Liver damage in viral infections. Viral hepatitis, liver cirrhosis: characteristics, symptoms, treatment. Viral hepatitis B - features and treatment
Hepatitis is an inflammatory disease of the liver of various nature, characterized by necrosis of the liver cells. The most common cause of hepatitis are specific viruses (for example, hepatitis A, B, C virus and others), less often - other viruses ( cytomegalovirus, infectious mononucleosis virus).
Hepatitis A virus
Hepatitis A virus (HAV) is spread primarily by the fecal-oral route, i.e. infection can occur through food, water, etc.), sometimes through the blood. Epidemics caused by contamination of water or food are very common, especially in underdeveloped countries. The infection is very often asymptomatic or goes unrecognized. Population screening for anti-HA antibodies reveals a high prevalence of the virus.
The incubation period of the disease (the time from the onset of infection to the appearance of signs of damage to internal organs) with viral hepatitis A lasts from 2 to 6 weeks. The disease begins with symptoms of malaise, decreased appetite, nausea, vomiting, and sometimes fever. After a few days, jaundice appears - yellowness of the skin, mucous membranes, sclera, urine becomes dark color. At this time, the general symptoms preceding jaundice are significantly weakened. Jaundice lasts about 2-4 weeks. In the patient's blood, a significant increase in the content of liver enzymes (AST, ALT) is detected. Hepatitis A is diagnosed by the presence of Ig M antibodies. It usually clears up spontaneously in 4-8 weeks. Hepatitis A virus-associated hepatitis rarely becomes chronic, has a benign course, cirrhosis and an aggressive chronic form do not develop.
Personal hygiene helps prevent the spread of hepatitis A. Currently, no great importance is attached to the isolation of patients with hepatitis. Standard immunoglobulin (Ig or IgG) provides protection against hepatitis A infection and is given to those who have household contacts with an established carrier of the virus, and to those who will have a long stay in endemic areas.
Hepatitis B virus
Hepatitis B virus (HBV) is usually transmitted parenterally via contaminated blood or donated blood products. Currently, testing of donated blood for the presence of the HbsAg antigen has dramatically reduced the number of cases of infection after blood transfusion. The risk of infection is increased for cancer patients, for patients on hemodialysis, as well as for hospital personnel in contact with blood. The possibility of transmission of infection through insect bites has not been proven. In many cases of acute hepatitis B, the source of infection remains unknown. The spread of infection is sometimes recorded between sexual partners. Chronic carriers of HBV (hepatitis B virus) serve as a reservoir of infection. It is possible to transmit the virus in utero from mother to child. When infected with HBV, any form of liver damage is possible: carriage, acute and chronic hepatitis, cirrhosis, hepatocellular carcinoma. The role of HBV in initiating the development of such serious diseases as periarteritis nodosa, glomerulonephritis, etc. is not excluded.
The incubation period for infection with the hepatitis B virus is 6-25 weeks. A specific way to diagnose hepatitis B is the presence of HbsAg in plasma or the presence of anti-HBc antibodies of the Ig M class. In hepatitis B, the prognosis is usually less favorable than with HAV infection, especially in the elderly and after blood transfusion, mortality reaches 10-15%. Also, hepatitis B has a tendency to a chronic course (5-10% of cases), while the following forms are possible: mild persistent hepatitis, advanced chronic hepatitis with an outcome in cirrhosis, subclinical (i.e. asymptomatic) state of chronic carriage. The latter especially often leads to the development of hepatocellular carcinoma (a malignant tumor of the liver).
The chance of post-transfusion (i.e., after a blood transfusion) infection with HBV can be minimized by transfusion only when absolutely necessary, under strict indications, and using blood from donors tested for Australian antigen. Hepatitis B immunoglobulin (HBIg) contains a high titer of anti-HBV antibodies. This drug is expensive, it is prescribed for an accidental needle prick that has been in contact with HBsAg-positive blood, for prophylaxis with regular sexual contact with an identified carrier. It is effective in 70% of cases in preventing chronic HBV infection in infants born to HBsAg-positive mothers.
Vaccination against HBV leads to the production of antibodies in healthy recipients and can achieve a dramatic reduction (by almost 90%) in the prevalence of hepatitis B. Currently, there is a need to vaccinate all newborns, and vaccine prophylaxis is also recommended for people at high risk of hepatitis B virus infection (patients and employees in hemodialysis units, healthcare staff, dentists, etc.).
Four are currently known various systems an antigen-antibody closely associated with the hepatitis B virus (hepatitis B antigen, for example, is the envelope proteins of the virus, the presence of which can be determined in blood plasma by immunological methods).
Hepatitis B surface antigen (HBsAg), Australian antigen. Its detection in plasma makes it possible to diagnose acute hepatitis B. The patient's blood becomes a potential source of infection. Appears during the incubation period, disappears during recovery. Antibodies (anti-HBs) can be detected later, usually persist throughout life, and their presence in the blood indicates past infection and future protection against HBV. If HBsAg continues to be detected for a long time, and antibodies do not appear, this means that the patient has developed chronic hepatitis and has become an asymptomatic carrier of the virus.
The HvcAg antigen is associated with the core of the viral particle. It is found in infected liver cells. The presence of antibodies (anti-HBc) indicates a past HBV infection and is regularly found in HBsAg carriers.
HbeAg antigen - is part of the viral core, is detected if HBsAg is positive. The presence of this antigen indicates active replication (multiplication) of the virus, combined with a higher infectious ability of the blood and an increased likelihood of developing chronic liver damage. The presence of antibodies (anti-HBe) indicates a low infectivity and portends a favorable outcome.
