Chronic viral hepatitis
Chronic viral hepatitis – group of the infectious damages of a liver proceeding with inflammatory dystrophic - proliferative changes of a parenchyma of body. As clinical displays of chronic viral hepatitises serve dispepsichesky, astenovegetativny and hemorrhagic syndromes, a resistant gepatosplenomegaliya, dysfunction of a liver. Diagnostics includes definition in serum of markers of hepatitises B, C, D, F and G; assessment of biochemical tests of a liver, ultrasonography of a liver, reogepatografiya, punktsionny biopsy of a liver, gepatostsintigrafiya. Treatment of chronic viral hepatitises conservative, including a diet, reception of eubiotik, enzymes, gepatoprotektor, antiviral medicines.
Chronic viral hepatitis
The non-uniform antroponozny diseases caused by hepatotrophic viruses understand etiologichesk as chronic viral hepatitises in gastroenterology (A, B, C, D, E, G), having a manifest current lasting over 6 months. Chronic viral hepatitises meet at young age more often and in the absence of adequate therapy lead to early development of cirrhosis, cancer of a liver and death of patients. Progressing of a disease accelerates at abuse of drugs, alcohol, simultaneous infection with several viruses of hepatitis or HIV.
Reasons of chronic viral hepatitis
Chronic hepatitises of an etiologicheska are closely connected with sharp forms of viral hepatitises B, the C, D, E, G which are especially proceeding in easy icteric, bezzheltushny or subclinical option and accepting long character.
Chronic viral hepatitis usually develops against the background of adverse factors – the wrong treatment of an acute hepatitis, an incomplete convalescence at the time of an extract, the burdened premorbidny background, alcoholic or narcotic intoxications, infection with other viruses (including hepatotrophic) etc.
As the leading pathogenetic mechanism at chronic viral hepatitis serves violation of interaction of immune cages with the hepatocytes containing a virus. At the same time deficiency of T-system, a depression of macrophages, weakening of system of an interferonogenez, lack of a specific antitelogenez concerning anti-genes of viruses is noted that finally breaks adequate recognition and elimination by immune system of anti-genes of viruses on the surface of hepatocytes.
Classification of chronic viral hepatitises
Taking into account an etiology distinguish chronic viral hepatitises B, C, D, G; combinations of B and D, In and With, etc., and also not verified chronic viral hepatitis (not clear etiology).
Depending on degree of activity of infectious process allocate chronic viral hepatitises with the minimum, poorly expressed, moderately expressed, expressed activity, fulminantny hepatitis with hepatic encephalopathy. The minimum degree of activity (a chronic persistention of viral hepatitis) develops at genetically caused weak immune answer when proportional oppression of all indicators of cellular immunity is noted (T-lymphocytes, T-supressorov, T-helperov, T-killers, etc.). The low, moderated and expressed activity of chronic viral hepatitis takes place at a sharp imbalance of immune regulation.
During chronic viral hepatitis distinguish stages:
- with absence of fibrosis;
- with existence of ill-defined periportalny fibrosis;
- with existence of moderate fibrosis with portoportalny septa;
- with existence of the expressed fibrosis with portotsentralny septa;
- with development of cirrhosis;
- with development of primary gepatotsellyulyarny carcinoma.
Chronic viral hepatitis can proceed with the leading cytolytic, holestatichesky, autoimmune syndrome. The cytolytic syndrome is characterized by intoxication, increase in activity , decrease in PTI, a disproteinemiya. At a holestatichesky syndrome as primary manifestations serve the skin itch, increase in activity of ShchF, GGTP, bilirubin. The autoimmune syndrome proceeds with the astenovegetativny phenomena, artralgiya, a disproteinemiya, a gipergammaglobulinemiya, increase in activity of ALAT, existence of various autoantitet.
Depending on the developing complications distinguish the chronic viral hepatitis burdened by hepatic encephalopathy edematous a syndrome, a hemorrhagic syndrome, bacterial complications (pneumonia, gut phlegmon, peritonitis, sepsis).
Symptoms of chronic viral hepatitis
The clinic of chronic viral hepatitis is defined by activity degree, a disease etiology, and expressiveness of symptomatology – the accompanying background and duration of defeat. As the most characteristic manifestations serve astenovegetativny, dispepsichesky and hemorrhagic syndromes, gepato-and a spenomegaliya. Astenovegetativny manifestations at chronic viral hepatitis are characterized by increased fatigue, weakness, emotional lability, irritability, aggression. Complaints to a sleep disorder, headache, perspiration are sometimes noted, subfebrilitt.
The phenomena of dyspepsia are connected both with violation of normal functioning of a liver, and with the frequent accompanying defeats of a biliarny path, 12-perstny gut and a pancreas therefore accompany the majority of cases of chronic viral hepatitis. The Dispepsichesky syndrome includes heavy feelings in epigastriya and a podreberye, a meteorizm, nausea, an eructation, intolerance of greasy food, deterioration in appetite, instability of a chair (tendency to a diarrhea). Jaundice is not a patognomonichny symptom of chronic viral hepatitis; in some cases the skler can be noted a subikterichnost. Obvious jaundice develops more often and accrues in process of development of cirrhosis and a liver failure.
