Acute viral hepatitis
Acute viral hepatitis – group of the infectious damages of a liver having a virus etiology, which are shown symptoms of a liver failure and intoxication. Jaundice, increase in a liver, pain in the right podreberye, the raised bleeding, ascites, neurologic violations, fatigue are characteristic of this pathology. For diagnostics use serological and molecular and genetic blood tests (IFA, PTsR), ultrasonography of a liver and a gall bladder, MRT of a liver and biliary tract, liver OFEKT, a punktsionny biopsy. Treatment is conservative: diet, antiviral medicines and gepatoprotektor, refusal of addictions.
Acute viral hepatitis
The acute viral hepatitises having a parenteral way of transfer (In, With, D), are the most serious infectious pathology in Russia. Annually thousands of new cases are registered, and high extent of synchronization of process and an invalidization leads to search of new techniques of diagnostics and treatment of this pathology. The main problem of acute viral hepatitises is that the patient is most infectious in a preicteric stage when there are practically no symptoms yet.
To the acute viral hepatitises which are transmitted in the fecal and oral way (And, E, F), children of preschool age and persons of working-age are most susceptible. Seasonality and frequency is inherent in this group of acute hepatitises. To hepatitises A, E and F resistant and lifelong immunity is formed. To catch acute viral hepatitises B, C, D, G, SAN, TTV is possible in various ways: parenteral, sexual, vertical (to a fruit during pregnancy), contact and household. All age categories are subject to infection with these forms of pathology, during a disease there is no seasonality and frequency. Immunity is also formed lifelong. Acute viral hepatitis leads to recovery or passes into a chronic form within three months.
Reasons of acute viral hepatitis
Acute viral hepatitises are caused by the types of viruses (HAV, HBV, HCV, HDV, HEV, HFV, HGV, HTTV, HSANV) or their combination. Causative agents of hepatitises B and TTV contain in the basis deoxyribonucleic acid, the others – ribonucleic acid. Viruses with an enteralny way of transfer (And, E) are least sensitive to influence of aggressive factors of the environment, and the virus of hepatitis B is most persistent – it maintains even long boiling (within more than 10 minutes).
The viruses having a fecal and oral way of transfer (And, E, F), at hit in an organism migrate at first in intestines, then in a liver where begin to breed, with bile current getting into intestines again. Presence of virus bodies at blood activates immunity owing to what the antibodies stopping replication of a virus begin to be produced. This group of acute viral hepatitises differs in the adequate answer of immunity to an infection thanks to what they have the favorable forecast and good sensitivity to treatment.
Pathogenesis of acute viral hepatitises with a parenteral way of transfer more difficult. Replication of viruses in a liver causes activation of the autoimmune processes having the damaging effect on a liver with gradual transition of a disease to a chronic form. The course of acute viral hepatitises B, C, D, F, G, SAN, TTV usually heavy, fulminantny (lightning) forms often meet, especially at infection of pregnant women in the last trimester.
To infection with hepatitises A, E, F contributes non-compliance with hygienic actions; parenteral forms of acute viral hepatitises – chaotic sex life, transfusion of not enough surveyed and nekarantinizirovanny medicines of blood, use of injection drugs, visit manicure and a tattoo salons, dental clinics with doubtful reputation, sharing of means of hygiene (especially razors).
Acute viral hepatitises classify by a number of parameters:
- On an etiology: hepatitis A, B, C, D, E, F, G, SAN, TTV, unspecified etiology.
- On a current: a subclinical form, with a typical clinical picture, the erased form, bezzheltushny and holestatichesky.
- On weight: easy current, average weight, heavy and fulminantny (malignant) current.
Symptoms of acute viral hepatitis
During a disease differentiate five periods: incubatory, preicteric, heat period, post-icteric and period of a convalescence. Besides, the clinical picture can differ depending on concrete type of a virus, severity of pathological process, a disease form.
During the incubatory period there is an active reproduction of viruses, at the same time there are no clinical manifestations. The first clinical symptoms correspond to the beginning of the preicteric period during which distinguish several syndromes: catarrhal (pharynx hyperaemia, temperature increase, a fever, cold) – at hepatitis A, E; dyspepsia – at hepatitis A, E, TTV; astenovegetativny – at all types of hepatitises; artralgicheskiya (joint pains, rash around them) – at hepatitises B, D, sometimes With; hemorrhagic (petekhiya on skin, hemorrhages, bleedings from a nose) and abdominal (belly-aches, tension of a forward belly wall) – it is very rare at hepatitis B. By the end of this period the liver increases, becomes dense, urine darkens, and the kcal becomes colourless.
During the icteric period the ikterichnost of skin and mucous gradually accrues within 3-5 days, about 10 days remain and then gradually decreases. The liver and a spleen increase in sizes. Intoxication phenomena with development of jaundice gradually decrease. At height of a heat of symptoms emergence of a skin itch is possible. The icteric period lasts about two weeks, its maximum duration – three months. The post-icteric period is characterized by gradual disappearance of jaundice, but enzymatic activity remains raised. The period of a convalescence can last before half a year, during this time there is a gradual normalization of all indicators.
