Acute Hepatitis - Causes, Symptoms, Types, Diagnosis And Treatment Of Acute Hepatitis

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Acute hepatitis

Content:

• Causes of acute hepatitis
• Symptoms of acute hepatitis
• Types of acute hepatitis
• Diagnosis of acute hepatitis
• Treatment of acute hepatitis

Hepatitis is a group of diseases of a completely different nature, in which the pathological process spreads to the entire liver tissue, as a result of which its functions are impaired.

Hepatitis can be divided into acute and chronic, depending on the characteristics of the course. Acute hepatitis is damage to the liver tissue, which develops under the influence of various reasons in a short time, is characterized by the rapid development of symptoms and, in its outcome, may result in recovery, death of the patient, or transition to a chronic form.

Chronic hepatitis is a liver disease that lasts more than 6 months without improvement and the outcome is the development of various forms of liver cirrhosis.

Causes of acute hepatitis

Acute hepatitis is most often caused by the following reasons:

• viral infection;
• bacterial infection;
• toxic damage (hepatotropic poisons);
• medications.

Acute viral hepatitis includes:

• hepatitis A, B, C, D, E;
• hepatitis caused by the herpes virus, infectious mononucleosis, Epstein-Barr, cytomegalovirus.

Acute hepatitis caused by bacterial infections develops when:

• leptospirosis;
• severe lobar pneumonia;
• sepsis;
• brucellosis;
• tuberculosis;
• toxoplasmosis.

Certain chemicals have a selective ability to damage liver tissue and cause hepatitis:

• carbon tetrachloride (used in industry as a fatty solvent, in the manufacture of fire extinguishers, in dry cleaning of clothes);
• trinitrotoluene - a benzene derivative (used in the manufacture of paints and varnishes, furniture);
• poisons of some mushrooms (pale toadstool);
• insect control agents (insecticides) that are used in the home and in agriculture.

Medicinal hepatitis can be caused by:

• tetracycline;
• anabolic steroid preparations;
• antidepressants;
• anti-tuberculosis drugs.

Symptoms of acute hepatitis

Depending on the causes of the development of hepatitis, the symptoms of the disease and the time of their appearance can vary greatly.

Types of acute hepatitis

Hepatitis A

Hepatitis A belongs to intestinal infections, the transmission mechanism is fecal-oral (through contaminated water, dirty hands, food), caused by the hepatitis A virus (HAV), which belongs to the picornovirus family. About 1.5 million people fall ill with hepatitis A worldwide every year.

The incubation period of the disease lasts an average of 1 month. Hepatitis A can occur in 2 forms: icteric and anicteric.

The disease begins acutely, with a rise in temperature up to 38 ° C, headache, loss of appetite, weakness, chills, pain in muscles and joints. Because of this, flu or colds are often taken. There is nausea, bitterness in the mouth, vomiting, pain in the right hypochondrium, there may be constipation or mild diarrhea. The duration of the preicteric period is 3 to 7 days. At its end, the urine becomes dark (the color of beer), and the feces, on the contrary, become discolored.

As soon as the color of the stool has changed, the body temperature normalizes, the patient's well-being improves significantly, but jaundice replaces this. The skin, mucous membranes, whites of the eyes are stained with a yellowish color, the liver enlarges and becomes painful. Jaundice intensifies within 3-5 days, then about 5-10 days does not change its intensity, and then gradually decreases. The jaundice lasts for about 2 weeks.

The recovery period begins from the moment the skin is cleared and the symptoms of jaundice disappear, lasts about 3 months. At this time, the patient may experience weakness, heaviness in the right hypochondrium after eating, and reduced resistance to physical activity.

Acute hepatitis E

Hepatitis E is another type of viral intestinal infection. Infection occurs through contaminated water. It is caused by the hepatitis E virus (HEV), which belongs to the hepevirus family.

Its peculiarity lies in the fact that the most severe clinical manifestations and high mortality are observed in pregnant women. Distributed mainly in tropical and subtropical regions. A European resident falls ill with hepatitis E while vacationing in southern countries, which is why it is also called the "traveler's disease".

The incubation period lasts from 2 weeks to 2 months. Hepatitis E is similar in clinical presentation to hepatitis A, but it does not have fever. The disease begins gradually with the appearance of weakness, muscle pain, loss of appetite, nausea, pain in the right hypochondrium. The preicteric period lasts approximately 5 days. At its end, the color of urine (darkens) and stools (lightens) change.

In contrast to jaundice in hepatitis A, in which the patient's condition improves after the color of the skin appears, in hepatitis E, on the contrary, all symptoms intensify, together with the liver, the spleen may enlarge. The duration of the icteric period is 1 to 3 weeks.

