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pathology perspectives BY RUTH WERNER THE ABCs OF HEPATITIS Know the Basics of Contagious Liver Infections Hepatitis is an umbrella term that describes any situation involving inflammation of the liver. In this country, that usually means a viral infection with one of three candidates: hepatitis A, hepatitis B, or hepatitis C. It is important to emphasize from the beginning that exposure to any one of these viruses provides no protection from any of the others. These are completely distinct pathogens; the only thing they share is a predilection for liver cells. In this article, we will review the healthy liver, and what happens when the liver is under viral attack. Then we will examine the interplay between massage therapy and various forms of hepatitis. The goal is to point out that this professional hazard is a serious—but completely manageable—issue. LIVER FUNCTION: IT'S AMAZING! Entire textbooks have been devoted to the topic of liver function; in this context, we will review just a few of its important jobs. • Fluid receiver. The liver receives blood from the left and right hepatic arteries, as well as from the portal system. • Bile. The liver manufactures bile, which emulsifies fats. Bile has several ingredients, but one of them is bilirubin: a byproduct of red blood cell recycling, delivered through the portal vein from the spleen. Bilirubin is dark golden-brown, and it is a coloring agent for feces. • Blood proteins. The liver manufactures many of the substances in our plasma that assist with blood clotting and other functions. • Detoxification. The liver extracts potentially toxic metabolic wastes from the bloodstream. Sometimes it converts these products into a format that the body can manage more easily—the conversion of ammonia to urea is a good example. The liver also filters out excessive masculine and feminine hormones. HERE COME THE VIRUSES Viral infections of the liver can range on a continuum from mild to very severe. No matter which virus causes the infection, the signs and symptoms are related to a liver that is temporarily or permanently losing function: fatigue, headache, and nausea are the most common complaints. These may be accompanied by complications that are discussed below. hePaTITIS a Hepatitis A is the least serious of all the hepatitis infections. This virus concentrates in the digestive tract, so it is spread most easily through oral-fecal contamination. We occasionally hear about outbreaks of hepatitis A where fecal matter has entered the food or water supply. The good news about hepatitis A is that one infection imparts lifelong immunity, and that this virus is only rarely associated with serious consequences. For most people, it is an inconvenience with unpleasant symptoms that may last several weeks, but it is not a threatening infection. hePaTITIS B Hepatitis B is a slow-acting virus that can silently and progressively destroy the liver. It causes long-term, low-grade inflammation that leads to scarring around and between hepatocytes; this interferes with liver function, and has wide-ranging implications for general health. tune in to your practice at ABMPtv 101