OVERVIEW
Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it's caused by a virus. This is known as viral hepatitis. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

TYPES OF HEPATITIS

VIRAL HEPATITIS

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. The most common forms are the types A, B, C. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.

Hepatitis A:
Hepatitis A is highly contagious and can spread from person to person in many different settings. It typically causes only a mild illness, and many people who are infected may never realize they're sick at all. The virus almost always goes away on its own and does not cause long-term liver damage.
Hepatitis A usually passes within a few months, although it can occasionally be severe and even life-threatening. There's no specific treatment for it, other than to relieve symptoms such as pain, nausea and itching.

Treatments for hepatitis A
There's currently no cure for hepatitis A, but it will normally pass on its own within a couple of months. You can usually look after yourself at home.

Hepatitis B
Hepatitis B is caused by the hepatitis B virus, which is spread in the blood of an infected person. It is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use.

Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.

Symptoms of hepatitis B
Many people with hepatitis B won't experience any symptoms and may fight off the virus without realizing they had it. If symptoms do develop, they tend to occur two or three months after exposure to the hepatitis B virus.

Symptoms of hepatitis B include:
flu-like symptoms, including tiredness, a fever, and general aches and pains
loss of appetite
feeling and being sick
diarrhea
tummy (abdominal) pain
yellowing of the skin and eyes (jaundice)
Treatments for hepatitis B

Treatment for hepatitis B depends on how long you've been infected for:
If you've been exposed to the virus in the past few days, emergency treatment can help stop you becoming infected.
If you've only had the infection for a few weeks or months (acute hepatitis B), you may only need treatment to relieve your symptoms while your body fights off the infection.
If you've had the infection for more than six months (chronic hepatitis B), you may be offered treatment with medicines that can keep the virus under control and reduce the risk of liver damage.
Chronic hepatitis B often requires long-term or lifelong treatment and regular monitoring to check for any further liver problems.

Hepatitis C
Hepatitis C is caused by the hepatitis C virus and is usually spread through blood-to-blood contact with an infected person. Hepatitis C often causes no noticeable symptoms, or only flu-like symptoms, so many people are unaware they're infected.
Around one in four people will fight off the infection and be free of the virus. In the remaining cases, it will stay in the body for many years. This is known as chronic hepatitis C and can cause cirrhosis and liver failure.
Chronic hepatitis C can be treated with very effective antiviral medications, but there's currently no vaccine available.

Hepatitis D
Hepatitis D is caused by the hepatitis D virus. It only affects people who are already infected with hepatitis B, as it needs the hepatitis B virus to be able to survive in the body.
Hepatitis D is usually spread through blood-to-blood contact or sexual contact. It's uncommon in the UK, but is more widespread in other parts of Europe, the Middle East, Africa and South America. Long-term infection with hepatitis D and hepatitis B can increase your risk of developing serious problems, such as cirrhosis and liver cancer.
There's no vaccine specifically for hepatitis D, but the hepatitis B vaccine can help protect you from it.

Hepatitis E
Hepatitis E is caused by the hepatitis E virus. is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries.
Hepatitis E is generally a mild and short-term infection that doesn't require any treatment, but it can be serious in some people, such as those who have a weakened immune system.
There's no vaccine for hepatitis E. When travelling to parts of the world with poor sanitation, where epidemic hepatitis E may be common, you can reduce your risk by practicing good food and water hygiene measures.

Parasitic hepatitis

Parasites can also infect the liver and activate the immune response, resulting in symptoms of acute hepatitis with increased serum IgE (though chronic hepatitis is possible with chronic infections). Protozoans such as  Trypanosoma cruzi, Leishmania species, and the malaria-causing Plasmodium species all can cause liver inflammation. Entamoeba histolytica, causes hepatitis with distinct liver abscesses.
 Echinococcus granulosus(dog tapeworm), infects the liver and forms characteristic hepatic hydatid cysts.The liver flukes Fasciola hepatica and Clonorchis sinensis live in the bile ducts and cause progressive hepatitis and liver fibrosis.