Recovery is delayed for 1-2 months, during which time all clinical manifestations of the disease and changes in blood tests completely disappear.

A characteristic feature of the course of hepatitis E in late pregnancy is the rapid development of massive necrosis of the liver tissue with profuse bleeding, acute renal failure, abortion, death of newborns within 1 month of life. Mortality from hepatitis E in this category of patients ranges from 25 to 70% (according to different authors), while in other patients, death from the disease occurs in 0.4-4% of cases.

Acute hepatitis B

Hepatitis B is an infection caused by the hepatitis B virus (HBV). The transmission mechanism is through blood or intrauterine. Infection occurs parenterally (injections, medical manpulations), sexual and household routes, when the virus enters the body through micro-damage to the skin with general use, for example, toothbrushes, nail files, bed linen and towels contaminated with the patient's blood. A large number of cases of hepatitis B have been reported among injecting drug users (heroin). Infection is possible within the walls of medical institutions (at the reception of a dentist, gynecologist, blood transfusion), as well as in beauty salons (manicure, pedicure, piercing, tattooing).

The incubation period for hepatitis B is very long and is 2-4 months (in some cases up to 6 months). The preicteric period lasts 1-5 weeks, it is characterized by: weakness, loss of appetite, bitterness in the mouth, bursting pains in the right hypochondrium, sleep disturbances, headache very often occur. In 1/3 of patients, there is a rash like urticaria, a slight increase in body temperature.

With the onset of jaundice, the patient's general condition worsens: weakness increases, appetite disappears completely, bitterness in the mouth, headache, and dizziness are characteristic. However, despite this, the body temperature is normalized, the pain in the muscles and joints goes away. Jaundice reaches its maximum in 2-3 weeks from the moment of onset, while the urine is dark, and the feces become the color of white clay. The duration of the icteric period is approximately 1 month.

The recovery period for hepatitis B is delayed by 6 months or more.

Acute viral hepatitis D

This is a special disease that is caused by a defective viral particle that is capable of multiplying in the human body only when the hepatitis B virus is present.

It is transmitted through contact with the patient's blood. In terms of its clinical symptoms, it is similar to hepatitis B, but its feature is a severe course.

According to various studies, 25% of patients have a fulminant form of the disease, which develops in a matter of days, turns into a hepatic coma and ends with the death of the patient, the remaining 75% of patients recover.

Acute viral hepatitis C

Hepatitis C is an infectious disease caused by the hepatitis C virus from the flavivirus family. The routes of infection are completely similar to those of hepatitis B.

In the medical literature, he is often figuratively called "affectionate killer" because of the characteristic oligosymptomatic course (in 50-80% of patients), rapid transition to a chronic form with the development of cirrhosis and liver cancer, followed by the death of the patient.

Acute hepatitis with herpes

Herpes hepatitis is caused by the herpes simplex virus. Infection occurs in utero or by contact in the household. Basically, newborns and children of 1-2 years of age are sick, as well as patients undergoing chemotherapy for cancer.

The disease is difficult, the incubation period lasts 5-7 days, then weakness appears, the body temperature rises sharply, lethargy, drowsiness develop, the liver and spleen increase. Jaundice develops almost immediately, accompanied by spontaneous bleeding. Herpetic hepatitis most often ends with the death of the patient, much less often turns into a chronic form.

Infectious mononucleosis

This is an acute viral disease in which liver damage is insignificant, more often it proceeds in an anicteric form. The development of the disease can only be judged on the basis of changes in the biochemical blood test. After the underlying disease is cured, the liver functions are completely restored.

Cytomegalovirus hepatitis

The mechanism of transmission, the patient population and clinical symptoms completely resembles herpes hepatitis. The outcome is the development of liver cirrhosis.

Acute bacterial hepatitis

Hepatitis developing in various infectious diseases, as a rule, is a complication and its symptoms only complement the clinical picture of the underlying disease. The emergence of acute hepatitis is associated with the toxic effects of microorganisms on the liver tissue. The main symptoms are jaundice, liver enlargement and soreness, and changes in blood biochemistry. As a rule, bacterial hepatitis is benign, and liver function is fully restored after treatment of the underlying disease.

Acute toxic and drug hepatitis

Poisoning with various chemicals and drugs that have a hepatotoxic effect is caused by the development of hepatic tissue necrosis. Depending on the dose of poison (medicine) and massive death of liver cells, clinical manifestations can be: jaundice of varying severity, acute liver failure and, in the most severe case, hepatic coma, which usually ends in the death of the patient.

