Acute hepatitis – the polietiologichny, arisen sharply, anatomic and functional damage of a liver. It is shown by an asthenic syndrome; change of coloring of skin, mucous membranes, chair and urine; dispepsichesky phenomena; hemorrhagic syndrome; gepatosplenomegaliya, etc. Diagnostics includes the list laboratory (hepatic tests, serological reactions), tool (ultrasonography, KT, MPT), morphological (a punktsionny biopsy with a research of bioptat) researches. Treatment is conservative: a dietotherapy, specific etiologichesky therapy, desintoxication and antihistaminic medicines, an exception of the damaging factors (toxins, drugs, allergens, etc.).
The acute hepatitis has an infectious, alcoholic or medicinal etiology in 90% of cases, septic, toxic and other types of hepatitises fall on other 10%. Among acute viral hepatitises about a half are presented by hepatitis B, less than 40% - hepatitis A, other forms of viral hepatitises are diagnosed no more than for the tenth part of patients. In recent years growth of incidence of medicinal and alcoholic hepatitises is noted though there are no exact data on their prevalence in Russia. Gastroenterologists note that at young people the virus etiology of hepatitises, at elderly – toxic, alcoholic and dosage forms meets more often.
The lethality among young people of healthy patients usually does not exceed before 0,1%; with age mortality among the hospitalized patients increases in tens of times. It is connected not only with decrease in protective forces of an organism at elderly patients, but also with existence of the accompanying pathology (oncological diseases, diabetes, cardiovascular insufficiency, etc.). Pregnant women, patients with the heavy course of alcoholic hepatitis, with the combined viral hepatitises (have the most adverse forecast especially at infection with a hepatitis D virus).
Reasons of an acute hepatitis
The main etiologichesky agent of acute hepatitises – a specific viral infection (viruses of hepatitis A, B, C, D, E). Besides, can lead infection with causative agents of intestinal infections to formation of sharp pathology of a liver, enteroviruses. The acute hepatitis is often diagnosed for patients mononukleozy, sepsis, tropical infectious and parasitic diseases.
Abuse of alcohol is the reason of an acute hepatitis, the second for the importance. Also organism intoxication at poisoning can lead to this pathology industrial (FOS, trinitrotoluene) and usual poisons, medicines (MAO inhibitors, aminazine, antitubercular medicines, barbiturates, PASK, male sex hormones, antibacterial means, etc.), poisons of mushrooms. Sometimes the acute hepatitis arises against the background of a burn disease, toxicosis of pregnant women, radiation defeat, transfusion of incompatible blood etc.
Types of acute hepatitises
Acute hepatitises of a virus etiology are presented by diverse group of diseases. Acute viral hepatitis A has a fecal and oral way of transfer, the long incubatory period, severe and chronic forms of a disease are not characteristic of it. Viral hepatitis B is transmitted from the patient to the patient in the parenteral and contact way, differs in a long incubation of a virus, development of heavy and lightning options of damage of a liver, frequent virus infection carrier state, process synchronization. The causative agent of the hepatitis Delta is presented by the defective virus capable to reproduction only to combinations with a hepatitis B virus. The specified virus considerably worsens a current of an acute hepatitis In, increases the frequency of lightning and fulminantny forms of a disease. Acute viral hepatitis C has similar to hepatitis During, but has the increased process synchronization frequency, and sharp options of a disease proceed easier. Often it is found already at a stage of chronic viral hepatitis.
The acute hepatitis of an alcoholic etiology mainly arises after the period of long hard drinking. People with alcoholic dependence usually suppress this fact from doctors therefore all patients with clinic of an acute hepatitis are recommended to conduct an express research on ethanol at receipt to a hospital. Besides, there is a number of the clinical signs demonstrating long alcohol intake – expansion of superficial vessels of face skin, a ginekomastiya, a tremor of extremities and language, a hypertrophy of parotid salivary glands. Alcoholic hepatitis causes increase in activity of GTTF in serum of 80% of patients.
In pathogenesis of medicinal hepatitis the large role is played by not only a type of medicamentous medicine, but also the previous condition of a liver, treatment duration, a combination of several medicines. All medicines can render both direct hepatotoxic action (paracetamol), and mediated - connected with hypersensitivity of immediate type (medicines of a penicillinic row, sulfanylamide antibiotics), the slowed-down type (). It is known that women have medicinal hepatitises three times more often than men, but the reason of this phenomenon is still not found out. At the use of the medicines possessing hepatotoxic action it is recommended to control two times a month the ALT, nuclear Heating Plant levels, G-GTP and bilirubin.
Acute toxic hepatitis is formed as a result of influence of various poisons: FOS, pesticides and insecticides, connections with a phenolic ring and so forth. The first displays of toxic hepatitis are usually sudden and quickly accrue. If treatment is not begun in due time, the disease passes into a chronic form and comes to an end with cirrhosis.
Symptoms of an acute hepatitis
The clinic of acute hepatitises includes as the general, and signs, specific to each type of hepatitis. General symptoms: weakness and increased fatigue, loss of appetite, joint, muscles pains, right podreberye. Practically at all patients the gepatomegaliya, at a smaller part – a splenomegaliya is noted. Other symptoms of an acute hepatitis can vary depending on a disease etiology.
