The word hepatitis simply means inflammation of the liver without any search for a specific reason. Someone with hepatitis may:

• Have one of several disorders, including viral or bacterial infection of the liver
• Having liver damage caused by a toxin (poison)
• Having liver damage caused by the interruption of normal blood supply of organs
• Experience of an attack by its own immune system through an autoimmune disease
• Have experienced trauma to the abdomen in the region of the liver

Hepatitis is most commonly caused by one of three viruses:

1. Hepatitis A
2. Hepatitis B
3. Hepatitis C

In rare cases, the Epstein Barr virus (which causes mononucleosis) can also cause hepatitis, which can cause liver inflammation. Other viruses and bacteria that can cause hepatitis include hepatitis D and E, varicella, and cytomegalovirus (CMV).

Hepatitis

In children, the most common form of hepatitis hepatitis A (also called infectious hepatitis). This form is caused by hepatitis A (HAV), who lives in the stool (feces or superstructure) of infected people. Infected feces may be present in small amounts in food and objects (from doorknobs to diapers).

HAV is spread:

• When someone eats something contaminated with infected feces-HAV (which makes it easier for the virus to spread in overcrowded, unsanitary conditions)
• Water, milk and food, especially seafood

Because hepatitis A can be a mild infection, especially in children, it is possible that some people are unaware they have the disease. In fact, although medical evidence indicates that about 40% of Americans in urban areas have had hepatitis A, only 5% recall being sick. Although hepatitis A can cause prolonged illness up to 6 months, usually causes illness of short duration and does not cause chronic liver disease.

Hepatitis B

Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide range of symptoms ranging from malaise to chronic liver disease that can lead to liver cancer.

HBV is spread:

• Infected body fluids such as blood, saliva, semen, vaginal secretions, tears and urine
• A contaminated blood transfusion (uncommon in the United States)
• Sharing of contaminated needles or syringes for injecting drugs
• Sexual activity with a person infected with HBV
• HBV infection for infants

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Hepatitis C

Hepatitis C virus (HCV) is spread by direct contact with the blood of an infected person. Symptoms of hepatitis C can be very similar to hepatitis A and B viruses. However, HCV infection and chronic liver disease is the leading cause of liver transplantation in the United States.

Hepatitis C virus can spread:

• Sharing needles to inject drugs
• Make a tattoo or body piercing unsterilized tools
• Blood transfusions (especially those that occurred before 1992, since the blood supply of the United States has been systematically examined for the disease)
• The transmission from mother to newborn
• Sexual contact (although this is less common)

Hepatitis C is also a common threat to kidney dialysis centers. Rarely, people living in the infected can develop by sharing items that may be the person’s blood, such as razors or toothbrushes.

Diagnosis

All of these viral hepatitis conditions can be diagnosed and controlled by the use of blood tests available.

Signs and symptoms

Hepatitis in its infancy, it can cause flu-like symptoms, including:

• A malaise (a general feeling of illness)
• Fever
• Muscle aches
• Loss of appetite
• Nausea
• Vomiting
• Diarrhea
• Jaundice (yellowing of the skin and whites of eyes)

However, some people with hepatitis have no symptoms at all and not even know they are infected. Children with hepatitis A, for example, usually have mild symptoms or no symptoms.

If hepatitis progresses, symptoms start to see the source of liver disease. The chemicals normally excreted by the liver begin to accumulate in the blood, which causes:

• Jaundice
• Bad breath
• A bitter taste in the mouth
• A dark or “tea-colored” urine
• White, light, or “clay-colored” stools

There may also be abdominal pain, which may be centered below the right ribs (over a tender, swollen liver) or below the ribs on the left (over the spleen race).

Contagion

Hepatitis A, Hepatitis B and Hepatitis C are all contagious.Hepatitis A virus can spread in food or contaminated water and unsanitary conditions in child care centers and schools. Toilets and sinks used by an infected person should be cleaned with an antiseptic. People who live with or care for someone with hepatitis should wash their hands after contact with an infected person. Also, when traveling in countries where hepatitis A is prevalent, your child should be vaccinated with two doses of vaccine against hepatitis A.

