There are various infectious diseases that may confront the caregiver in off-grid settings. These can affect various organs of the body, one of which is the liver.

Although your skin is the largest organ you have, the liver is the largest organ that resides inside the body. It is located on the right side of your abdomen just under the lowest rib.

The liver is susceptible to damage from drugs and alcohol, as well as inflammation from certain viruses, a condition known as “hepatitis”. If the liver is diseased, it can become enlarged and tender. This compromises its ability to perform functions like helping your body eliminate toxins, digest food, store energy, and more.

There are various types of hepatitis, listed as A, B, C, D, and E. Each has its own characteristics, but many symptoms are similar. Some types are related to poor hygiene, others from poorly prepared food or contaminated water, and some are even transmitted sexually, but all cause liver dysfunction and scarring. Symptoms can range from none at all (but still contagious) to life-threatening, and may include:

• Loss of appetite
• Nausea and vomiting
• Diarrhea
• fever
• Dark-colored urine and pale greyish bowel movements
• Stomach pain
• Itching
• Muscle and joint aches
• Fatigue
• General ill feeling (also called “malaise”)

Although sufferers may experience several of the above symptoms, the hallmark of hepatitis is jaundice, a yellowing of skin and eyes that occurs due to an excess of a yellowish substance called “bilirubin” in your system. Bilirubin is formed by the breakdown of old red blood cells in the liver. A healthy liver eliminates bilirubin as part of this process.

HEPATITIS A

Hepatitis A virus is caused by oral-fecal contamination; it can be gotten, for example, by drinking water that has particles from the bowel movements of infected individuals. It’s begins as a flu-like syndrome, then quickly manifests many of the symptoms mentioned above 2 to 6 weeks after exposure. It can also be transmitted sexually.

In survival, failing to properly purify water can cause an epidemic of Hepatitis A. In normal times, a restaurant employee who doesn’t wash his hands after using the bathroom can pass the disease along to customers.

Hepatitis A usually gets better without treatment after a few weeks. Interestingly, children rarely get symptoms, while 80% of adults do. In areas at risk, a vaccine is available.

HEPATITIS B

Hepatitis B can be spread by exposure to infected blood products, semen, and vaginal fluids. Symptoms are usually indistinguishable from Hepatitis A.

Hepatitis B. however, may cause scarring in the liver that leads to a chronic condition known as “cirrhosis”.  In cirrhosis, the functioning cells of the liver are replaced by non-functioning nodules. Cirrhosis may also be caused by long-term alcohol or drug abuse. Besides jaundice, the condition can lead to “ascites”, an accumulation of fluid that causes swelling of the abdomen, swollen legs, and other symptoms.

HEPATITIS C

Hepatitis C can cause acute or chronic infection, and is seen most often in older individuals. It may be contracted by intravenous drug use, transfusion, and unsafe sexual practices. A percentage of these patients will progress to cirrhosis over time and, sometimes, complete liver failure. A vaccine is now actively promoted by the government that may protect infected individuals from future damage.

HEPATITIS D

The hepatitis D virus is unusual because seems to only occur in those with an active Hepatitis B infection. In tandem, the two viruses cause a significant “superinfection”.

HEPATITIS E

Hepatitis E is typically an acute infection that is sometimes associated with eating poorly cooked pork or wild game. It is self-limited, which means that it gets better without treatment after several weeks. Some types of hepatitis E virus are spread by oral-fecal contamination similar to Hepatitis A.

PREVENTION AND TREATMENT OF HEPATITIS

Make the patient comfortable by encouraging rest, encouraging rest and hydration, and giving antihistamines like diphenhydramine for itching. There are limitations about can be done in an austere setting regarding this condition. The anti-viral and immune drugs used for this condition will simply be unavailable.

The austere medic can, however, practice good preventive medicine by encouraging the following policies:

• Wash hands after using the bathroom and before preparing food
• Wash dishes with soap in hot water
• Avoid eating or drinking anything that may not be properly cooked or filtered
• Make sure children don’t put objects in their mouths
• Use condoms to avoid sexual transmission
• Don’t share personal items, if at all possible, like toothbrushes or razors with infected persons

Some natural substances may encourage good liver health and were used in the past to treat those with hepatitis. Avoiding fatty foods and alcohol Increase, taking zinc supplements, and staying hydrated may help.

There is little hard data proving their effectiveness, but they may be your only options in a survival setting. They include:

• Milk Thistle
• Artichoke
• Dandelion
• Turmeric
• Licorice
• Red Clover
• Green Tea

Although viral diseases are difficult to treat off the grid, a focus on prevention will help make sure your people have the least chance of getting hepatitis.

Joe Alton MD

Learn more about hepatitis and 150 other medical topics in the 700 page third edition of the 2017 Book Excellence Award winner in medicine, The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way,