Travel Reference
In-Depth Information
Most people with hepatitis should be evacuated. Recovery usually takes so long that
delaying evacuation until the person is well is impossible. In addition, complications that
require a physician's care may develop. If the infection is severe, important proteins in-
volvedintheclottingmechanismofbloodarenoteffectivelyproducedbytheliver,predis-
posing the individual to bleeding.
Treatment of chronic hepatitis B with lamivudine and subsequent newer nucleotide or
nucleoside agents has produced favorable results and is well tolerated. Considerable viral
resistance to lamivudine has displaced this agent in favor of the newer medications. He-
patitis C can be treated with injectable interferon in combination with oral ribavirin, pro-
ducing an agonistic antiviral effect, but therapy is prolonged, expensive, and only partially
successful. Prevention is of utmost importance to avoid contracting infection in endemic
areas.
Cirrhosis
Hepatic cirrhosis is a progressive scarring or fibrosing process that results from chronic
hepatitis B and C infections, prolonged alcohol abuse, and other inflammatory disorders.
It is ultimately lethal. Jaundice and ascites, an accumulation of fluid in the abdomen, are
common complications. The scarring blocks the normal flow through the liver of blood re-
turning from the intestines. Toreturn to the circulation, the blood must find other channels,
which results in the enlargement of veins in several areas, most prominently the lower eso-
phagus. Death often results from massive bleeding from these enlarged esophageal veins
(knownasvarices),whichcanonlybecontrolledinahospitalsetting.Varicealhemorrhage
in a wilderness setting would often be fatal. Liver failure is also a common cause of death
forindividualswithcirrhosis.Suchproblemsarerareinwildernesssituationsbecauseindi-
viduals with these conditions rarely feel well enough to visit the backcountry; in any case,
they should be discouraged from doing so.
Acute Hepatic Necrosis
Acute hepatic necrosis is a disorder that is usually fatal within a week. Toxic fungi
( Amanita mushrooms); large quantities of some drugs, such as acetaminophen (Tylenol®),
particularly when associated with regular alcohol consumption; rare reactions to medica-
tion; and certain chemicals such as carbon tetrachloride or other toxic exposures can pro-
duce this disorder. However, knowledge of these hazards has become more widespread,
and the most common cause of acute hepatic necrosis now is probably acute hepatitis.
Individuals with acute hepatic necrosis rapidly deteriorate, become intensely jaundiced,
and sink into a coma that cannot be reversed. The only effective treatment is hepatic trans-
plantation, which rarely can be performed rapidly enough, even in major medical centers.
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