bilirubin in the bile are low in the case of hepatitis, because of the destruction of the liver tissue, the stool won't be colored brown, but will instead appear pale or even clay-colored.

4. Itchiness

One of the symptoms related to hepatitis is itchiness, or pruritus. One of the roles of the liver is eliminating toxins from the organism. When the liver loses its capacity to do so, the toxins (including bilirubin) build up in the organism. Our nerves register that, and send the signals to the brain, which we perceive as itching.

5. Loss of appetite

Loss of appetite is often connected to the liver inflammation. It isn't quite known why this happens, but studies suggest that the reason for this is because hepatitis patients have altered taste perception, especially for sweet and umami (which is one of the five basic tastes, besides sweet, sour, salty and bitter).

6. Fatigue

Although it is often overlooked by doctors, fatigue is the most common symptom of hepatitis B, as well as other forms of liver disease.

The exact mechanism is yet to be explained, but several hypotheses have been proposed to explain this symptom, and it is generally believed that the fatigue comes from altered neurotransmission in the brain. This is believed to be caused by the liver and the brain communicating through nerves, as well as the effect of chronic stress the disease causes to the organism.

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