Viral hepatitis

Viral hepatitis (Botkin's disease) - viral diseases that occur with general intoxication and predominant liver damage. These include viral hepatitis A (infectious hepatitis), viral hepatitis B (serum hepatitis) and hepatitis A or B.

Etiology, pathogenesis. Hepatitis A virus is resistant to ether, acids, chlorine, it is sensitive to formalin, it is inactivated during boiling for 5 minutes. It is allocated with feces, beginning from the end of the incubation and during the pre-zheltushnogo period. With the appearance of jaundice, the virus in the stool can not be detected. The hepatitis B virus (Dane particle) is stored at room temperature for up to 6 months, withstands heating to 60 g. With up to 10 hours, at a temperature of 100 gr. C is inactivated within 10 minutes. Resistant to chemical factors. In the human body can persist for several years. The introduction of the hepatitis A virus occurs through the mucous membranes of the gastrointestinal tract. Hepatitis B virus enters the body with blood transfusions or blood products (except albumin and donor immunoglobulin), with medical manipulations, tattooing, blood contacts (surgeons, lab technicians); The sexual way of transmission of an infection is proved.

Symptoms, course. The incubation period for viral hepatitis A varies from 7 to 50 days (usually 15-30 days), with hepatitis B from 50 to 180 (more often 60-120 days). Viral hepatitis, can occur in icteric, jaundiced and subclinical forms. Duration distinguish acute (up to 3 months), prolonged (3-6 months) and chronic (over 6 months) course of viral hepatitis. The disease begins gradually from the pre-zheltushnogo period, which lasts 1-2 weeks. There are flu-like, dyspeptic, asthenovegetative and arthralgic variants of this period. At the end of the pre-jaundice period, the urine becomes dark, the feces discolor, an increase in the spleen is revealed, and the activity of serum enzymes, especially ALT, increases. During icteric period, patients complain of general weakness, decreased appetite, dull pain in the liver, itchy skin. Jaundice is gradually increasing, its severity reflects the severity of the disease, although there may be severe forms with a slight jaundice. Often not only the liver, but also the spleen is enlarged. With viral hepatitis A, icteric period lasts 7-15 days, and recovery occurs within 1-2 months. Viral hepatitis B can take a long and chronic course. When hepatitis B can develop acute liver failure (hepatic coma, hepatic encephalopathy). Signs of liver failure increase-memory loss, increased general weakness, dizziness, exacerbation, increased vomiting, jaundice, diminished liver size, hemorrhagic syndrome, ascites, fever, neutrophilic leukocytosis, lower cholesterol (below 2.6 mmol / l), The coefficient of esterification is below 0.2, the mercury titer is less than 1.4, the prothrombin index is below 40%, the fibrinogen is below 2.93 μmol / l, the platelet count is less than 50%. SE / liter.

The diagnosis of viral hepatitis is based on clinical and epidemiologic data. Laboratory confirmation of the diagnosis is the detection in the blood serum of a patient with the immunofluorescent method of antibodies to the hepatitis A virus. For hepatitis B, the detection of the surface antigen of the hepatitis B virus or antibodies to it is of diagnostic importance. Differentiate viral hepatitis from liver damage in other infections (leptospirosis, infectious mononucleosis, pseudotuberculosis, ornithosis, salmonellosis, sepsis), toxic hepatitis (poisoning with carbon tetrachloride, dichloroethane), medicinal jaundice (aminazine, antituberculous drugs, etc.), hemolytic and mechanical Jaundice, functional hyperbilirubinemia (Gilbert syndrome, Dubin-Johnson syndrome).

Treatment. The basis of treatment is a gentle regime and nutrition (table number 5). Liquid up to 2-3 l / day in the form of juices, alkaline mineral water. Assign a complex of vitamins. For moderate to severe forms, a 5% solution of glucose and a Ringer-Locke solution of 250-300 ml are injected intravenously intravenously. In more persistent cases, intravenously inject haemodes or rheopolyglucin 200-400 ml. In severe cases, patients are transferred to wards or intensive care units. Introduce / in a 10% glucose solution (up to 1 L / day), Lobari solution (in 1 liter of pyrogen-free water contains 1.2 g of potassium chloride, 0.8 g of magnesium sulfate, 0.4 g of calcium chloride and 100 g of glucose) Up to 1-1,5 l / day. In acute liver failure, prednisolone (IV or IM) is administered at 60-90 mg / day. Apply 20% solution of sorbitol (250-500 ml / day), 15% albumin solution (200-300 ml / day). Intravenously, 2-3 times a day, 10,000-30,000 units of ED contrikal (trasylol) are administered. To suppress the intestinal microflora inside appoint neomycin for 1 g4razavdenylyakaminatsinovogo0,5g4 times a day. Every day, a siphon enema is made with a 2% solution of sodium hydrogencarbonate. Blood transfusion is recommended. Perspective was hyperbaric oxygenation with a regimen of sessions from 1.5 to 2.5 atm, a duration of 45 minutes, as well as hemosorption using activated carbons.

The prognosis for life is usually favorable. After hepatitis B, chronic hepatitis and cirrhosis can develop.

Prevention. Methods for preventing hepatitis A are the same as for dysentery. For the prevention of viral hepatitis B, it is necessary to monitor donors (exclude persons with a surface antigen of the hepatitis B virus or antibodies to it), careful sterilization of the instruments.