Fulminant hepatitis

Fulminant hepatitis or massive hepatic cell death is a rare and life-threatening complication of acute hepatitis that can occur in cases of hepatitis B, D, and E, in addition to drug-induced and autoimmune hepatitis.

Bacterial hepatitis

Bacterial infection of the liver commonly results in pyogenic liver abscesses, acute hepatitis, or granulomatous (or chronic) liver disease. This involves enteric bacteria such as Escherichia coli and Klebsiella pneumonia. Acute hepatitis is caused by Neisseria meningitidis, Neisseria gonorrhea, Bartonella henselae, Borrelia burgdorferi, salmonella species, brucella species and campylobacter species. Chronic or granulomatous hepatitis is seen with infection from mycobacteria species, Tropheryma whipplei, Treponema pallidum, Coxiella burnetii, and rickettsia species.

Metabolic

This form of Hepatitis includes:

Alcoholic hepatitis

Excessive alcohol consumption is a significant cause of hepatitis and is the most common cause of cirrhosis in the U.S. Alcoholic hepatitis is within the spectrum of alcoholic liver disease. This ranges in order of severity and reversibility from alcoholic steatosis, alcoholic hepatitis, cirrhosis, and liver cancer (most severe, least reversible). Hepatitis usually develops over years-long exposure to alcohol, occurring in 10 to 20% of alcoholics. Long-term alcohol intake (in excess of 80 grams of alcohol a day in men and 40 grams a day in women) is associated with development of alcoholic hepatitis.

Toxic and drug-induced hepatitis

Many chemical agents, including medications, industrial toxins, and herbal and dietary supplements, can cause hepatitis. Toxins and medications can cause liver injury through a variety of mechanisms, including direct cell damage, disruption of cell metabolism, and causing structural changes.  Some drugs such as paracetamol exhibit predictable dose-dependent liver damage while others such as isoniazid cause idiosyncratic and unpredictable reactions that vary among individuals.
Exposure to other hepatotoxins can occur accidentally or intentionally through ingestion, inhalation, and skin absorption. Examples of such toxins are carbon tetrachloride and the wild mushroom Amanita phalloides.

Non-alcoholic fatty liver disease

Non-alcoholic liver disease occurs in people with little or no history of alcohol use, and is instead strongly associated with metabolic syndrome, obesity, insulin resistance and diabetes, and hypertriglyceridemia. Over time, non-alcoholic fatty liver disease can progress to non-alcoholic steatohepatitis, which additionally involves liver cell death, liver inflammation and possible fibrosis.

Autoimmune Hepatitis

Autoimmune hepatitis is a rare cause of long-term hepatitis in which the immune system attacks and damages the liver. The liver can get so damaged that it stops working properly. As in other autoimmune diseases, circulating auto-antibodies may be present and are helpful in diagnosis. Treatment for autoimmune hepatitis involves very effective medicines that suppress the immune system and reduce inflammation. The causes of autoimmune hepatitis are still unclear and it's not known whether anything can be done to prevent it.

Other forms include:
Genetic hepatitis.
Ischemic hepatitis
Neonatal hepatitis

DIAGNOSIS OF HEPATITIS

Diagnosis of hepatitis is made on the basis of some or all of the following:
*a patient's signs and symptoms
* medical history including sexual and substance use history.
* Blood tests, imaging, and liver biopsy.
 In general, for viral hepatitis and other acute causes of hepatitis, the patient's blood tests and clinical picture are sufficient for diagnosis but in chronic hepatitis, blood tests may not be useful, instead, liver biopsy is used for establishing the diagnosis as histopathology analysis is able to reveal the precise extent and pattern of inflammation and fibrosis.