Diagnosis of acute hepatitis

All diseases, which are characterized by jaundice, have a standard diagnostic scheme, including:

• survey (complaints, features of the development of symptoms, finding out the moment of infection);
• examination (objective signs of the disease);
• laboratory tests (analysis of blood, urine, bacteriological culture, determination of specific immunoglobulins);
• instrumental methods (ultrasound, intravital liver biopsy).

Poll

One of the important diagnostic techniques for acute hepatitis is a survey. It allows you to narrow down the range of alleged causes of liver damage. The doctor asks the patient about the peculiarities of the development of the disease: when it began, how the symptoms changed, what preceded the onset of jaundice (intravenous injection, visiting a dentist, a manicure office, traveling to southern countries, the countryside, contact with wild and domestic animals). If a toxic lesion is suspected, work conditions, occupational hazards, medication, contact with certain chemicals, for example, spraying with insecticides, are determined.

Attention is paid to the patient's age, his physiological (pregnancy, taking immunosuppressive drugs) and social characteristics (taking drugs, alcoholic).

Inspection

During the examination, the doctor must examine the patient's entire body, and not only the liver, since acute hepatitis may not be the main disease, but a complication. Attention is drawn to the color of the skin, mucous membranes, whites of the eyes, the presence of scratching with hepatic itching, punctate hemorrhages or bruises in case of bleeding disorders. Lymph nodes are felt, body temperature is measured.

When examining the liver, its size, going beyond the edge of the costal arch, soreness, consistency (dense, loose) are determined. The spleen is immediately palpated in the left hypochondrium.

Laboratory research

They are divided into 2 groups:

• non-specific;
• specific.

Non-specific methods are used to determine the severity of liver damage, the activity of the process, the prognosis, but cannot indicate the pathogen or cause. These include:

• Blood chemistry. It allows you to determine the level of fractions of bilirubin, enzymes AST, ALT, glutamate dehydrogenase, urokinase. In acute hepatitis, they are increased.
• Biochemical analysis of urine with determination of bile acids and urobilin.

Specific methods of laboratory diagnostics are aimed at accurately identifying the pathogen. These include ELISA methods, which determine the fractions of antiviral immunoglobulins (Ig M indicates an acute process) and PCR, which allows the detection of viral DNA or RNA particles in blood serum.

Instrumental methods

Allows to assess the level of structural liver damage. The most common instrumental method for acute hepatitis is ultrasound diagnostics of the liver and spleen.

Intravital liver biopsy is used mainly in the diagnosis of toxic and medicinal organ damage.

Treatment of acute hepatitis

In the treatment of acute hepatitis, 2 areas can be distinguished:

• etiotropic, aimed at the pathogen (cause);
• pathogenetic and symptomatic, designed to prevent complications arising from impaired liver function, and to alleviate the symptoms of the disease.

Acute hepatitis A

There are no etiotropic drugs that target the hepatitis A virus. Therapeutic tactics are as follows:

• sparing motor regime at home or hospitalization in the infectious diseases department;
• diet (the menu should be complete, high-calorie and physiological)
• choleretic drugs;
• mineral waters (alkaline);
• multivitamins (group B).

Acute hepatitis E

As with hepatitis A, etiotropic therapy is not prescribed; treatment is carried out according to a similar scheme. In severe cases, intensive intravenous detoxification is performed. In a malignant course, glucocorticoids may be prescribed.

Acute hepatitis B, C, and D

Etiotropic therapy of these forms of acute hepatitis consists in the early administration of interferon preparations. Pathogenetic and symptomatic therapy is carried out in the same way as in hepatitis A.

Acute hepatitis with bacterial infections

As a rule, no separate treatment is required. The main bacterial disease is being treated. In severe cases, detoxification, glucocorticoid drugs can be prescribed.

Acute toxic and medicinal hepatitis

The main direction in their treatment is the rapid cessation of the entry of the poison (drug) into the body, its neutralization and removal through the introduction of antidotes. For example, in case of poisoning with mercury, arsenic, lead, unitiol or sodium thiosulfate is injected intramuscularly. If poisoning with iron salts has occurred, then the appointment of desferal is shown. With advanced liver failure, hemodialysis is the most effective treatment.

On the subject: What can and cannot be eaten with liver disease?

It should be remembered that acute hepatitis is not a separate disease, it is a pathological condition of the liver, which can be caused by completely different reasons, therefore, its clinical picture, diagnosis and treatment methods will differ depending on the etiological factor.

Author of the article: Kletkin Maxim Evgenievich | Hepatologist

Education: Diploma in the specialty "General Medicine" received at the Military Medical Academy. S. M. Kirov (2007). At the Voronezh Medical Academy. NN Burdenko graduated from residency in the specialty "Hepatologist" (2012).