Hepatitis C
Hepatitis C is widespread, transmitted parenterally (i.e. through the blood). It is known that they cause about 80% of post-transfusion hepatitis (i.e., hepatitis that occurs after a blood transfusion or its substitutes). The process is usually chronic (sometimes latent course). For example, it is assumed that some healthy people among the population are chronic carriers of hepatitis C. You can become infected with hepatitis C through blood transfusion, the use of non-sterile syringes (among drug addicts), during hemodialysis, and organ transplantation. The incubation period (the period of active reproduction of the virus and effects on tissues) averages 7-8 weeks, although it can take up to 6 months.
Acute hepatitis C is rarely detected, because it proceeds easily, often even without jaundice. However, chronization (i.e., a long undulating course of the disease) of the process is characteristic of hepatitis C.
Chronic hepatitis C is often benign, but cirrhosis ends in 20% of patients. The diagnosis is made during the examination - markers of hepatitis C are detected, an increase in the level of liver enzymes, jaundice (an increase in the content of bilirubin), according to ultrasound - signs of damage to the liver tissue, incl. cirrhosis. In most cases of acute hepatitis, specific treatment is not required; in chronic cases, antiviral drugs (more often interferons) are used.
Preventive measures include monitoring donors, limiting indications for blood transfusion as much as possible, using disposable needles, syringes, infusion systems, etc.
hepatitis D virus
Hepatitis D virus (HDV, delta factor) is a virus that replicates only in the presence of HBV, or is associated with acute hepatitis B, or appears as a superinfection in certain chronic hepatitis B. Clinical HDV infection usually presents with very severe hepatitis B.
With Botkin's disease, liver damage occurs. Usually accompanied by a benign course. But the necrotic phenomenon in liver cells is considered. Liver cells are hepatocytes.
Botkin's disease is characterized by the presence of an intestinal infection. The mechanism of infection is fecal-oral. That is, infection occurs through feces. There is an oral route of transmission, that is, through the mouth.
The virus is the most stable in the external environment. It usually keeps for several months. The water and alimentary path is important in the development of the disease. Including allocate a household way of transmission.
What it is?
Botkin's disease is an acute infectious lesion, accompanied by liver damage. In another way, the disease is called viral hepatitis A. Viral hepatitis A is usually not accompanied by damage to other organs and systems.
However, there may be exacerbations from other organs and systems. That is why there are some complications. These complications are some diseases:
- cholecystitis;
- dyskinesia of the gallbladder.
There are cases that Botkin's disease is complicated by the addition of an infection. This infection is a secondary process of infection. The most formidable complication is acute hepatic encephalopathy.
Causes
What is the etiology of the disease? Botkin's disease, as mentioned above, is transmitted by water and alimentary. How does it happen? Including possible infection by contact-household way.
Infection often occurs when using household items. And also when using utensils. The virus can enter public water. The food route of infection is also noted.
In the food route of infection, infection occurs by eating contaminated vegetables and fruits. Including infection occurs when using shellfish that live in a reservoir. Contact-household transmission is observed in the following cases:
- mass infection in children's groups;
- violation of the sanitary and hygienic regime in collectives.
The following trend is also observed. For example, infection of workers in the food unit. Food workers become infected in the following cases:
- employees of preschool catering units;
- school staff;
- employees of medical institutions;
- resort staff.
Including the hepatitis A virus is transmitted among drug addicts and homosexuals. That is, the parenteral route of infection transmission is meant. And, of course, sexual transmission.
Symptoms
The incubation period for hepatitis A virus is three or four weeks. Including the change of periods. Periods before the onset of jaundice alternate with periods of onset of jaundice. The period before the onset of jaundice is characterized by the following clinical signs:
- increase in body temperature;
- dyspeptic phenomena;
- vegetative manifestations.
The period of fever is associated with the development of intoxication. Intoxication is also accompanied by certain symptoms:
- weakness;
- myalgia;
- headache;
- dry cough;
- rhinitis.
Dyspepsia is accompanied by certain symptoms. Signs of dyspeptic phenomena are expressed as follows:
- nausea;
- loss of appetite;
- belching.
With dyspepsia, there is practically no intoxication of the body. Including moderate pain in the right hypochondrium may be noted. Defecation disorder may be observed. Defecation disorder is associated with the following phenomena:
- diarrhea;
- alternating constipation and.
The period before the onset of jaundice is characterized by general weakness. The patients are lethargic. They suffer from sleep disorders. Sometimes there is no period before jaundice.
Sometimes a period occurs almost immediately. During the period of jaundice, the bright symptoms subside. Usually improves general state sick. But the dyspepsia doesn't stop there. Jaundice develops gradually:
- first dark urine;
- yellowish tint of the sclera;
- then the skin turns yellow.
The severe course of Botkin's disease develops in the form of a hemorrhagic syndrome. Hemorrhagic syndrome is characterized as follows:
- hemorrhages;
- nosebleeds.
Symptoms of the disease is an enlarged liver. In some cases, there is an increase in the spleen. There is bradycardia, decreased blood pressure. With viral hepatitis A, there is practically no chronic stage of the disease.
During the period of convalescence, there are no signs of the disease. There is a decrease in the period of intoxication, normalization of the size of the liver. Moreover, these phenomena can persist for a long time.
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Diagnostics
Diagnosis includes history. The anamnesis is aimed at studying clinical picture, as well as clinical signs. Pay attention to the patient's condition possible reasons this state.
Laboratory diagnostics has great importance. In the general analysis of blood, a decrease in the concentration of leukocytes is observed. Including characteristic lymphocytosis, increased erythrocyte sedimentation rate. At biochemical analysis the following picture is noted:
- a sharp increase in aminotransferases;
- bilirubinemia;
- a decrease in albumin.
In the diagnosis of Botkin's disease, the use of serological research methods is appropriate. These include antibody detection. However, the following trend is observed:
- in the icteric period - an increase in immunoglobulin M;
- in the convalescent period - an increase in immunoglobulin G.