Hepatitis B can be found in almost all body fluids, though its main routes of infection are through sexual contact, contaminated blood transfusions and sharing needles for drug injections. Contact homes with adults with hepatitis B can put people at risk of contracting hepatitis. However, frequent hand washing and good hygiene practices can reduce this risk.

All children in the United States are routinely vaccinated against hepatitis B at birth and use of hepatitis B vaccine can greatly reduce the incidence of this infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they are in danger.

Hepatitis C is spread through shared drug needles, contaminated blood products, and, less commonly, through sexual contact. Although hepatitis C can be transmitted from mother to fetus during pregnancy, the risk of transmission of hepatitis C to the fetus is not very high (about 5%). If you are pregnant, consult your doctor if you think you have been exposed to hepatitis C.

In recent years, improved medical technology virtually eliminated the risk of catching hepatitis from contaminated blood products and blood transfusions. But as tattoos and acupuncture have become more popular, the risk of developing hepatitis improperly sterilized equipment used in these procedures has increased. Shared needles in drug use and shared straws in cocaine use are two very common ways for hepatitis C to spread.

Prevention

In general, to prevent viral hepatitis you should:

• Follow good hygiene and avoiding overcrowding, unhealthy living.
• Take extra precautions, especially when drinking or swimming, if you travel in the world where sanitation is poor and water quality is uncertain.
• Do not eat shellfish waters contaminated by sewage.
• Remind all family members to wash hands thoroughly after using the toilet and before eating.
• Use an antiseptic cleansers to clean any toilet, sink, potty chair, or a pan that is one of the family who develops hepatitis.

Because contaminated needles and syringes are a major source of infection with hepatitis, is a good idea to promote drug prevention programs in their communities and schools. At home with your child to talk openly and often about the dangers of drug use. It ‘also important to encourage abstinence and safe sex for teenagers, in order to eliminate the risk of hepatitis infection through sexual contact.

Hepatitis vaccine is available to children 12 months and older. Previously, the vaccine is only recommended for those at high risk for the disease (such as those who have lived or traveled in places where high-HAV), but now the vaccine is available to anyone who wants immunity to hepatitis A .

If you plan to travel abroad, consult your doctor in advance so you and your family have enough time to complete necessary vaccinations. The vaccine is especially useful for staff in nurseries or schools that may be at risk of exposure.

There is also a hepatitis B vaccine, which must be given to children and adults as part of routine immunization.

Unfortunately, there is no vaccine against hepatitis C – Animal studies show that this may not be possible because the virus does not cause the kind of response that would be a need for a vaccine to be effective.

Duration

In viral hepatitis, the incubation period (the time it takes for a person to become infected after being exposed), as the hepatitis virus causes the disease:

• For hepatitis A, the incubation period is 2 to 6 weeks.
• For hepatitis B, the incubation period is between 4 and 20 weeks.
• For hepatitis C, it is estimated that the incubation period is 2 to 26 weeks.

Hepatitis A is usually active for a short period of time and once a person recovers, he or she can no longer transmit the virus to others. It is virtually unknown people to become chronic carriers of hepatitis A. Almost all previously healthy persons who have hepatitis A recover completely from their disease within weeks or months without long-term complications.

With hepatitis B, recover 85% to 90% of patients of their illness completely within 6 months, without long-term complications.

However, 75% to 85% of those who have hepatitis C do not recover completely and will likely continue to be a long-term inflammation. People with hepatitis B (percentage who do not recover completely) or hepatitis C who still can not go to develop chronic hepatitis and liver cirrhosis (chronic degeneration and disruption of the structure of the liver). Some people with hepatitis B or C may also become carriers throughout the life of these viruses and can spread to other people.

Treatment

When symptoms are severe or laboratory tests show liver damage, it is sometimes necessary for hepatitis to be treated in the hospital. Here’s a quick look at the treatments available for different hepatitis

• There are no medications used to treat hepatitis A because it is a short-term infection that disappears by itself.
• Hepatitis B can sometimes be treated with medication. Four types of drugs are approved for use in adults with hepatitis B, but has not been enough research on their use in children. However, you can talk to your child’s doctor about a drug that may be available in some centers in search of children.
• Hepatitis C, has been significantly improved with both drugs, only one of which has been approved for use in children. Another effective drug is not approved for children yet, but is accessible to children in some research focuses on. These are adults, just to have hepatitis C (by accidental needle injury, for example), combination therapy with two drugs is the treatment of choice and can eliminate the virus by approximately 50% of infected people.

