Hepatitis is a diffusion inflammation of hepatic fabric owing to toxic, infectious or autoimmune process. The general symptomatology – weight and pains in the right podreberye with irradiation under a right shoulder-blade, nausea, dryness and feeling of bitterness in a mouth, lack of appetite, an eructation. In hard cases – jaundice, loss of weight, rash on skin. The chronic shape, a hepatic coma, cirrhosis and cancer of a liver can be an outcome of hepatitis. Diagnosis of hepatitises includes a research of biochemical tests of blood, ultrasonography of a liver, a gepatokholetsistostsintiografiya, a punktsionny biopsy. Treatment is based on observance of a diet, reception of gepatoprotektor, carrying out desintoxication, specific etiotropny and pathogenetic therapy.
Hepatitis – an inflammatory disease of a liver. On character of a current distinguish acute and chronic hepatitises. Acute hepatitises proceed with the expressed symptomatology and have two options of an outcome: full treatment, or transition to a chronic form. The vast majority of hepatitises (90%) have an alcoholic, virus or medicinal etiology. Frequency of developing of hepatitis at different groups of persons differs depending on a form and a cause of illness.
As chronic recognize hepatitis which lasts more than half a year. Chronic process on a morphological picture represents the dystrophic changes in tissue of a liver of an inflammatory origin which are not affecting dolkovy structure of body. Initially chronic hepatitises originally proceed or without the expressed symptomatology, or with the minimum manifestations. The disease quite often is found at medical examinations and inspections concerning other pathologies. Develop at men more often, but to some specific hepatitises women have big tendency. Special attention is paid to a condition of a liver at the patients who transferred an acute hepatitis, and being carriers of the Australian anti-gene, and also at the persons who are abusing alcohol, or undergoing treatment by hepatotoxic medicines.
- because of development - virus, alcoholic, medicinal, autoimmune hepatitis, specific hepatitises (tubercular, opistorkhozny, ekhinokokkovy, etc.), hepatitises secondary (as complications of other pathologies), cryptogene hepatitis (not clear etiology);
- on a current (sharp, chronic);
- on clinical signs (icteric, bezzheltushny, subclinical forms).
Viral hepatitises happen sharp (viruses of hepatitis A and B) and chronic (hepatitis B, D, C). Also hepatitis can be caused by viral and virus-like infections, not specific to a liver, – , a cytomegalovirus, herpes, yellow fever. Autoimmune hepatitises differ on types depending on targets of antibodies (type 1, type 2, type 3).
The acute hepatitis develops or owing to direct damage of a liver hepatotoxic factors or a viral infection, or owing to development of autoimmune reaction – development of antibodies to own body tissues. In both cases the acute inflammation develops in liver tissues, damage and destruction of hepatocytes, inflammatory hypostasis and decrease in functional activity of body. Insufficiency of zhelcherodny function of a liver is the prime cause of a bilirubinemiya and, as a result, jaundices. As in tissues of a liver there are no painful receptor zones, the pain syndrome is seldom expressed and connected with increase in a liver, an extension of its well innervated capsule and inflammatory processes in a gall bladder.
The chronic inflammation, as a rule, develops owing to the uncured or insufficiently healed acute hepatitis. Often bezzheltushny and asymptomatic forms of hepatitis do not come to light in time, and inflammatory process gains chronic character, there are centers of dystrophy and regeneration of hepatic fabric. Decrease in functional activity of a liver is aggravated. Quite often chronic hepatitis gradually passes into cirrhosis.
The current and symptomatology of hepatitis depends on extent of defeat of hepatic fabric. From same also disease severity depends. Easy forms of an acute hepatitis can proceed asymptomatically and, often, flow in a chronic form if the disease is not revealed in a random way at preventive inspection.
At heavier current the symptomatology can be expressed, quickly accrue to be combined with the general intoxication of an organism, fever, toxic defeat of bodies and systems.
Both for an acute hepatitis, and for an aggravation of a chronic form of a disease yellowness of integuments and a skler of a characteristic shafranny shade is usual, but the disease can proceed also without the expressed jaundice. However to find insignificant extent of yellowing a skler, and it is also possible to reveal yellowness mucous the top sky and at an easy form of hepatitis. Urine darkens, at the expressed violations of synthesis of bilious acids of kcal loses color, becomes whitish and clay.
Patients can note such symptoms as a skin itch, emergence on skin of red points – petekhiya, bradycardia, neurotic symptoms.
At a palpation the liver is moderately increased, slightly painful. Also increase in a spleen can be noted.
