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Question 14 Viral hepatitis

- inflammation of the liver tissue caused by viruses. Hepatitis viruses belong to different taxa and differ in biochemical and molecular characteristics, but all these viruses are united by the fact that they cause hepatitis in humans. Chronic liver diseases, including viral hepatitis B and C, are among the ten leading causes of death in the world. At the moment, a large number of viruses are known that can cause viral hepatitis: hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus, virus hepatitis E, hepatitis F virus and hepatitis G virus, hepatitis TTV and SEN viruses, rubella virus, cytomegalovirus, Epstein-Barr virus, AIDS virus (HIV) and others. Some viruses that cause viral hepatitis are not well understood.

By type of pathogen

Hepatitis A (Botkin's disease)

Hepatitis B (serum hepatitis)

Hepatitis C

Hepatitis D (delta infection, hepatitis?)

Hepatitis E

Hepatitis F

Hepatitis G

Hepatitis TTV

Assume the existence of other yet unidentified hepatitis viruses. In addition, hepatitis can be caused by viruses such as yellow fever virus, herpes viruses, rubella virus, Coxsackie viruses, Lassa fever virus, Marburg-Ebola fever viruses and others, as part of the generalized process.

According to the clinical course

1. Acute viral hepatitis

2. Primary chronic viral hepatitis

3. Secondary chronic viral hepatitis

Hepatitis A is an acute infectious liver disease caused by the hepatitis A virus. The virus is well transmitted through the fecal-oral route, through contaminated food and water, about ten million people become infected with the virus every year. The incubation period is from two to six weeks, an average of 28 days.

In developing countries and in areas with insufficient hygiene, the incidence rate of hepatitis A is high and the disease itself is transmitted in early childhood. Ocean water samples are examined for the presence of hepatitis A virus when studying water quality. There is no specific treatment for hepatitis A. About 6-10% of people diagnosed with hepatitis A may have one or more symptoms of the disease for up to forty weeks after the onset of the disease.

The causative agent of the disease is the hepatitis B virus from the hepatadavirus family. The virus is extremely resistant to various physical and chemical factors: low and high temperatures (including boiling), repeated freezing and thawing, prolonged exposure to an acidic environment. In the external environment at room temperature, the hepatitis B virus can persist for up to several weeks: even in a dried and inconspicuous spot of blood, on a razor blade, the end of a needle.


The transmission mechanism is parenteral. Infection occurs through the natural (sexual, vertical, domestic) and artificial (parenteral) routes. The virus is present in the blood and various biological fluids - saliva, urine, semen, vaginal secretions, menstrual blood, etc.

The disease begins gradually with the preicteric period, which lasts 1-2 weeks.

There are flu-like, dyspeptic, asthenovegetative and arthralgic variants of this period. At the end of the preicteric period, the urine becomes dark, the cap becomes discolored, an increase in the spleen is detected, the activity of serum enzymes, especially AlAT, increases. During the icteric period, patients complain of general weakness, decreased appetite, dull pain in the liver, and skin itching. Jaundice is gradually increasing, its severity reflects the severity of the disease, although there may be severe forms with mild jaundice. Not only the liver, but also the spleen is often enlarged. With viral hepatitis A, the icteric period lasts 7-15 days, and recovery occurs within 1-2 months. Viral hepatitis B can take a protracted and chronic course. With hepatitis B, acute liver failure (hepatic coma, hepatic encephapopathy) may develop. Signs of an increase in liver failure - memory impairment, increased general weakness, dizziness, agitation, increased vomiting, increased jaundice, decreased liver size, the appearance of hemorrhagic syndrome, ascites, fever, neutrophilic leukocytosis, decreased cholesterol (below 2.6 mmol / l), the esterification coefficient is lower than 0.2, the sublimate titer is less than 1.4, the prothrombin index is lower than 40%, fibrinogen is lower than 2.93 μmol / l, and platelet count is less than 100-109 / l.
Symptomatic treatment (relief of the patient's condition), detoxification, pathogenetic (aimed at correcting the immune system) and antiviral. Patients with acute hepatitis in moderate and severe form, as well as with a pronounced exacerbation of chronic hepatitis, need rest, even after discharge from the hospital for 1-3 months, it is necessary to exclude even hard homework and any physical overload. It is necessary to follow a diet: restriction of extractives, exclusion of alcohol.

The diagnosis of viral hepatitis is based on clinical and epidemiological data. Laboratory confirmation of the diagnosis is the detection of serum antibodies using the immunofluorescence method of antibodies to hepatitis A.

Treatment. The basis of treatment is a sparing regimen and nutrition (table No. 5).

Liquid up to 2-3 l / day in the form of juices, alkaline mineral waters. Prescribe a complex of vitamins. In moderate forms, a 5% glucose solution is administered intravenously. In more persistent cases, hemodesum or rheopolyglyukin 200-400 ml are administered iv. In severe forms, patients are transferred to wards or intensive care units.

In acute liver failure, prednisone (i.v. or i / m) is administered at 60-90 mg / day. Apply a 20% solution of sorbitol (250-500 ml / day), a 15% solution of albumin (200-300 ml / day). Intravenously 2-3 times a day, 10,000-30,000 units of contracal are prescribed (trasi-lol). To suppress intestinal microflora, neomycin is prescribed orally 1 g 4 times a day or kanamycin 0.5 g 4 times a day.

A siphon enema is made daily with a 2% sodium bicarbonate solution.

An exchange blood transfusion is recommended.

Prevention, both specific (vaccination), and non-specific, aimed at interrupting transmission: correction of human behavior; the use of one-time tools; careful observance of hygiene rules in everyday life; limitation of transfusions of biological fluids; the use of effective disinfectants; the presence of a single healthy sexual partner or, otherwise, protected sex (the latter does not give a 100% guarantee of non-infection, since in any case there is unprotected contact with other biological secretions of the partner - saliva, then, etc.).

Vaccination is widely used to prevent infection. Routine vaccination is accepted in almost all countries of the world. WHO recommends starting to vaccinate a child on the first day after birth, unvaccinated school-age children, as well as people at risk: professional groups (doctors, emergency services, military, etc.), people with non-traditional sexual preferences, drug addicts, patients often receiving blood products , people undergoing hemodialysis and some others. For vaccination, the hepatitis B virus vaccine is usually used, which is a protein of the shell of a viral particle, the so-called HBs antigen. In some countries (such as China), a plasma vaccine is used. Both types of vaccines are safe and highly effective. The vaccination course usually consists of three doses of the vaccine administered intramuscularly at time intervals.

The vaccination efficiency of newborn babies born to infected mothers, provided that the first dose was administered in the first 12 hours of life, is up to 95%. Emergency vaccination in close contact with an infected person, getting infected blood into the blood of a healthy person is sometimes combined with the introduction of a specific immunoglobulin, which theoretically should increase the chances that hepatitis will not develop.

The hepatitis B vaccine also protects against hepatitis D (the historical name is delta hepatitis), since the hepatitis D virus cannot multiply without the hepatitis B virus
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Question 14 Viral hepatitis

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