The method of PCR diagnostics is also used. It is based on the detection of the virus in the blood. Since the disease is accompanied by an increase in the liver and spleen, the use of ultrasound diagnostics is appropriate.
Ultrasound diagnostics allows you to determine damage to the liver. Often there is necrosis of liver cells. Diagnosis of the disease is also based on the advice of specialists. These specialists are a therapist and a gastroenterologist. Including in connection with the viral origin of the disease, it is appropriate to consult an infectious disease specialist.
Prevention
In order to prevent the development of Botkin's disease, it is necessary to adhere to certain measures. This reduces the risk of developing the disease. These activities are:
- high-quality purification of drinking water sources;
- control over the discharge of wastewater;
- sanitary and hygienic measures.
Sanitary and hygienic measures include requirements for the regime at enterprises Catering. Any violation of the sanitary regime leads to mass infection of people. The same measures must be applied to the catering departments of children's and medical institutions.
We also need epidemiological control. Epidemiological control is carried out as follows:
- food production and storage;
- food transportation.
If there are cases of outbreaks of the epidemic, then it is advisable to declare a quarantine. This measure helps to prevent further spread of the infection. Patients are isolated from society for two weeks.
It is possible to admit patients to employment only after a period of recovery. If there are cases of direct contact with sick people, then observation is carried out for more than one month. It is advisable to disinfect the foci of infection.
Active vaccination is widely used for preventive purposes. Active vaccination is recommended for children from one year of age. As well as adults who move to an area at high risk of infection.
Prevention of Botkin's disease is also aimed at clinical examination. Clinical examination helps to prevent complications and identify the disease. You can also prevent the disease by:
- sexual hygiene;
- introduction of a healthy lifestyle;
- exclusion of drug addiction;
- food at home.
Treatment
The treatment process is not always aimed at hospitalization for Botkin's disease. The disease can be treated on an outpatient basis. Only in severe cases indicated treatment with hospitalization.
When a period of intoxication is traced, patients are prescribed bed rest. Diet No. 5 is widely used. Vitamin therapy is also used. Food should be fractional.
Some products need to be excluded. Mostly exclude the following meals:
- fatty food;
- products that stimulate the production of bile.
Preference is given to dairy and vegetable components of the diet. In particular, alcoholic beverages are excluded. Since alcohol only worsens the disease. Promotes intoxication.
In order to reduce the syndrome of intoxication, it is necessary to prescribe a plentiful drink. Transfusion of crystalline solutions is used. Lactulose preparations are used in the treatment.
Antispasmodics are also used in the treatment. In the presence of pain and prevention of cholestasis. Even in the presence of recovery, patients are under dispensary control. They are observed by a gastroenterologist for three or six months.
Pathology of the biliary tract can become a complication of the disease. In this case, the treatment process should be lengthened. Recovery from this pathology can be significantly delayed.
In adults
Botkin's disease in adults is observed at any age. In this case, the presence of adults in the focus of infection is important. Including food in various eateries can cause infection.
The disease affects both men and women equally. In older people, the disease may be more severe. Up to necrosis of liver cells. The risk of disease in adults increases in the following situations:
- Unhealthy Lifestyle;
- addiction;
- homosexuality;
- improper nutrition.
An unhealthy lifestyle leads to irreversible phenomena. The virus in combination with alcohol intoxication causes the following symptoms:
- increase in body temperature;
- intoxication syndrome;
- liver enlargement;
- jaundice;
- pain sensations;
- dyspepsia.
In adults, the disease is observed during employment in the departments of food nutrition. Employees Food Industry most susceptible to Botkin's disease. Especially if they neglect sanitary regimes.
In adults, the following trend is observed. People who have had Botkin's disease acquire immunity. That is, subsequently, hepatitis viruses bypass the person who has had this disease.
Adults with this disease are distinguished by the presence of a long prodromal period. The prodromal period in adults has the following symptomatic complexes:
- fever;
- dyspepsia;
- malaise;
- loss of appetite;
- pain in the right hypochondrium.
In turn, the icteric period of the disease develops as follows. In the icteric period, the following symptoms are noted:
- headache;
- insomnia;
- skin itching;
- irritability.
In children
Botkin's disease in children may be accompanied by a lack of symptoms. It is observed with sufficient frequency. In children, the disease does not develop into chronic stage. In young children, the virus is transmitted through contact with infected objects.
It is known that metabolic disorders in children contribute to developmental delays. Including lead to various pathologies. In the period before the development of jaundice in children, the following signs are observed:
- anorexia;
- nausea;
The most initial sign of the disease in children is headache, weakness. Including harbingers of the disease in children is a runny nose, cough. In young children, at the initial stage of the development of the disease, an increase in the spleen is noted.
The icteric period of the disease is characterized in children by yellowness in the whites of the eyes. Including yellowness of the oral cavity of sick children may be noted. In some cases, depending on the severity of the disease, there may be no acute symptoms.
How younger age child, the higher the likelihood of exacerbations in this disease. Therefore, timely treatment of Botkin's disease is required. Although most often it ends favorably.
Forecast
With Botkin's disease, in most cases, the prognosis is favorable. This is due to the stage of improvement of the patient's condition. Although there may be exacerbations in the severe course of the disease.
The prognosis is influenced by the presence of an exacerbation stage. This is associated with the development of severe damage to the liver and biliary tract. In this case, it is possible to delay the healing process.
The patient's lifestyle also influences the prognosis. The presence of addictions does not lead to favorable forecasts. The same can be said about drug addiction.
Exodus
With Botkin's disease, the outcome is often favorable. There may also be adverse outcomes. However, the manifestation of the chronic stage is not typical for Botkin's disease.
Recovery can take a long time. This is due to the presence of exacerbations. Especially in the icteric period. Although in some cases the icteric period may differ in the absence of acute symptoms.