Above the typical clinical picture of acute viral hepatitis is described. The subclinical form of a disease has no obvious symptomatology, usually this diagnosis is exposed to contact persons at increase in activity of enzymes and positive serological tests. The Bezzheltushny form is characterized by lack of changes of coloring of skin, urine and a chair. Activity of enzymes is increased several times, however bilirubin level considerably does not grow; the liver is increased. The erased form is shown by short-term coloring of skin and change of color of urine and a calla (within no more than 3 days), insignificant increase in a liver and level of bilirubin. The Holestatichesky form usually has the course of average weight, jaundice very intensive and remains from one and a half to four months, is followed by a severe itch. Urine very dark, kcal completely becomes colourless. Figures of bilirubin increase considerably, hyperactivity of the indicators specifying on (ShchF, cholesterol, an aldomanhole).
At acute viral hepatitis A the incubatory period proceeds 10-45 days. The preicteric period lasts about a week, is shown by catarrhal symptoms, dyspepsia, increased fatigue. As soon as the heat period (jaundice develops) begins, the intoksikatsionny phenomena considerably decrease, the health improves. Jaundice on average remains no more than a week or two. Hepatitis A seldom proceeds in a severe form, a thicket in easy or medium-weight. Virus infection carrier state and transition to a chronic form are not characteristic of hepatitis A.
At acute viral hepatitis in the period of an incubation much longer – from 45 to 180 days. The disease develops gradually, till the period of a heat of the patient joint and stomach pains disturb. On average within two weeks jaundice develops, on this background the condition of the patient considerably worsens. Icteric coloring of skin and mucous sticks to not less than a month. The course of acute viral hepatitis In a thicket heavy. Formation of virus infection carrier state is characteristic of this disease, transition to a chronic form at 1/10 patients is possible. In the future cirrhosis, a gepatotsellyulyarny carcinoma can be found in such patients.
The incubatory period at acute viral hepatitis C makes from 15 days to three months. The preicteric period which is usually erased can be characterized by increased fatigue, dyspepsia, belly-aches and joints. The beginning of a disease more often sharp, at the same time jaundice and signs of an intoksikatsionny syndrome are expressed poorly. The easy or medium-weight current without the expressed clinical symptomatology is inherent in acute viral hepatitis C. Virus infection carrier state meets rather often. Pathology practically in 70% of cases passes into a chronic form and comes to an end with cirrhosis, formation of a gepatokartsinoma.
Hepatitis D can proceed in two forms: koinfektion (simultaneous infection with viral hepatitis B and D) or superinfections (infection with hepatitis D of the patient who already have viral hepatitis B or being the virus carrier). The incubatory period of one and a half months before half a year is characteristic of a koinfektion. The onset of the illness is sharp, the clinical picture proceeds with the preicteric and icteric periods. Recovery takes a long time, virus infection carrier state and a chronic form of a disease are formed at the tenth part of patients. In the presence of a superinfection the incubation passes quickly (in 15-50 days), the current very heavy, wavy, often leads to a lethal outcome. At the survived patients the chronic form with a malignization develops more than in 90% of cases.
The period of replication (incubation) of viruses at acute viral hepatitis E lasts from ten days to one and a half months. It is characterized by the sharp beginning, in the preicteric period the artralgichesky syndrome and belly-aches prevail in a clinical picture. The disease proceeds usually benign, jaundice is not followed by the expressed intoxication. Viral hepatitis E most often leads to development of fulminantny forms of a disease in pregnant women if infection occurred in the last trimester of pregnancy. Virus infection carrier state does not develop, does not pass into a chronic form.
Diagnosis of acute viral hepatitis
Consultation of the gastroenterologist will allow to define previously a clinical form, severity and the period of acute viral hepatitis. For establishment of an exact etiologichesky form of acute viral hepatitis special laboratory tests are appointed. For this purpose make determination of level of antibodies (IgM, IgG) in blood by means of IFA, virus DNA and RNA in biological liquids by PTsR method. Thus reveal the hepatitises A, B, C, D, E. Specific diagnosis of other hepatitises at the moment only takes root in practical laboratories.
Nonspecific diagnostics allows to define degree of activity and weight of virus damage of a liver. For this purpose carry out hepatic tests in which determine the level of bilirubin and its fractions, a prothrombin, fibrinogen, nuclear heating plant, ALT, ShchF, anti-trypsin and aldomanholes. In the analysis of urine increase in level of direct bilirubin, decrease in an urobilin is registered. In Calais the level of a sterkobilin is considerably reduced. Additional data provide ultrasonography of a liver and a gall bladder, MRT of a liver and biliary tract for establishment of the exact diagnosis and severity of process, liver OFEKT, a punktsionny biopsy of a liver.
Treatment and prevention of acute viral hepatitis
All patients with acute viral hepatitis (except hepatitis A benign) demand hospitalization in an infectious hospital. Basic therapy includes rational physical activities, observance of a diet No. 5 or 5a, the therapy corresponding to disease severity.
From medicamentous means appoint holekinetik and spazmolitik, polyvitamins, dezintoksikatsionny means, inhibitors of proteases, hormonal and antibacterial means desensibilizing medicines and gepatoprotektor. At the hepatitises B, C and D use antiviral means and interferona.
Prevention of acute viral hepatitis can be nonspecific (directed to the prevention of infection) – control of a sanitary condition of food, water, observance of the sanitary and anti-epidemic mode, timely identification and isolation of patients with acute viral hepatitis. Specific prevention consists in vaccination of the population from risk groups.
The forecast at hepatitises A, E favorable. Hepatitises with parenteral ways of transfer often pass into a chronic form, patients have to be observed in office of gastroenterology or hepatology for a long time. Acute viral hepatitises can lead to a lethal outcome.