PROGNOSIS OF HEPATITIS

Acute hepatitis
Nearly all patients with hepatitis A infections recover completely without complications if they were healthy prior to the infection. Similarly, acute hepatitis B infections have a favorable course towards complete recovery in 95–99% of patients.[14] However, certain factors may portend a poorer outcome, such as co-morbid medical conditions or initial presenting symptoms of ascites, edema, or encephalopathy.[14] Overall, the mortality rate for acute hepatitis is low:
In contrast to hepatitis A & B, hepatitis C carries a much higher risk of progressing to chronic hepatitis, approaching 85–90%.[105] Cirrhosis has been reported to develop in 20–50% of patients with chronic hepatitis C. Rare complications of acute hepatitis include pancreatitis, aplastic anemia, peripheral neuropathy, and myocarditis.

Fulminant hepatitis
Fulminant hepatitis represents a rare but feared complication. Mortality rates in cases of fulminant hepatitis rise over 80%, but those patients that do survive often make a complete recovery. Liver transplantation can be life-saving in patients with fulminant liver failure. Hepatitis D infections can transform benign cases of hepatitis B into severe, progressive hepatitis, (superinfection).

Chronic hepatitis
Overall, the 5-year survival rate for chronic hepatitis B ranges from 97% in mild cases to 55% in severe cases with cirrhosis. Most patients who acquire hepatitis D at the same time as hepatitis B (co-infection) recover without developing a chronic infection; however, in people with hepatitis B who later acquire hepatitis D (superinfection), chronic infection is much more common at 80-90%, and liver disease progression is accelerated.
Chronic hepatitis C progresses towards cirrhosis, with estimates of cirrhosis prevalence of 16% at 20 years after infection. While the major causes of mortality in hepatitis C is end stage liver disease, hepatocellular carcinoma is an important additional long term complication and cause of death in chronic hepatitis.

Externship-

1)Jackson Park, Chicago
Contact Email:[email protected]

2)Mercy hospital st louis
Externship on merit and credentials.
Its free.
( Internal Medicine - Filled till December 2013. They accept applications on October 1st for January to May. Need Social Security and scores above 220, one month only).
www.mercygme.net.
Applicable only if you have US Social security number.

Observerships:

1)North Shore Medical Centre-Salem Hospital Program, MA in IM,
email CV to Program co-cordinator.
Link is http://nsmc.partners.org/residency/questions

2)Children's hospital of Pittsburgh: department of endocrinology

3)Cooper University Hospital: Pediatrics
Contact [email protected]

4)Texas, Good Shepherd Medical center,
Send email for observership to program coordinator, her email address given on frieda. they have usually 3 observers every month and no fees for observership

5)UMC Las Vegas - you'll need to find a faculty sponsor.

6)University of Florida Gainesville/Pediatrics,
Free of cost.
Need to find a sponsoring faculty.. the information is given on their website....
clerkship coordinator - Haltam Tabatha ([email protected])
for one month only
http://residency.pediatrics.med.ufl.edu/resources/observing-shadowing-volunteering/

7)Alleghany General Hospital.
IM paid.
Contact Email: [email protected]
http://www.wpahs.org/locations/allegheny-general-hospital/education-physician

8)Cleveland Clinic/Ohio/Pediatrics-
paid observership..
visit their website for more information.

9)Memorial Sloan Kettering cancer center observership,new york:
http://www.mskcc.org/cancer-care/healthcare-professionals/international-observership

10)Texas, Good Shepherd Medical center,
Send email for observership to program coordinator, her email address given on frieda.
they have usually 3 observers every month and no fees for observership.

11)Griffin hospital Connecticut has paid observership @500$/month.(needs official transcripts).
http://www.griffinmeded.org/Clinical-Observership.aspx

12)Boston Childrens Hospital:
http://childrenshospital.org/healthprofessionals/Site1392/mainpageS1392P95.html
NICU Observership for 1 month at Boston Children'sHospital...
contact person is Hossain Tanzeema...email is [email protected].

13)Ochsner medical center at New Orleans has free observerships,
if any of the faculty working there recommends the candidate.

14)CHM,children's ,Detroit-observer ship in ED,
no cost
contact email:[email protected]

15)USF infectious disease,Tampa,Florida paid observership(2000$)

16)Wayne state univ paid observership $1500/month
http://gme.med.wayne.edu/future/observership.php
(website says not offering now- i donno why-i knew people who have done recently too).