Liver necrosis is the most dangerous outcome of the disease. In this case, there is a high risk lethal outcome. Much depends on the patient himself. That is, from observing their diet, diet, lifestyle correction.
Lifespan
With Botkin's disease, life expectancy does not decrease. However, there may be exceptions. The more the patient looks after himself, observing the principles of nutrition and the treatment process, the higher the likelihood of increasing life expectancy.
Life expectancy is influenced by the course of the disease in this disease. With a mild course of the disease, life expectancy does not decrease. Although non-compliance with the conditions of hospitalization in severe cases leads to irreversible processes.
Life expectancy increases if the patient follows the doctor's recommendations. Only a specialist will help the patient choose the right treatment. Self-medication in this case is excluded!
The prevalence of viral hepatitis is caused by free sexual behavior, drug addiction, environmental degradation and the quality of medical care.
Every year there are new forms of hepatitis that are difficult to treat and cause complications. To ensure proper treatment of the disease, it is necessary to determine its etiology, source of infection and stage of development.
There are two main forms of hepatitis - non-infectious and infectious.
Infectious viruses include A, B, C, E and D:
- Type A (epidemic hepatitis, Botkin's disease). It enters the body through the alimentary or oral-fecal route - along with contaminated food, dirty water. An acute form of the disease that causes liver failure called fulminant hepatitis.
- Type B is transmitted through bodily fluids and causes damage to liver cells indirectly. The immune system perceives the cells of the body as foreign elements and begins to destroy them. Resistant to boiling and can be stored in environment over a week. Undiagnosed hepatitis B flows into seronegative or chronic. It is diagnosed when the Australian antigen is detected in the blood. Vaccination is carried out to prevent infection.
- Type C. Most dangerous view hepatitis, to which strong immunity is not developed, re-infection is possible. There is no vaccine to prevent hepatitis C. The long incubation period complicates the diagnosis of the disease. Therefore, hepatitis of unspecified etiology, a latent or latent form of hepatitis C, is often diagnosed.
- Type E. Epidemic hepatitis, proceeds in a milder form than type A virus. It is transmitted by the fecal-oral and alimentary route. It is detected in regions where there is no normal water supply system.
- Type D. It develops only in combination with hepatitis B and is difficult to treat. In 20%, the delta virus provokes liver cancer.
- Herpetic hepatitis is present in the body in combination with the herpes virus and has a latent course. It manifests itself against the background of colds with a decrease in immunity. As a result of the disease, the mucous membranes are affected, intoxication of the body develops, and in about a third of cases the death of the patient occurs. The disease is determined by pronounced signs of the inflammatory process of the liver, acute pneumonia and encephalitis.
According to the form of occurrence, they are distinguished:
- biliary hepatitis or a secondary inflammatory process that occurs due to narrowing of the bile ducts;
- unverified hepatitis - unconfirmed by tests;
- parenteral hepatitis - B, C and D;
- persistent hepatitis - if the virus persists in the body for more than six months.
Persistent hepatitis occurs as a consequence of a toxic, viral, or autoimmune disease. The disease has no specific symptoms, but causes inflammation in the portal tracts of the liver. Persistent hepatitis does not provoke organ necrosis. To monitor development and successfully treat persistent hepatitis, liver samples should be taken twice a year.
According to the type of localization of the inflammatory process, parenchymal and interstitial hepatitis are distinguished. Parchenimatous forms of the disease affect the parchenyma (cells) of the liver, and instinctive - connective tissue, blood and lymphatic vessels.
noninfectious hepatitis
Allocate non-infectious forms of the disease:
- radiation hepatitis. It arises as a result of exposure to ionizing radiation and causes changes in liver tissues at the molecular level. As a result of such an impact, the cells of the organ are destroyed and cannot fully remove toxins from the body, the patient's metabolism is disturbed. A latent form of the disease is often observed when a person is exposed to low doses of radiation.
- Neonatal hepatitis or hepatitis of unspecified etiology. It develops in the neonatal period and is accompanied by damage to liver cells and jaundice. May result in liver failure.
- Allergic (drug) hepatitis. Occurs as a result of taking drugs that destroy the hepatic parchenyma.
- Fetal hepatitis. A congenital form that is transmitted to the fetus from a sick mother with jaundice during pregnancy.
- fatty hepatitis. It occurs as a result of diseases that cause fatty infiltration of the liver, diabetes mellitus can become the cause of the disease.
- Mechanical inflammatory process. The disease causes blockage of the gallbladder and its ducts, gallstones.
- Nutritional inflammatory process. The disease is associated with poisoning of the liver with poisons that entered the body with food.
- Alcoholic hepatitis. It develops as a result of damage to liver cells by alcoholic enzymes.
An accurate definition of the form of the disease makes it possible to prescribe competent treatment and predict the course of hepatitis.
With liver diseases, there may be pain or a feeling of heaviness in the right hypochondrium. The pains are constant during the day, aching, aggravated by physical exertion, bumpy driving, eating fats, spicy and fried foods, calm down at rest. Pain is usually accompanied by loss of appetite, belching bitterness, heartburn, nausea, and vomiting.
Complaints about the appearance of yellow skin are also characteristic of liver diseases. At first, patients or their relatives may notice yellowness of the sclera, then the skin. At the same time, you can notice the appearance of a dark color of urine, discoloration of feces.
Against the background of jaundice, especially prolonged, skin itching appears. This indicates an increase in the amount of bile components in the blood.
Patients with liver diseases very often have general complaints of weakness, lethargy, fatigue, decreased performance. There may be headaches, a tendency to faint. Often there are hemorrhages on the skin. Women may have menstrual irregularities, men - impotence.
When contacting a doctor, they almost always find an enlarged liver, sometimes the spleen..
To recognize liver diseases, at the first stage, a whole series of blood tests is carried out - a battery of liver tests. This is due to the fact that the functions of the liver are extremely diverse and it is impossible to identify their violations with the help of one or two tests.
