viral hepatitis
Introduction
Introduction to viral hepatitis Viral hepatitis is a group of infectious diseases caused by several different hepadnaviruses (hepatitis viruses) with long-term liver inflammation and necrotic lesions. It is a legal type B infectious disease with strong contagiousness and complicated transmission routes. It has a wide range of epidemics and high incidence. Some patients with hepatitis B, C and D can develop chronic disease and develop liver cirrhosis and primary hepatocellular carcinoma, which is very harmful to people's health. Viral hepatitis is an infectious disease caused by hepatitis. The main symptoms are fatigue, loss of appetite, abnormal liver function, some patients may have fever and jaundice, and some cases may be chronic or recurrent. Chronic hepatitis Severe hepatitis is a dangerous disease with high mortality. The main causes of death are hepatic coma, liver failure, electrolyte imbalance and secondary infection. Viral hepatitis can be divided into five types: A, B, C, D, and E. basic knowledge The proportion of illness: 1% Susceptible people: no specific people Mode of transmission: blood transmission, mother-to-child transmission Complications: cirrhosis, cirrhosis, ascites
Cause
Cause of viral hepatitis
Virus infection (40%):
The pathogenesis of viral hepatitis is complex, and the mechanisms by which different types of viruses cause disease are also different. Hepatitis A and E are caused by infection with HAV and HEV, respectively. After entering the body, HAV/HEV enters the bloodstream through the intestine and reaches the liver, and then is discharged into the intestine through bile and appears in the feces. The main organ that the virus invades is the liver. The mechanism of HAV-induced hepatocyte injury is not clear. It is generally believed that HAV does not directly cause hepatocyte lesions. Liver damage is caused by the immunopathological reaction of HAV-infected hepatocytes; the early liver inflammation of hepatitis E mainly involves direct cytopathic effect of HEV. The pathological changes of hepatocytes during viral clearance are mainly caused by the immune response induced by HEV.
Route of transmission (20%):
In general, sporadic cases are predominant in developed countries, and developing countries are dominated by epidemics. Since 1980, there have been several epidemics in Xinjiang, China. There have been reports of sporadic hepatitis E in other places, accounting for about 10% of acute sporadic hepatitis. At least 6 provinces, municipalities and autonomous regions have reported an outbreak of hepatitis E. Its popular characteristics are like hepatitis A, which is transmitted through the fecal-oral route.
Source of infection (20%):
Hepatitis A patients and asymptomatic infections are the source of infection. Hepatitis A patients only excrete pathogens from the feces. The blood HAV mainly occurs 14-21 days before the onset of jaundice. In this period, the blood of patients is contagious. It is transmitted by blood transfusion, but the blood of the patient is usually not contagious after the occurrence of jaundice. The patient discharged the most amount of HAV from the feces 2 weeks before the onset and 1 week after the onset, and the infection was the strongest at this time. However, a small percentage of patients discharged HAV from the feces up to 30 days after the onset of illness.
Prevention
Viral hepatitis prevention
Control of the source of infection should adopt comprehensive preventive measures focusing on cutting off the transmission route. For example, focusing on water source protection, drinking water disinfection, food hygiene, and manure management are important for cutting off the spread of hepatitis A. To prevent the spread of blood and body fluids, various medical and preventive injections (including skin tests, BCG vaccination, etc.) should be carried out by one person, one tube and one tube, and the contaminated substances with serum should be strictly disinfected. Dialysis wards should strengthen health management.
Complication
Viral hepatitis complications Complications cirrhosis cirrhosis ascites
Hepatitis is a systemic disease. In addition to invading the liver, the virus can also invade other organs. For example, the HBV marker can be found in tissues such as kidney, pancreas, bone marrow, and thyroid. Common complications include arthritis (12% to 27%). , glomerulonephritis (26.5%), nodular polyarteritis, etc., using direct immunofluorescence and electron microscopy, found that there are HBV particles on the synovial membrane, serum HBsAg persistent positive membranous glomerulonephritis patients, kidney HBcAg deposition was found in biopsy glomerular tissue. In this hospital, 180 patients with glomerulonephritis were examined by renal puncture. 33 patients (18.3%) with HBcAg deposition in the kidney were found, and those with nodular polyarteritis were found. Immunological complexes composed of HBcAg, IgG, IgM, C3, etc. can be seen on the wall of the diseased vessel. Uncommon complications include diabetes, fatty liver, aplastic anemia, polyneuritis, pleurisy, myocarditis and pericarditis. Diabetes and fatty liver are worthy of attention, and a small number of patients can have hyperbilirubinemia after hepatitis.