17)St Agnes hospital Baltimore MD-
In Int.Medicine 500 $/month if any faculty or resident recommend you for observership.

18)St. Vincent Hospital Worcester, MA - Observership -
free as long as one of the doctors agrees to it so email and call them

19)Mt.Sinai New York  
Cardiology observership
free of cost-long waiting list.
So plan ahead. contact
Email: [email protected]

20)Mt.Sinai New York
PEDS - Hepatic transplant observership-500$/MONTH.
Sometimes they waive the fee(that is they give it for free).
contact email: [email protected]
http://icahn.mssm.edu/departments-and-institutes/surgery/programs-and-services/recanati-miller-transplantation-fellowship/residents-students-observers/observers

21)UT houston-observership
They have an application fee apart from processing fee too. You need to find a faculty sponsor.
http://www.uthouston.edu/global-health/observers/
An application processing fee ($350.00 USD if paid by money order or $375.00 USD if paid by wire transfer) will be charged to all Foreign Observers and Foreign Professional Trainees who will start their visit on or after September 01, 2012.

22)Tulane University,New Orleans
You need to find a faculty sponsor-Free Observership

23)UPMC -Offers observerships
you need to find a faculty sponsor
http://www.ccm.pitt.edu/clinical-visitor-observe

24)Miller school of Medicine, Miami
Paid observership(May be around 1500$).
http://imi.med.miami.edu/education-and-training/global-observership-program

25)Mayo Clinic,Florida
Does offer
Should plan ahead. You need to find a faculty sponsor.
http://my.clevelandclinic.org/florida/education/observerships.aspx
this website says- There is a $500.00 application fee which is non-refundable. Checks should be made payable to Cleveland Clinic Florida. In addition to the application fee we require a weekly tuition fee in the amount of $100.00. This fee can be paid on or before starting your rotation.

26)Cleveland Clinic
Two kinds of observerships
A)International physician observer program(doesn't need ECFMG cert-not meant for USMLE aspirants-but still give a try).
http://portals.clevelandclinic.org/cime/VisitingPhysicianPrograms/InternationalPhysicianObserverProgram/tabid/5479/Default.aspx

B)Global observership program.(ECFMG certificate required).
http://portals.clevelandclinic.org/cime/VisitingPhysicianPrograms/GlobalClinicalObserverProgram/tabid/5480/Default.aspx

27)Cleveland Clinic Epilepsy observer ship 3 months.
http://my.clevelandclinic.org/neurological_institute/epilepsy/for-medical-professionals/observership.aspx

28)Oklahoma state Medical Association - observership
3 months (Paid)
Application fee $250 + $900 for 12 weeks. not a University hospital,
No choice of speciality but you get placed in IM mostly.
http://www.okmed.org/index-2_internationalsection.html

29)Mercy St.Vincents ,Toledo, Ohio
Check their website.(Needs ECFMG certificate-contacts help-because many with ECFMG cert dint get).
http://mercymedicalresidency.org/index.php/observership/

30)UNMC,nebraska-various specialities
VERY VERY long Waiting list-Should Plan Really ahead-I am on waiting list still.

31)UNMC neurology observership,Nebraska:
http://www.unmc.edu/neurologicalsciences/observership_program.htm

32)Creigton University neurology observership program-(Needs step1,step2 ck score).
(FREE).
http://medschool.creighton.edu/medicine/departments/neurology/neurologyobservership/index.php

33)University of Kentucky-Neurology observership-see their website.(free)
http://ukneurology.com/education/observership.html

34)Massachusetts General hospital-Paid observership.
http://www.massgeneral.org/vep/observerships/

35)Moffitt's Cancer hospitals-Tampa,florida
http://moffittcancercenter.com/Site.aspx?spid=52228CED6507409E8C68B26ED85A9FC6

36)Cleveland Clinic Florida-Paid observership(Cost: $500 for application and $100/ week if selected.)
http://my.clevelandclinic.org/florida/education/observerships.aspx

37)Mt.Sinai Medical CENTER,Miami-Paid observership(I think miller school of medicine and this are almost same).
http://www.msmc.com/education/internation-observership-course

38)Drexel has a paid observership-around 7500$ for 4-6 weeks.
http://www.drexelmed.edu/Home/OtherPrograms/PhysicianRefresherCourse.aspx

39)Griffin memorial Hospital, Norman, Oklahoma - Psychiatry. Cost- $400, 1 month.
For more details contact program coordinator- Pam Melton, [email protected]

40)Duke University, Durham- Oncology.

