Viral hepatitis - diseases caused by hepatitis A and E viruses, which are manifested in liver damage and general intoxication of the body. Hepatitis A and E viruses do not affect the liver on their own, but liver inflammation comes from the fact that protective blood cells begin to respond to changes in liver tissue caused by viruses A and E.
It should be noted that hepatitis A is among the most common in the world. intestinal infections. Many suffer this disease in childhood and acquire lifelong immunity.
Viral hepatitis E, isolated from the group of hepatitis "neither A nor B" using marker diagnostics, leads to liver damage and is accompanied by an acute and especially severe course in pregnant women. In severe hepatitis E, damage is observed not only in the liver, but also in the kidneys. Chronic forms of viral hepatitis E, as well as its carriers have not been identified.
Causes of Hepatitis
The causative agent is hepatitis A virus belonging to the picornavirus family, stable in the environment, but which can be inactivated within 5 minutes of boiling.
Hepatitis A (jaundice, Botkin’s disease) mainly children of 4-15 years old fall in the winter, who study in kindergartens, schools, orphanages, especially in poor sanitary conditions. In addition, there is a cyclical increase in the incidence of hepatitis A after 3-5, and then after 7-20 years. Infection occurs by the fecal-oral route, from the virus carrier or a person with hepatitis, through water, food and household items. The waterway of infection leads to diseases of people who used infected water, bathed in contaminated pools, lakes. It is also possible infection through vegetables, if they were fertilized by the feces of a person infected with the virus. Dishes prepared from thermally unprocessed seafood, especially shellfish, are also dangerous. Infection occurs among drug addicts who use shared syringes, as well as among homosexuals. In addition, there is a high probability of contracting the hepatitis A virus in hot countries - traditional places of tourism, namely in Africa (Egypt), Asia (Turkey, India), Central America, as well as during water-related disasters.
Hepatitis E virus It is transmitted through water, mainly from open water sources, less often - by the fecal-oral method. Adult population (30-40 years old) is infected with hepatitis E virus.
Hepatitis E is common in countries with a subtropical and tropical climate (countries of Southeast Asia, Africa), especially in areas with poor water supply to the population, and where there is a shortage of it. Hepatitis E is relatively rare in our latitudes. Women in the third trimester of pregnancy are especially susceptible to the hepatitis E virus; children are relatively rare.
When drinking water or products infected with the hepatitis virus, they penetrate the intestines, and then with blood enter the liver and its cells - hepatocytesbreaking their membranes. In the liver tissue, inflammatory reactions begin, the outflow of bile is disrupted, the size of the liver increases.
Thanks to the immune mechanisms that fight the virus, it, through the bile ducts, enters the intestines and is released into the environment.
Symptoms of Hepatitis A
Distinguish sharp (icteric - in adolescents and adults), subacute (anicteric) and suclinical form of the disease (in the absence of clinical manifestations - most often in young children).
Hepatitis A is characterized a clear change of periods - yellowish, jaundice and recovery period.
The incubation period lasts from two to four weeks (with hepatitis E - up to 50 days). After which the patient may experience flu-like symptoms. Namely: an increase in temperature to 38-39 ° C, accompanied by general weakness, muscle pain, lability of the pulse, cough, sore throat, and dyspeptic syndrome, characterized by a decrease in appetite, nausea, vomiting can be observed at the same time, especially after eating, diarrheaepigastric discomfort, pain and heaviness in the right hypochondrium, bitterness in the mouthburping. After 3-7 days, the temperature drops, and the so-called icteric period. Which lasts 2-3 weeks, at this time such symptoms of hepatitis A as a decrease in body temperature and pigmentation are manifested. The skin and mucous membranes of the eyes, mouth (hard palate, frenum of the tongue) acquire an icteric shade, urine becomes dark (the color of strong black tea), and feces become discolored, as bile produced in the liver enters the bloodstream.