All liver diseases are conditionally divided into two groups - diffuse diseases, when the entire mass of liver tissue is affected by the inflammatory process, for example, acute viral hepatitis; and focal process - tumors, cysts. The best method of distinguishing between these two groups of diseases is ultrasound (ultrasound), which is also used at the first stage of examination of patients. In the future, if necessary, may be assigned additional methods research.
Acute hepatitis
Acute hepatitis is a sudden onset inflammatory disease affecting the entire liver tissue (diffuse lesion). The main role in the occurrence of hepatitis is played by viruses: A, B, C, D, E and F. Hepatitis A is characterized by the route of transmission of infection through the mouth (food products contaminated with the virus, water). The course of the disease is relatively mild. There is no transition to a chronic form. The hepatitis B virus is transmitted parenterally (through the blood during drug injections, blood transfusions, sera). Contact (sexual) transmission is also possible. Often there are severe forms and a transition to chronic hepatitis is possible. The hepatitis C virus is also transmitted parenterally, sexual transmission is suspected. Erased, asymptomatic forms of the disease often develop. In a large percentage of cases, there is a transition to a chronic form. Virus D attaches itself to virus B and does not cause independent disease. Viruses E and F are actively studied, the first is transmitted through food and water, the second - parenterally. Whether these viruses cause chronic forms of hepatitis is not yet known.
Acute hepatitis can be caused by alcohol. Acute alcoholic hepatitis develops in people who abuse alcohol due to malnutrition. The immediate cause may be "alcoholic excess" - taking enough a large number alcohol for a short time.
Some drugs can cause liver damage, very similar in their manifestations to acute hepatitis: salicylates, tetracycline antibiotics, anticancer drugs. With increased sensitivity of the body, any medicine can cause liver damage.
Typical for acute viral hepatitis is the icteric form, in which certain periods are distinguished - preicteric, icteric and the period of recovery from the disease.
There are various variants of the preicteric period. There may be pronounced unmotivated weakness, increased fatigue. Often patients feel constant nausea, vomiting occurs periodically, there is practically no appetite. With a flu-like variant, the temperature rises, sore throats appear, and there may be a runny nose. The least common is the rheumatoid variant, when pain in the joints and muscles is disturbing.
Further, the patient or his relatives notice jaundice, which is growing rapidly. At this moment, there is also a darkening of the urine, discolored feces. There may be pain in the right hypochondrium. The liver, sometimes the spleen, increases, changes in a number of indicators of liver function are found in the blood. The general symptoms of the disease are reduced. The duration of jaundice is usually 2-3 weeks, in severe cases up to 2 months.
The final period can also take place in three versions. At the first, recovery gradually occurs - the main signs disappear, the altered laboratory parameters normalize, the virus disappears from the patient's blood. In the second variant, a “healthy” carriage of the virus develops. The third is unfavorable, characterized by a transition to a chronic form. The patient has a slight jaundice, an enlarged liver, altered indicators of functional liver damage for a long time.
Very often there are asymptomatic anicteric forms of acute hepatitis, when there is no severe jaundice or it is absent altogether. But when examining people who have been in contact with patients with hepatitis, it is possible to detect the presence of the virus in the blood, disturbed laboratory parameters. Such forms of acute hepatitis are dangerous in two ways - they also turn into chronic forms and can serve as a source of infection for other people.
There are two approaches to the tactics of treating acute hepatitis - more radical and more conservative. According to the first, no special treatment for acute hepatitis is required, there is no need for hospitalization of patients, dieting both in the acute period and after recovery.
With a more conservative approach, hospitalization of patients, diet is recommended (see the section on the treatment of diffuse liver diseases). Patients with alcoholic hepatitis should categorically completely abandon the use of alcohol. If drug-induced hepatitis is suspected, the drug that caused liver damage should be discontinued.
In mild forms of the disease, additional treatment is not carried out. In patients of moderate severity, an intravenous transfusion of 5% glucose, saline up to 1-1.5 l / day is prescribed. In patients with severe forms, this therapy becomes more active. Patients with very severe forms are treated in intensive care units and intensive care units.
It is extremely important to prevent acute hepatitis. Primary prevention of hepatitis A is the same as for acute intestinal infections - you must follow the usual hygiene rules. If contact with a patient with hepatitis is known, especially in children, immunoglobulin injections are used at a dose of 0.03-0.06 ml / kg intramuscularly. A vaccine against hepatitis A has been developed and is already being used.
Primary prevention of hepatitis B is the use of disposable syringes and systems for injection and intravenous administration of drugs, the use of condoms during sexual intercourse. Vaccinations are carried out with a vaccine against hepatitis B. The course of immunization consists of three injections. If there is a threat of infection of persons who have not received vaccinations, immunoglobulin is administered. To date, there is no sufficiently reliable vaccine against hepatitis C.
chronic hepatitis
Chronic hepatitis is a widespread (diffuse) inflammatory process in the liver that lasts more than 6 months. It can be a consequence of acute hepatitis or immediately develop as a chronic process. There are two main forms of chronic hepatitis - chronic persistent and chronic active hepatitis. These two types of hepatitis are more or less clearly distinguished clinically. However, it is almost absolutely necessary to try in each case of chronic hepatitis to identify its etiological factors, since this circumstance has a significant impact on the choice of therapy.
The main etiological factors of chronic hepatitis: hepatitis B, C and D viruses; alcohol, chemicals poisonous to the liver, drugs. At the same time, viruses as the cause of inflammation of the liver are recognized by all researchers. Other factors are questionable. In some cases, the cause cannot be established, then they speak of idiopathic forms of hepatitis. In order for the process in the liver to become long, chronic, there is not enough virus. In the body, the state of its protective, immune system, it starts to work incorrectly, cannot remove the virus from the body, which leads to a long course of the disease.