Allocate several clinical options of an acute hepatitis. The asymptomatic form is characterized by lack of any clinical signs. In biochemical analyses increase in levels not less than by 2,5 times for seven days in a row is noted. Asymptomatic forms usually come to light at inspection of the contingent, contact on hepatitis.
The typical form of an acute hepatitis can proceed in icteric and bezzheltushny option. The icteric form is shown subfebrilitety, pains in a liver, by ikterichny coloring of skin and mucous. Eventually in blood the level of direct bilirubin, in urine – an urobilina increases, and the level of a sterkobilin in Calais decreases. Substantial increase of temperature, sharp severe pains in a liver speak about the heavy course of a disease and a possibility of transition to a lightning form. The icteric period lasts about one and a half months. During this period there can be a symptomatology demonstrating development of an acute liver failure: increase of the phenomena of intoxication, the raised bleeding, strengthening of jaundice, consciousness oppression. The Bezzheltushny form differs in easier course of disease, lack of a considerable giperbilirubinemiya.
The Holestatichesky option of an acute hepatitis mainly develops at patients with pathology of a liver and biliary tract in the anamnesis, at elderly people. Patognomonichny signs are: the expressed skin itch, increase in activity of ShchF, the long period of jaundice and total absence of a sterkobilin in Calais.
The lightning option of an acute hepatitis is still described as a total necrosis of a liver. Practically always this form of hepatitis is formed at patients with a virus and medicinal acute hepatitis. No predictors capable to point to development of lightning option of an acute hepatitis, exist therefore it is in advance impossible to suspect this form of a disease. Tell reduction of a gepatomegaliya against the background of preservation of an ikterichnost of skin about transition of hepatitis to a lightning form, tachycardia, strengthening of bleeding, a sweet smell from a mouth, clinic of encephalopathy (a disorientation, day drowsiness in combination with sleeplessness, irritability).
The beginning of the period of a convalescence is marked by reduction of the phenomena of a gepatosplenomegaliya, disappearance of the main symptoms of a disease, improvement of laboratory indicators. In the period of a convalescence both the absolute recovery, and emergence of a recurrence of jaundice, transition of an acute hepatitis to a chronic form is possible.
Acute alcoholic hepatitis has a number of features of a clinical current. So, in a clinical picture the anorexia, nausea and vomiting wandering pains in the top half of a stomach prevail. Hepatic encephalopathy can develop even at an acute hepatitis of moderate severity, and expressiveness of encephalopathy often does not correspond to weight of hepatitis. The disease often is complicated by an acute liver failure. Development edematous a syndrome considerably worsens the forecast – in this case a lethality within a year after development of an acute hepatitis of nearly 100%.
Identification of a medicinal acute hepatitis is often complicated because in clinic symptoms of the main disease concerning which medicines turned out prevail and also because at a third of patients jaundice does not develop. The clinic of medicinal hepatitis differs in moderation of jaundice, rare emergence of pains in a liver, considerable enzymatic activity.
Diagnostics of an acute hepatitis
Consultation of the gastroenterologist is required for diagnosis of an acute hepatitis of any etiology. After collecting the anamnesis and survey of the patient for diagnostics biochemical tests of a liver, serological analyses have crucial importance. Ultrasonography of a liver and a gall bladder, MRT of a liver and biliary tract, MSKT of abdominal organs allow to visualize inflammatory changes in a liver, blood circulation violations, reveal . Authentically will help to confirm the diagnosis a punktsionny biopsy of a liver with a morphological research of bioptat (it is a research more often it is required at suspicion of acute alcoholic hepatitis).
For carrying out the differential diagnosis consultation of the endoscopist, ERHPG, a radio isotope stsintigrafiya of a liver can be required. It is necessary to differentiate acute holestatichesky hepatitis with tumors and stones of biliary tract. Other acute hepatitises differentiate with a sharp fatty liver at pregnancy. Significant increase in the sizes of a liver at acute alcoholic hepatitis can imitate a new growth (cancer of a liver or a benign tumor of a liver).
Treatment and forecast of an acute hepatitis
Patients in a serious condition need hospitalization in office of gastroenterology or infectious diseases hospital. The exception of an etiologichesky factor (toxins, medicines), a dietotherapy, restriction of physical activity is the cornerstone of therapy. To patients with an easy and medium-weight current of an acute hepatitis drug treatment is as much as possible limited (only vitamins, plentiful drink are appointed). At a heavy current dezintoksikatsionny and symptomatic therapy is carried out, gepatoprotektor are appointed. Treatment of lightning forms is carried out in the conditions of intensive care unit. Today efficiency and safety of use of antiviral, immunocorrective and glyukokortikosteroidny medicines at an acute hepatitis is not proved.
The forecast of the majority of kinds of an acute hepatitis favorable – at a timely initiation of treatment comes an absolute recovery. The forecast considerably worsens at development of a lightning form of an acute hepatitis, alcoholic genesis of a disease. A part of cases of an acute hepatitis passes into a chronic form that can come to an end with cirrhosis, sharp dystrophy of a liver, a sharp or chronic liver failure and lead to the death of the patient.
Prevention of acute hepatitises consists in observance of sanitary and anti-epidemic actions, rules of personal hygiene. It is necessary to observe safety measures during the work with poisons, to exclude uncontrolled reception of medicines, to carry out sanitary and educational work during collecting mushrooms.