The size of the liver is increased, its palpation is painful, an enlarged spleen is often observed. Nasal appear bleeding, tongue tightness and lowering blood pressure. Against this background, they may appear dizziness, sleep disorders, bradycardia. Recovery occurs gradually, within 2-3 months, and is characterized by a gradual decrease in the signs of the disease, up to their disappearance, normalization of appetite, restoration of liver size. Lifelong immunity also develops. Hepatitis A virus does not go into a chronic form, and due to the fact that it mostly passes in a mild form, complications are rare, in the form of relapses of the disease and lesions of the biliary tract, bile stone disease.
Symptoms of Hepatitis E
With hepatitis E, an initial rise in temperature, a gradual digestion is observed. With the onset of the icteric period, the condition of patients with hepatitis A improves, while with hepatitis E the icteric period is short (up to 15 days), and the patients do not feel better during this period, the main symptoms of hepatitis E are pain in the right hypochondrium during this period. Full recovery occurs in 2-4 weeks. In addition, with hepatitis E, severe forms are often observed in which damage to both the liver and kidneys occurs. In severe cases, appears cholecystitis, cirrhosis of the liver.
Viral hepatitis E is especially dangerous in the second and third trimesters of pregnancy, because it leads to death in 40% of cases. With a pregnant hepatitis E virus, the icteric period is short, it goes into acute liver and kidney failure, as a result of which patients can fall into a coma, and the fetus freezes. Miscarriages and childbirth in patients with hepatitis E are usually accompanied by large blood loss and a very high frequency of death of newborns.
Particularly dangerous clinical forms of hepatitis A and E are cholestatic and fulminant forms. At the first, due to stagnation of bile in the body, yellowness of the skin, mucous membranes is pronounced, a strong increase in the liver and itchy skin. With fulminant (fulminant) form of viral hepatitis A, more common in older people, liver necrosis and acute hepatic encephalopathythat can develop within a few days lead to a kidney coma. There is nosebleed, vomiting, severe swelling of the legs. All this is fatal.
All forms of viral hepatitis are successfully diagnosed and cured with early treatment.
Diagnosis is based on the manifestations of the symptoms of the disease, taking into account the possibility of the occurrence of the disease due to contact with the patient with hepatitis A (the patient’s departure to the countries of Asia and Africa according to the incubation period of the disease), and laboratory tests are carried out to confirm the diagnosis of viral hepatitis, namely blood chemistry to detect leukopenia, lymphocytosisincreasing bilirubin levels as well differential diagnosis viral hepatitis (determination of specific antibodies to the virus) - polymerase chain reaction (PCR). As additional diagnostic methods, biopsy, ultrasound and computed tomography of the liver are used. Finally, the type of hepatitis is established on the basis of the detection of appropriate immunological markers. When examining urine, urobilin and bile pigments are found. The most reliable confirmation of the diagnosis of hepatitis A is achieved using immunochemical methods (RIA, ELISA)
Diagnosis of hepatitis E is complicated by the fact that its clinical course is very similar to the course of other viral hepatitis, and pregnant women suspect this disease marker diagnostics (detection of antiviral immunoglobulin M and G), as well as the determination of ribonucleic acid of the virus in the patient’s blood by PCR.
Hepatitis A and E treatment
Treatment of patients with viral hepatitis A or E is carried out on an outpatient basis; patients with severe treatment of the disease are subject to hospitalization if there are severe concomitant diseases (to an infectious diseases hospital). Patients are assigned bed rest (10-15 days) and good nutrition. Assigned diet number 5consisting of easily digestible foods, supplemented with carbohydrates and reduced fat. According to this diet, food should be taken 5-6 times a day, preferably in warm boiled, stewed or baked form. Hard-to-digest varieties of meat (pork), fish (sturgeon, catfish), fried foods, soups on meat and fish broths, canned foods, savory foods, spices, coffee, chocolate, mushrooms, radishes, pickled vegetables, peppers, smoked foods, alcohol are excluded from the diet . Vegetable and dairy foods, low-fat fish, beef, poultry, vegetables, oatmeal, buckwheat, cottage cheese, tea, broth of wild rose, non-acidic juices and compotes and with the addition of B vitamins, ascorbic acid, 5% glucose are preferred.