Symptom
Viral hepatitis symptoms Common symptoms Liver capsule tension Large liver cells Necrotic proteinuria Big three yang Disgusting irritability Liver qi stagnation bleeding tendency Ascites fatigue
Viral hepatitis is an infectious disease caused by hepatitis. The main symptoms are fatigue, loss of appetite, abnormal liver function, some patients may have fever and jaundice, and some cases may be chronic or recurrent. Chronic hepatitis Severe hepatitis is a dangerous disease with high mortality. The main causes of death are hepatic coma, liver failure, electrolyte imbalance and secondary infection. Viral hepatitis can be divided into five types: A, B, C, D, and E. The pathogens of viral hepatitis are different, but there is a great similarity in clinical practice. However, the course of the disease is different. The course of the disease is acute hepatitis within 6 months, and the course of disease is more than 6 months. The type A and E virus hepatitis are only acute hepatitis B type C virus hepatitis. It is manifested as acute hepatitis or chronic hepatitis, and may develop into cirrhosis and hepatocellular carcinoma.
Examine
Viral hepatitis check
(1) The total number of white blood cells in the blood is normal or slightly lower, the lymphocytes are relatively increased, and occasionally abnormal lymphocytes appear. The number of white blood cells and neutrophils in patients with severe hepatitis can be increased. Thrombocytopenia in some patients with chronic hepatitis.
(II) Liver function test There are many types of liver function tests, which should be selected according to the specific conditions.
1. The jaundice index and bilirubin quantitative test The above indicators of jaundice hepatitis can be increased. Urinary examination increased bilirubin, urobilinogen and urinary bilirubin.
2. Serum enzymes are commonly used in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Serum aminotransferase can be elevated in the latent stage of hepatitis, early onset and latent infection, so it is helpful for early diagnosis. It has been confirmed that there are two types of AST, one is ASTs, which is present in the liver cytoplasm, and the other is ASTm, which is present in the shallow cells of hepatocytes. When liver cells are extensively necrotic, ASTm in the serum is increased, so ASTm is mainly increased in severe hepatitis. Since the half-life of ASTm is shorter than ASTs, recovery is also earlier. When ASTm continues to increase in acute hepatitis, it may become chronic hepatitis. Chronic hepatitis should continue to be considered as chronic active hepatitis. Glutathione-S-transferase (GST) is the earliest elevated in severe hepatitis and is helpful in early diagnosis. Fructose 1,6-bisphosphatase is one of glycogen synthase, and the serum content of various types of chronic hepatitis is significantly increased. Serum guaninease (GDA) is consistent with ALT activity and is organ specific.
3. Cholesterol, Cholesterol Ester, and Cholesterol Lipase When blood cell damage is measured, total cholesterol in the blood is reduced, and cholesterol is increased in obstructive jaundice. Cholesterol, cholesterol esters, and cholesterol cholesterase in patients with severe hepatitis can be significantly decreased, suggesting a poor prognosis.
Diagnosis
Diagnosis and identification of viral hepatitis
The diagnosis of various types of viral hepatitis is mainly based on antigen, antibody determination, and the diagnosis of hepatitis must be determined based on epidemiological data, symptoms, signs and laboratory tests, and can be used for liver biopsy if necessary.
The disease should be associated with elevated levels of serum transaminases or serum bilirubin caused by toxic hepatitis, cholecystitis, infectious mononucleosis, leptospirosis, epidemic hemorrhagic fever, fatty liver, and amoebic liver disease. Identification, cholestatic hepatitis should be differentiated from extrahepatic obstructive jaundice (such as pancreatic head cancer, cholelithiasis, etc.).