In half of observations at patients with chronic viral hepatitis the hemorrhagic syndrome which is characterized by tendency to skin hemorrhages, nasal bleedings, petekhialny rashes is noted. Gemorragiya are caused by thrombocytopenia, violation of synthesis of factors of coagulability. At 70% of patients emergence of extra hepatic signs is noted: teleangiektaziya (vascular asterisks), a palmarny eritema, a kapillyarit (expansion of capillaries), the strengthened vascular drawing on a breast.
Mialgiya and artralgiya, peripheral polyneuropathy, , a ginekomastiya, decrease in a libido, damage of eyes and salivary glands belong to extra hepatic displays of chronic viral hepatitis. At the prevailing autoimmune syndrome can join nodular periarteriit, the cardiomyopathy, an anti-phospholipidic syndrome, dermatomiozit, , Bekhchet's disease, Takayasu's disease, autoimmune hepatitis, chronic glomerulonefrit, diabetes, etc.
At chronic viral hepatitis the gepatomegaliya is noted: the liver can act from under a costal arch on 0,5-8 cm; the upper bound to be defined perkutorno at the level of VI — the IV mezhreberiya. The consistence of a liver becomes plotnoelastichesky or dense, hypersensibility or morbidity at a palpation can be noted. At most of patients the splenomegaliya also comes to light. Expansion of veins of a gullet, gemorroidalny veins, development of ascites testify to neglect of chronic viral hepatitis and formation of cirrhosis.
Diagnosis of chronic viral hepatitis
The diagnosis of chronic viral hepatitis is established at is long flowing (over 6 months) the infectious process caused by viruses of hepatitis B, C, D, F, G; existence of a gepatosplenomegaliya, asthenic, dispepsichesky and hemorrhagic syndromes.
For the purpose of verification of a form of a disease definition of markers of viral hepatitises by the IFA method, detection of RNA of viruses by means of PTsR-diagnostics is carried out. From biochemical indicators of function of a liver the research Alat and ASAT, the alkaline phosphatase (AP), gamma (GGT), letsitinaminopeptidaz (PAWS), a serumal cholinesterase (HE), a laktatdegidrogenaza (LDG), bilirubin, cholesterol, etc., allowing to judge a liver parenchyma damage rate at chronic viral hepatitis is of the greatest interest. For the purpose of assessment of a condition of a hemostasis the koagulogramma research, determination of quantity of platelets is made.
Ultrasonography of a liver allows to see changes of a hepatic parenchyma (an inflammation, consolidation, a sklerozirovaniye and so forth). By means of a reogepatografiya information on a condition of intra hepatic haemo dynamics is studied. Carrying out a gepatostsintigrafiya is shown at symptoms of cirrhosis.
The biopsy of a liver and morphological research of a bioptat is carried out at the final stage of inspection for assessment of activity of chronic viral hepatitis.
Treatment of chronic viral hepatitis
In a stage of remission of chronic viral hepatitis it is necessary to adhere to a diet and the sparing mode, to conduct preventive courses of reception of polyvitamins, gepatoprotektor, bile-expelling means. The exacerbation of chronic viral hepatitis demands hospitalization.
The basis of basic therapy of chronic viral hepatitis is made by a dietary table No. 5; purpose of the medicines normalizing intestinal microflora (, , ); enzymes (festat, enzistat Pancreatinum); gepatoprotektor (inosine, karsit, geptrat, to the essentsiala, etc.). Reception of the infusions and broths possessing antiviral (a calendula, a St. John's Wort), spazmolitichesky and weak bile-expelling and action is expedient (, mint).
At a cytolytic syndrome intravenous infusions of proteinaceous medicines and freshly frozen plasma, carrying out a plasma exchange are necessary. Knocking over of a holestatichesky syndrome is carried out by means of adsorbents (absorbent carbon, to polifepa, ), medicines of nonsaturated fatty acids (, ). At an autoimmune syndrome immunodepressants, glucocorticoids are appointed, delagit, haemo sorption is carried out.
Etiotropny therapy of chronic viral hepatitis demands purpose of antiviral medicines: synthetic nucleosides (, ), interferon (, And), etc.
Forecast and prevention of chronic viral hepatitis
Patients with chronic viral hepatitis are on the lifelong dispensary account at the infectiologist-hepatologist. Chronic viral hepatitises get an adverse current at the burdened background: simultaneous infection with several viruses, abuse of alcohol, drug addiction, HIV infection. As an outcome of chronic viral hepatitises serves cirrhosis and cancer of a liver.
Prevention of synchronization of infectious process consists in identification of malosimptomny forms of viral hepatitis, performing adequate treatment and control of rekonvalestsenta. The patients who had viral hepatitises have to adhere to the diet recommended by the doctor and a way of life.