Chronic persistent hepatitis has a favorable prognosis, does not turn into cirrhosis of the liver. Patients complain of pain in the right hypochondrium, weakness, fatigue, sometimes mild jaundice. A constant symptom is a moderate enlargement of the liver. Laboratory parameters changed very little.
Active hepatitis is most often viral chronic hepatitis. Its course and outcomes are more severe than with persistent hepatitis. It can progress to cirrhosis of the liver. Patients are worried about a very strong weakness, reduced efficiency, many develop jaundice, itching, and hemorrhages appear on the skin. There are pains and a feeling of heaviness in the right hypochondrium, intolerance to spicy, fried and fatty foods. The liver is almost always enlarged, and in many patients the spleen is also enlarged. A violation of most functional liver laboratory tests is detected. Ultrasound indicates significant changes in the liver tissue, but the vessels of the liver do not change.
When examining a patient, it is very important to find out if there is a viral infection, which virus caused the development of hepatitis.
There are forms of active hepatitis, also severe, but the virus is not detected. Mostly young women get sick.
Approximately a quarter of patients with chronic hepatitis B and more than half of patients with hepatitis C have erased forms of the disease, when the clinical symptoms are not very pronounced, but the risk of complications is no less than in severe forms of the disease. Early detection of such patients, which is possible with timely access to a doctor, is very important for the necessary treatment.
Cirrhosis of the liver
Cirrhosis of the liver is the most severe diffuse liver disease. Along with an active inflammatory process in the liver tissue, there is a massive growth connective tissue. The strands of this tissue replace normal liver cells, constrict the vessels of the liver, which leads to impaired blood circulation not only in it, but also in all organs of the abdominal cavity. In the portal vein, blood pressure rises and fluid enters the abdominal cavity, ascites develops.
The most common causes of liver cirrhosis are active chronic viral hepatitis and alcohol abuse.
Patients with cirrhosis of the liver complain of weakness, malaise, increased fatigue, decreased performance, bad dream. Jaundice, hemorrhages on the skin, and itching appear periodically. Patients lose weight due to disorders of digestion and absorption. Often they notice the expansion of small blood vessels on the skin., reddening of the skin of the palms, men - breast enlargement. Disturbed by pain in the right hypochondrium, enlargement and bloating. The most dangerous complication of cirrhosis of the liver is bleeding from the dilated veins of the esophagus, sometimes so severe that it threatens life. The liver is either significantly enlarged or reduced in size.
Laboratory parameters are usually changed, there are typical signs of cirrhosis in the study of the liver using ultrasound, computed tomography.
Steatosis of the liver
Liver steatosis or fatty degeneration of the liver is an independent diffuse disease caused by the accumulation of fat in the liver cells.
The main causes of liver steatosis are alcohol abuse, diabetes mellitus in combination with obesity, obesity, certain diseases endocrine system, malnutrition (protein deficiency), chronic diseases digestive system with malabsorption syndrome.
Hepatic steatosis most often manifests only as an enlargement of the liver, which is detected incidentally during a doctor's examination or during an ultrasound examination. It is necessary to distinguish liver steatosis from such forms of its damage as chronic persistent hepatitis, Gilbert's disease.
Primary biliary cirrhosis of the liver
Primary biliary cirrhosis of the liver - special form liver disease, in which the inflammatory process first affects the smallest intrahepatic bile ducts, and only then spreads to the liver cells themselves, causing their damage, and then replacing them with connective tissue.
The causes of the disease are unknown. Mostly middle-aged women, from 35 to 60 years old, are ill.
early sign primary biliary cirrhosis of the liver - skin itching, first on the palms and soles, and then general. After a few months or even years, jaundice appears. Due to impaired bile secretion, the absorption of fat-soluble vitamins is reduced. Vitamin K deficiency is manifested by bruising, D - bone pain, A - night blindness, E - changes in the skin. The level of cholesterol in the blood rises. Over time, liver function suffers. Jaundice is almost constant, the liver and spleen are enlarged.
Treatment of primary biliary cirrhosis is a difficult task. It is carried out and supervised by a gastroenterologist. A radical approach is a liver transplant. Other treatments are aimed at reducing itching and replenishing vitamin deficiencies. In the diet, the amount of fat is reduced, vitamins A, D, E, C are prescribed. In order to reduce skin itching, cholestyramine, bilignin, and polyphepan are used. A temporary effect is given by the appointment of the antibiotic rifampicin.
Primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is a chronic disease of unknown cause, in which the inflammatory process affects the extrahepatic and then intrahepatic bile ducts. Gradually, these bile ducts narrow, making bile secretion into the intestine difficult, and jaundice develops. The progression of the disease eventually leads to biliary cirrhosis of the liver, a violation of its functions. Unlike primary sclerosing cholangitis, secondary cholangitis is also isolated, the causes of which are known. These are damage to the liver and biliary tract, cholelithiasis, anomalies of the bile ducts, as well as some diseases: cytomegalovirus infection, cancer of the bile ducts.
Most often men of young and middle age get sick. The main manifestations are pruritus, jaundice, fever, weakness. Often primary sclerosing cholangitis is combined with ulcerative colitis and Crohn's disease. The liver and spleen are usually enlarged. The course of the disease is long. There may be complications - the addition of a microbial infection, bile duct stones, 10-15% of patients develop tumors of the bile ducts.
An effective treatment for PSC is liver transplantation. Usually, the treatment is aimed at combating the stagnation of bile. Cholestyramine is used at 4-16 g / day, rifampicin - 0.15-0.45 g / day, phenobarbital - 0.1-0.3 g / day, ursodeoxycholic acid - 10-15 mg / kg / day. It is necessary to prescribe vitamins A, D, E, K.