Chronic hepatitis is characterized by gradual development of the following clinical syndromes:
- astenovegetativny (weakness, increased fatigue, frustration of a dream, mental lability, headaches) – it is caused by organism intoxication in connection with the accruing liver failure;
- dispepsicheskiya (nausea, sometimes - the vomiting, a loss of appetite, a meteorizm, ponosa alternating with locks, an eructation bitterness, unpleasant smack in a mouth) it is connected with violations of digestion in connection with insufficiency of development by a liver of enzymes, necessary for digestion, and bilious acids);
- the pain syndrome (pain of the constant, aching character is localized in the right podreberye, amplifies at physical activities and after sharp violations of a diet) – can be absent or be expressed in moderate heavy feeling in an epigastriya;
- subfebrilitt (moderate temperature increase to 37,3 – 37,5 degrees can keep till some weeks);
- permanent reddening of palms (palmarny eritema), teleangiektaziya (vascular asterisks on skin) on a neck, a face, shoulders;
- hemorrhagic (petekhiya, tendency to formation of bruises and bruises, nasal, gemorroidalny, uterine bleedings) it is connected with decrease in coagulability of blood owing to insufficient synthesis of factors of coagulability in cells of a liver;
- jaundice (yellowing of integuments and mucous – as a result of increase in level of bilirubin in blood that is in turn connected with violation of its utilization in a liver);
- the gepatomegaliya – increase in a liver, can be combined with a splenomegaliya.
Diagnosis of hepatitises is performed on the basis of existence of symptomatology, data of fizikalny survey of the gastroenterologist or therapist, functional and laboratory researches.
Laboratory researches include: biochemical tests of a liver, definition of a bilirubinemiya, decrease of the activity of serumal enzymes, increase in level of gamma albumine, at decrease in content of albumine; also note decrease in indicators of maintenance of a prothrombin, factors of coagulability of VII and V, fibrinogen. Change of indicators of timolovy and sulemovy tests is observed.
When performing ultrasonography of abdominal organs note increase in a liver and change of its sound permeability and, besides, note increase in a spleen and, perhaps, expansion of a hollow vein. For diagnosis of hepatitis the reogepatografiya (a research of a hepatic blood-groove), a gepatokholetsistostsintiografiya (a radio isotope research of biliary tract), a punktsionny biopsy of a liver will also be informative.
Treatment of hepatitis
Treatment of an acute hepatitis
Treatment is surely carried out in a hospital. Besides:
- the diet No. 5A, semi-bed rest (registers at a heavy current – bed);
- at all forms of hepatitis alcohol and gepatotoksichny medicines is contraindicated;
- intensive dezintoksikatsionny infusional therapy is made to compensate this function of a liver;
- appoint gepatoprotektivny medicines (essentsialny phospholipids, , extract of a thistle spotty);
- appoint a daily high enema;
- make exchange correction – medicines of potassium, calcium and manganese, vitamin complexes.
Viral hepatitises treat in specialized offices of infectious diseases hospitals, toxic – in the offices specializing in poisonings. At infectious hepatitises make sanitation of the center of spread of an infection. Antiviral and immunomodulators are still insufficiently widely applied in therapy of sharp forms of hepatitises.
Good results on improvement of the general state at the expressed hypoxia are yielded by a kislorodoterapiya, an oksigenobaroterapiya. If there are symptoms of hemorrhagic diathesis, appoint vitamin K (Vikasolum) intravenously.
Treatment of chronic hepatitis
Also the medical dietotherapy is appointed sick chronic hepatitis (a diet No. 5A in a stage of an aggravation and a diet No. 5 out of an aggravation), the full refusal of alcohol intake, decrease in physical activities is necessary. In the period of an aggravation hospitalization in office of gastroenterology is necessary.
Pharmacological therapy includes basic therapy by medicines-gepatoprotektorami, purpose of the medicines normalizing digestive and exchange processes, biological medicines for correction of bacterial flora of intestines.
Gepatoprotektivny therapy is performed by the medicines promoting regeneration and protection of hepatic fabric (, essentsialny phospholipids, , potassium ), is appointed courses for 2-3 months with semi-annual breaks. Include in therapeutic courses polyvitaminic complexes, fermental medicines (Pancreatinum), a probiotics.
As dezintoksikatsionny measures apply infusion of 5% solution of glucose with vitamin C addition. For desintoxication of the intestinal environment appoint enterosorbents (absorbent carbon, a lignin hydrolytic, a mikrotselluloza).
Antiviral therapy is appointed during the diagnosing of viral hepatitises B, C, D. At treatment of autoimmune hepatitis apply corticosteroids and immunodepressants. Treatment is carried out at continuous monitoring of biochemical tests of blood (activity of transferases, blood bilirubin, functional tests).
Prevention and forecast
Primary prevention of viral hepatitises – observance of hygienic instructions, implementation of sanitary and epidemic measures, sanitary inspection over the enterprises able to become the center of spread of an infection, vaccination. Prevention of other forms of hepatitises is avoiding of action of gepatotravmiruyushchy factors – alcohol, medicines, toxic substances.
Secondary prevention of chronic hepatitis consists in observance of a diet, mode, medical recommendations, regular passing of inspection, control of clinical indicators of blood. Regular sanatorium treatment, balneotherapy is recommended to patients.
The forecast at timely diagnosing and treatment of an acute hepatitis is, as a rule, favorable and leads to recovery. Acute alcoholic and toxic hepatitises come to an end letalno in 3-10% of cases, often heavy current is connected with weakening of an organism other diseases. At development of chronic hepatitis the forecast depends on full value and timeliness of therapeutic measures, observance of a diet and the sparing mode.
The adverse course of hepatitis can be complicated by cirrhosis and a liver failure at which the lethal outcome is very probable. Other widespread complications of chronic hepatitises are exchange violations, anemia and violations of coagulability, diabetes, malignant new growths (liver cancer).