41)Univ Of Louisville,Psychiatry-4 month duration

42)MD Anderson cancer center,Leukemia department,4 weeks,
No charge,apply early.(They are not offering them now these days-Also i don't see any benefit in doing here).

43)Baylor college of Medicine, Texas- Pediatrics.
Contact Ms. Claudia Flores. [email protected]
(I am not sure whether they are offering it now a days.

44)University of Minessota observership- multiple specialties
website- http://www.med.umn.edu/gme/observinfo/home.html

45)Internal Medicine externship at Heart and Vascular institute in Detroit,
you can fill the application form on their website http://www.heartteam.com/externship.php......
they take some time to process the application around 2 months...

46)Pediatrics observership at New york at MDPEDS clinic..
U need to meet the doctor personally..
U can access the address on http://www.mdpeds.com/...
The doctors name is Dr. Daniela Atanassova-Lineva M.D. the clinic is in queens, Ny..

47)Michigan state university-Sparrow Hospital-Internal Medicine Observership.
They offer limited Obsies and Application time is single day-It was on April 30 this year.
Timings was from 8AM to 1.30 PM .See how narrow it is. (Lets see how it goes).
http://www.im.msu.edu/applicants/observership.asp

48)Baylor College of Medicine, Multiple Sclerosis Observership Program
contact email:[email protected]

49)Jackson Memorial Hospitals,Miami:
http://www.jacksonhealth.org/residents-fellows-observers.as

50)Florida Hospital,Orlando:
http://www.floridahospital.com/careers-education/observership

51)Case Western Univesity, Urology Observership:
http://casemed.case.edu/dept/urology/Visiting_Medical_Students_Observer_Policy.cfm

52)George Washington University Observership Program:
http://www.gwumc.edu/smhs/imp/medical-programs/international-scholars/graduate/observer-training/index.cfm

53)Henry Ford Hospital,Detroit observership
http://www.iihe.org/fpres/policymanual/OBSERVERSHIP.htm

54)Dana Farber Cancer Institute Observership:
http://www.dana-farber.org/Education-and-Training/Fellowships-and-Training-Programs/Observing-Clinical-Care-and-Research-at-Dana-Farber.aspx

55)Inova observership, Virginia:
http://www.inova.org/education-and-research/education/education-for-students/physician-observerships.jsp

56)Penn Medicine Observer program:
http://www.uphs.upenn.edu/gme/coordina/observer/index.html

57)Beth-Israel Deaconess Center,Observership Program:
http://www.bidmc.org/MedicalEducation/Departments/Medicine/Divisions/CardiovascularMedicine/ClinicalandResearchFellowshipTrainingPrograminCardiovascularDisease20082009/ApplicationProcess.aspx

58)Baptist Health South Florida: Observer program:
http://baptisthealth.net/en/facilities/West-Kendall-Baptist-hospital/shadowing/Pages/default.aspx

59)Childrens National Peds Observership:
http://www.childrensnational.org/ForDoctors/gme/observerships/

60)Seattles childrens hospital observership:
http://www.seattlechildrens.org/healthcare-professionals/education/observership/

61)Brigham and Women's Hospital, Boston, MA (http://renalobserver.org)

62)Texas- University Of Texas Health Science Center at Houston
Observership in Anesthesiology(free)/ Critical Care (500$)/ Infectious Diseases(1000$)
http://www.uth.tmc.edu/schools/med/imed/education/Observership/Observer.html

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