Children with mild hepatitis may be treated at home. Unless you use the bathroom, they should stay in bed until fever and jaundice are gone and their appetite is normal. Children with poor appetite should try smaller more frequent meals and fluids that are high in calories (like milkshakes). They must also eat healthy foods rich in protein and carbohydrates and drink plenty of water.

When to Call the Doctor

Call your doctor if your child:

• Has the symptoms of hepatitis
• Participate in school or child care, where someone has hepatitis
• E ‘exposed to a friend or a relative is sick

If you have an older child who volunteers at the first aid station, hospital or nursing home, make sure he or she knows the proper safety procedures to avoid contact with blood or body . You can also choose to have your child vaccinated against hepatitis B. Call your doctor if you suspect your child may have been exposed to a patient with hepatitis.

If you already know that your child has hepatitis, call your doctor if you notice any of the following symptoms may be signs of worsening liver condition:

• Confusion or extreme drowsiness
• Rash
• Itching

Also, monitor your child’s appetite and digestion, and call your doctor if your child’s appetite decreases, or if the increase in nausea, vomiting, diarrhea or jaundice.

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Vaginismus, sometimes anglicized vaginism is the German name for a condition which affects a woman’s capability to engage in any form of vaginal penetration, including sexual intercourse, attachment of tampons, and the penetration involved in gynecological examinations. This is the result of a reflex of the pubococcygeus muscle, which is sometimes referred to as the “PC muscle”. The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration painful or impossible.

A woman struggling from vaginismus does not purposely control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The intensity of vaginismus and the pain during penetration, including sexual penetration, differs from woman to woman.

A woman is said to have main vaginismus when she has never been able to have penetrative sex or experience vaginal penetration without pain. It is generally discovered in teenagers and women in their early twenties, as this is when many young women in the Western world attempt to use tampons, have penetrative sex, or undergo a Pap smear. Women with vaginismus may be unaware of the condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should naturally be easy, or may be unaware of the reasons for her condition.

A few of the main factors which may contribute to primary vaginismus contain:

• a situation called vaginal vestibulair symptoms more or less synonimous to focal vaginitis a so called subclinical inflammation. No pain is perceived, until some form of transmission is tried.
• urinary tract infections or vaginal yeast infections.
• sexual abuse, rape, or attempted lovemaking abuse
• knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused
• domestic violence or discord in the early home environment
• having been taught that sex is immoral, vulgar, or demoralizing
• fear of pain associated with penetration, particularly the popular misconception of ‘breaking’ the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs
• being sexualized or told about sex in violent or unnecessarily graphic terms before an age at which one is comfortable with such details
• any physically invasive trauma
• generalized anxiety
• stress

Occasionally, primary vaginismus is idiopathic.

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Vaginismus has been categorized by Lamont according to the severity of the condition. He describes four degrees of vaginismus: In first degree vaginismus, the patient has spasm of the pelvic floor which can be relieved with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree vaginismus, the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination. Pacik expanded the Lamont classification to include a fifth degree in which the patient experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, going unconscious, wanting to jump off the table or attacking the doctor. The Lamont classification continues to be used to the present and allows for a common language among researchers and therapists. However, it does not allow for a language in which a woman might be able to verbalise her concerns, pain or problems. A woman with a lot of trust in the doctor might be classified as 1 but experience severe pain. A woman with less trust or a woman who is or has been exposed to harsh examination, might be classified as four or five .

Though spasm of the pubococcygeus muscle is commonly thought to be the primary muscle required in vaginismus, Pacik recognized 2 additional included spastic muscles in treated patients under sedation. These include the entry muscle (bulbocavernosum) and the mid oral muscle (puborectalis). This accounts for the common complaint that patients often say when trying to have sexual intercourse “It’s like reaching a brick wall”.

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