Functional hyperbilirubinemia (Gilbert, Dubin-Johnson, Rotor syndromes)
We are talking about several diseases of the liver, in which there are no changes in its structure. Most often, due to congenital genetic defects in the liver of these people, the activity of enzymes involved in the metabolism of the bile pigment bilirubin is absent or reduced. Its amount in the blood increases, a little pronounced jaundice appears, sometimes it is accompanied by slight weakness, pain in the right hypochondrium. Naturally, patients and those around them are worried about this, sometimes for many years a diagnosis of chronic hepatitis is made.
Jaundice - even a small one - is a serious symptom. The diagnosis of innocent functional hyperbilirubinemia can be made after a thorough examination, including the most modern techniques.
Usually planned treatment is not required. But, if the increase in jaundice (this happens after colds) is accompanied by other signs, phenobarbital can be prescribed for a short period, which enhances the synthesis of the missing enzyme in the liver, and jaundice decreases.
Treatment of diffuse liver diseases
For the treatment of diffuse liver disease, certain dietary and lifestyle recommendations remain relevant.
- Bread - white and black yesterday's baking.
- First courses - vegetable, dairy soups, cabbage soup, borscht, vegetarian beetroot soups.
- Second courses - from low-fat cuts of beef, chicken, rabbit, fish, boiled or in the form steam cutlets, rolls, meatballs, as well as beef stroganoff or boiled meat stew.
- Vegetable dishes and side dishes - from vegetables in any form, except for fried ones.
- Dishes from cereals and pasta - cereals, casseroles with the addition of cottage cheese, raisins, dried apricots.
- Dairy products - milk, kefir, curdled milk, cottage cheese; cream and sour cream limited.
- Fats - limited butter, vegetable oils.
- Egg dishes - eggs no more than 1 per day in dishes, protein omelet.
- Sweet dishes - fresh fruits, compotes, jelly, honey.
- Snacks - boiled fish, soaked herring, limited, mild cheese, vinaigrettes, vegetable salads with vegetable oil.
- Drinks - weak tea and weak coffee with milk, infusions of wild rose and currant.
Forbidden:
Very cold and very hot food and drinks, meat and fish and especially mushroom broths, fatty meats and fish, smoked meats, spices, fatty foods, pancakes, pancakes, cocoa, chocolate. Ice cream, mushrooms, sour apples, alcohol.
Patients should reduce their physical exercise, if possible, do not perform hard physical work, in the middle of the day a short rest is useful. During the period of exacerbation of the disease, the doctor prescribes bed or semi-bed rest.
In case of any liver diseases, and especially with its alcoholic lesions, it is necessary once and for all to abandon the use of any alcoholic beverages. In toxic and medicinal forms of liver disease, it is necessary to stop contact with the toxic agent, to cancel the “guilty” drug.
Currently, two antiviral agents are mainly used for viral liver damage - alpha-interferon and ribavirin. Treatment is prescribed and monitored by a physician. It should be long enough - up to 6-12 months. The simplest treatment regimen for alpha-interferon involves its administration in doses of 3 million units. intramuscularly 3 times a week, or the same dose in combination with ribavirin 1200 mg daily. If after 3 months there is no positive effect, treatment can be stopped, with a positive effect it is continued up to 12 months.
Active hepatitis of a non-viral nature with significantly pronounced manifestations is treated with a combination of prednisolone and azathioprine, which suppress the inflammatory process in the liver.
There are a number medicines which are called hepatotropic. Regardless of the mechanism of action, they improve the vital activity of liver cells in the broadest sense of the word. The effectiveness of not all of these drugs has been strictly proven, but they are used in practice, based on the clinical experience of doctors.
The main group of these substances is called hepatoprotectors or membrane protectors (protective), since the point of their application is the membranes (shells) of liver cells (hepatocytes). The main means here are Essentiale, legalon, multivitamin complexes, ursodeoxycholic acid. Most often, hepatoprotectors are used in patients with persistent hepatitis, with moderate inflammation in patients with active hepatitis and cirrhosis of the liver, with fatty degeneration of the liver. It is very important that these funds should not be used for very long, multi-month courses. It is advisable to change the drugs, the courses of treatment for each of them should last 3-4 weeks.
In the last decade, with extremely severe liver diseases, liver transplantation has been used - transplantation. Transplantation is especially effective in chronic viral hepatitis C.
Hemochromatosis
Hemochromatosis is a hereditary metabolic disease. Patients have a genetic defect in the enzyme systems that regulate iron absorption in the intestine. Normally, there are mechanisms that limit excessive absorption of iron. With hemochromatosis, they are disturbed, excess iron accumulates in the internal organs, in particular, in the liver, pancreas, skin, and heart. In the liver, this leads to the gradual development of cirrhosis.
In the initial stage, hemochromatosis resembles chronic hepatitis in the clinic. Patients are concerned about pain in the liver, poor appetite, weakness. The liver is enlarged. As the disease develops, other typical signs of hemochromatosis appear - dark skin color, it becomes bronze; blood sugar rises, heart rhythm is disturbed. The appearance of these two signs - changes in skin color and manifestations of diabetes mellitus - suggest hemochromatosis. You can verify the correctness of this diagnosis after a special desferal test and examination by a specialist gastroenterologist.
Treatment of hemochromatosis is, first of all, in limiting the amount of foods containing iron - meat, apples, pomegranates. Courses are treated with a special medicine deferoxamine (desferal). The drug binds iron and removes it from the body. Treatment of manifestations of cirrhosis of the liver, diabetes mellitus, and cardiac arrhythmias is also carried out.
Hepatolenticular degeneration
Hepatolenticular degeneration (Wilson's disease) is a rare disease. The production of an enzyme in the liver that regulates copper metabolism is disrupted. It accumulates in the internal organs in a greater than normal amount.
In childhood and adolescence, the disease begins as acute viral hepatitis, followed by a transition to chronic hepatitis. Only renal disorders are unusual. Further symptoms appear nervous system- trembling of the upper and lower extremities, increased muscle tone, gait is upset, there are difficulties in writing. Enlarged liver and spleen.
