Hepatitis is inflammation of the liver, usually an infection caused by one of three viruses.

Type A hepatitis is what we previously called infectious hepatitis. This virus is shed in the faeces and spreads from person to person by contamination from faecal matter. It has an incubation period of about 30 days.

The virus has recently been identified and can now be grown in culture and a vaccine to protect against this form of hepatitis may be available soon.

To protect immediate contacts of those with this type of hepatitis, an injection of gamma globulin may be given. This is prepared from human serum collected by the Blood Bank and, in Australia, extracted at the Commonwealth Serum Laboratories. It contains antibodies to the virus and can give short-term protection over two to three months.

Type  hepatitis, formerly called serum hepatitis, is due to a different virus and has a much longer incubation period, around 90 days. It is usually spread by contact with the blood.

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Persistent indigestion may be due to an ulcer, to irritation of the stomach or to the presence of what is called an hiatus hernia.

We now realise that it is not the presence of the hernia itself, but of the associated reflux of acid into the gullet which causes the trouble.

The gullet or oesophagus runs through the chest, then passes through a gap or hiatus in the diaphragm, the sheet of muscle which separates the chest from the abdominal cavity. Once through this hiatus, it widens out to become the stomach.

In hiatus hernia, this gap is widened and allows a portion of the stomach to push up or herniate through the diaphragm into the chest.

Hiatus hernia becomes increasingly common as we age. Symptoms do not seem to correlate with the size of the hernia.

Associated with the hernia is gastro-oesophageal reflux. The distortion in the anatomy allows the acid contents of the stomach to regurgitate into the lower part of the gullet and this irritates the lining and is responsible for the symptoms.

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The Rh antibodies should also be checked at 28 and 34 weeks of the pregnancy. Following delivery, the antibodies are again checked and so is the blood group of the child.

Should Rhesus antibodies be found in the mother’s blood, the doctor will consider inducing labor earlier than the due date. This is because the risk of the baby being affected increases as the birth date is approached.

However, if the child is delivered too soon, it has to face the risks of prematurity.

Amniocentesis is a procedure where a needle is inserted through the womb into the amniotic sac that surrounds the baby, and fluid is removed for examination to determine if the child is affected and how severely.

Those women who are already sensitised have to rely on the skill of their obstetrician and the paediatrician to save their babies.

Those other women who are Rhesus negative and conceive an Rh positive child should have anti-D globulin after each pregnancy and particularly after spontaneous or induced abortion. In this way, the frequency if not the severity of this disorder can be greatly reduced.

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Once the mother has formed these antibodies, they readily cross the placenta to enter the baby’s circulation and can destroy the baby’s red cells.

If the baby is severely affected, this can lead to death in the womb or soon after birth. Destruction of the red cells can also cause anaemia and jaundice due to an excess of bile pigment from the broken-down cells.

Destruction of the baby’s red cells, with a rapid onset of severe jaundice, is more likely in the first few hours after birth. If the jaundice is severe, it can lead to brain damage.

If Rhesus iso-immunisation occurs and the baby is severely affected, it is possible to treat by the technique of exchange transfusion.

In this, most of the baby’s blood is withdrawn and replaced by Rh negative blood. In this way, the Rh antibodies from the mother which are circulating in the child’s blood are washed out and those which remain are destroyed by the baby’s own immune system. While this is happening, the transfused Rh negative cells do the work of transporting oxygen and are not affected by the antibodies.

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