Thus, modern treatment of hepatitis A and E is aimed at eliminating harmful substances from the body resulting from liver damage, and the patient’s immune system can cope with the virus. To reduce the concentration of toxins and to restore liver cells, enter detoxification solutions, polyionic solutions, albumen, vitamins, glucose and special preparations - hepatoprotectors, protecting liver cells, are credited with drinking a lot of fluids (up to 3 liters per day). For the removal of toxins from their intestines take enterosorbents - Vaulen, Polyphepan, Enterosgel. Enzyme preparations may be prescribed to improve the digestive function of the stomach (creon, festal, abomin, liqurease, winter complex), which are taken simultaneously with food.
Antiviral drugs usually not assigned. Drugs to reduce temperature are also not recommended, because this will interfere with the immunological resistance of the body and a speedy recovery. You can use cold compresses on the forehead, enemas with a 2% solution of sodium bicarbonate at room temperature. Also during the recovery period are appointed choleretic drugs.
Hepatitis A usually almost always ends in recovery, especially if the person is in good health and has kept bed rest during the illness, and hepatitis E can cause hemolysis - destruction of red blood cells, which leads to damage to the kidneys and liver failure, and cirrhosis of the liver may occur in 5% of cases. An important role in the outcome in patients with hepatitis E in pregnant women is played by obstetric tactics aimed at preventing premature birth and miscarriage.
After recovery, having had hepatitis A, is subject to follow-up for 4-6 months in the presence of residual effects.
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Prevention of hepatitis A and E
The main measures for the prevention of viral hepatitis A and E infection, as well as other intestinal infections, include providing the population with benign drinking water and the implementation of sanitary rules for the preparation, storage, preparation and sale of food. It is important to maintain proper anti-epidemiological regimen in children's and adult training and working groups. It is necessary to check the quality of tap water for viral contamination, and disinfection with chlorine-containing preparations in the foci of morbidity. For people at risk of infection, medical supervision is 35 days.
Effective is immunoglobulin prophylaxis, manifested in vaccinations for children in kindergartens, orphanages and schoolchildren. The introduction of immunoglobulin provides short-term protection against the disease (for 3-4 months), and vaccines that prevent infection and block the hepatitis A virus, maintain immunity up to 10 years, costly. For children 1-6 years old, immunoglobulin is administered simultaneously 0.75 ml, at the age of 7-10 years - 1.5 ml., And for children over 10 years old and adults 3 ml of immunoglobulin is administered. Hepatitis A vaccines consist of killed hepatitis A viruses and are highly immunogenic. This is Havriks 1440, Avaxim, Vakta, GEP-A-in-VAK. Vaccination is carried out in two runs with an interval of 6 months, including for children from 2 years. Vaccination is advised to those who have not had hepatitis A, and those who have a high chance of contracting infection, namely: military and people traveling to countries where there are problems with water, water and sanitation workers, trade, food workers, staff children's educational institutions, doctors, as well as those who have chronic liver diseases.
Of particular importance is the disinfection of drinking water in foci of hepatitis E.
The main prevention of hepatitis A and E is reduced to compliance general hygiene principles - washing hands before eating and after visiting the restroom, washing vegetables and fruits, eating well-processed meat and all seafood, as well as boiled water.
Diet, nutrition for viral hepatitis A and E
Diet for hepatitis A
- Efficiency: therapeutic effect after 10 days
- Dates: from 3 months and more
- Product Cost: 1200-1400 rub. in Week
Diet for hepatitis
- Efficiency: therapeutic effect in a week
- Dates: 6 months or more
- Product Cost: 1400-1450 rubles a week
List of sources
- Viral hepatitis: clinic, diagnosis, treatment - Yushchuk N.D., Klimova EA, Znojko O.O., 2014, M.
- Skvortsov V.V., Tumarenko A.V. Problems of the modern treatment of viral hepatitis. // Therapist. - 2007. - No. 9
- Popova Yu.S., Hepatitis: the most effective methods of treatment. - SPb .: - Krylov, 2009 .-- 126 p.