In the diet of patients, foods rich in copper are limited - lamb, chicken, fish, mushrooms, sorrel, radishes, legumes, nuts, prunes.
Of the drugs, drugs are used that bind and remove copper from the body - unitiol courses, as well as D-penicillamine (cuprenil).
Amyloidosis
Amyloidosis is a disease in which in the internal organs, most often in the kidneys, liver, spleen, an altered protein alien to this organism is deposited.
There are primary (of unknown cause) and secondary amyloidosis. Primary amyloidosis refers to hereditary diseases, but very rare, with the transmission of predisposition to it through several generations. Primary amyloidosis occurs in Armenians, Jews, and in general immigrants from the Mediterranean. Secondary amyloidosis is the second disease. It complicates chronic purulent infections (osteomyelitis, bronchiectasis), tuberculosis, connective tissue diseases and tumors of the blood system.
With amyloidosis, the liver and spleen increase, a lot of protein is excreted in the urine, and edema appears in the later stages. Recognition of amyloidosis is carried out with the help of special studies.
In secondary amyloidosis, vigorous treatment of the underlying disease is carried out, including surgical removal of purulent foci.
The treatment of amyloidosis itself is being developed, using colchicine, unithiol, melphalan. The doctor makes the final decision.
Tumors of the liver
There are benign and malignant tumors of the liver.
Common to benign tumors are the practical absence of any patient complaints, changes in laboratory parameters. AT last years benign tumors began to be detected more often, mainly due to the widespread use of ultrasound.
Of benign tumors, hemangiomas (tumors from blood vessels) are often found. Usually patients do not complain about anything, the doctor may detect an increase in the size of the liver during examination. Hemangiomas are recognized with the help of ultrasound and especially computed tomography. With the help of ultrasound, it is necessary to monitor the growth of the tumor, conduct a study 1-2 times a year. Very slow growth with a high probability speaks in favor of a benign tumor.
Surgery hemangiomas and other benign tumors are carried out only with large tumor sizes and signs of compression of neighboring organs.
Malignant tumors are liver cancer (see diagram). There are primary liver cancer, liver cancer on the background of cirrhosis and liver metastases in tumors of other organs.
Primary liver cancer develops from liver cells, is largely associated with the presence of hepatitis B and C viruses, more than 2/3 of patients develop against the background of liver cirrhosis. Signs of liver cancer and the results of laboratory and instrumental studies in all variants are almost the same. Diagnostic value has an increase in the concentration in the blood of a special protein alpha-fetoprotein by 8 times or more compared to the norm. Of particular importance for the recognition of liver cancer are research methods that allow you to "examine" it - ultrasound, computed tomography, laparoscopy
Surgical treatment of primary liver cancer. According to some experts, one of the ways to prevent cancer is to be vaccinated against hepatitis B, and in the future against hepatitis C.
Liver cysts
Liver cysts are cavities in the liver filled with fluid.
Signs of a liver abscess are a fairly high prolonged temperature, pain in the right hypochondrium, an enlarged liver and its soreness when examined by a doctor. A blood test indicates an inflammatory process.
The final diagnosis is established using ultrasound and computed tomography, as well as special studies that allow you to determine whether it is a bacterial or protozoal abscess.
Bacterial abscesses are treated with antibiotics, and they are administered not only by injection, but also into the cavity of the abscess itself. Under the control of ultrasound, pus is removed from the abscess. For the treatment of amoebic abscesses, emetine, metronidazole, chloroquine are used.
With echinococcosis and amoebiasis, volumetric formations are formed in the liver. Schistosomiasis leads to fibrosis of the liver parenchyma. Infection with malarial plasmodium, trypanosomes, schistosomes leads to a significant increase in the size of the liver, inflammatory process, liver failure .
Hydatid echinococcosis. In the first years after infection, echinococcosis may not manifest itself in any way. The first clinical manifestations usually occur when the cyst reaches a large size - pain in the right side, nausea and vomiting, weakness, emaciation, chronic diarrhea, allergic skin rashes, brittle hair. The size of the liver increases, with a superficial location of the cyst, it can even be palpated. Jaundice develops only when the cyst compresses the ducts of the liver. A breakthrough of a cystic formation into the abdominal or chest cavity is possible, accompanied by severe pain, anaphylactic shock (a reaction to the absorption of the contents of the cyst). Suppuration of the contents of the cyst is accompanied by soreness of the liver, fever, deterioration of the general condition.
The main manifestations of ascariasis are cholangitis, cholestasis, liver abscesses. There are no specific symptoms of ascariasis. The diagnosis of ascariasis of the liver is established on the basis of the detection of ascaris and their eggs in vomit, feces; it is also possible to visualize helminths with ultrasound, CT of the liver.
Opisthorchiasis of the liver
Amoebiasis of the liver
The disease is common in tropical countries. It is characterized by a predominant lesion of the large intestine, dissemination of the pathogen into parenchymal organs. Amoeba cysts enter the human body with contaminated water, fruits and vegetables, greens.
Amoebas cause ulcers in the intestines, through which pathogens enter the bloodstream and then to the liver, leading to the formation of liver abscesses in about 10% of cases. The peculiarity of amoebic abscesses is that they do not have a capsule, contain molten tissues, coffee-colored pus. The condition of patients is usually very serious, the liver is enlarged and painful. The skin is icteric-gray, dry.
In the diagnosis of a liver abscess, ultrasound of the hepatobiliary system, liver scintigraphy, CT scan, puncture liver biopsy (to detect amoebae) are used. Treatment of amoebiasis is usually complex: anti-amoebic, antibacterial and detoxifying drugs. Surgical treatment is carried out with the ineffectiveness of conservative measures, the occurrence of complications.