Thus, like any infectious disease, hepatitis A goes through a number of stages in its development:

• prodromal
• icteric, or the height of the disease,
• convalescence.

The incubation period lasts from the moment of infection until the first symptoms of the disease appear. On average, from 15 to 40 days. There are no clinical manifestations during this period. The patient feels healthy, keeps working capacity in full.

Characteristics of the prodromal stage

The prodromal stage is usually short. On average, 7-10 days, although there are variations up to one month, or a reduction to two days. Clinically, it can develop in several forms:

1. catarrhal;
2. Asthenovegetative;
3. Dyspeptic;
4. Mixed.

Hepatitis A can be mild, moderate, or severe. The latter is typical for patients with concomitant pathology of the hepatobiliary system, as well as an alcohol history.

These diseases affect both men and women, the elderly and children. In children, it develops in milder forms. Symptoms of hepatitis A in women and men are similar.

The catarrhal form is characterized by a flu-like condition, when the patient has an increase in body temperature to subfebrile numbers, malaise, muscle aches, a runny nose, a sore throat and a dry cough may occur.

During this period, patients can already seek medical help. However, it is difficult to establish a correct diagnosis at this stage, and they are usually treated for acute respiratory illness.

The dyspeptic form of the prodromal period is characterized by a lack of appetite, the presence of nausea, sometimes vomiting, a violation of the stool, up to severe diarrhea, heaviness and bursting pain in the right hypochondrium.

For the asthenovegetative form, irritability, weakness, increased fatigue, and sleep disturbance are typical.

Most often in practical medicine there is a mixed form that combines a variety of clinical manifestations.

Stage of jaundice

The peak period of the disease is characterized by a rapidly growing icteric coloration of the skin. First, the sclera and mucous membrane of the soft palate acquire this shade, and by 3-4 days, all skin integuments. Along with these first signs of hepatitis A, there is a change in the color of the urine. It acquires a darker color (the color of beer) and becomes frothy.

During this period, a third of patients experience discoloration of the feces. It becomes grayish in color, resembling clay in appearance, sometimes shiny due to the presence of fat in it. Symptoms of hepatitis A is the presence of itching of the skin, often very intense, the appearance of which is associated with the circulation of bile acids in the blood, irritating skin receptors.

As for such symptoms of hepatitis A as catarrhal phenomena, fever, during the development of jaundice, they subside. Dyspeptic phenomena persist, and in some cases even intensify. Often, patients at the same time feel heaviness and pressing pain not only in the right hypochondrium, but also in the left, associated with an enlarged spleen.

When examining a patient, in addition to the yellowness of the skin, sclera and soft palate, traces of scratching caused by unbearable itching attract attention, and there may be hemorrhages at the injection sites. On palpation, the doctor notes pain and enlargement of the liver.

At the same time, its edge is rounded and protrudes from under the costal arch by 1-2 cm. In some patients, an enlarged spleen is palpated. On the part of the cardiovascular system, the doctor notes the presence of bradycardia, a decrease in blood pressure.

recovery stage

The duration of the icteric period is 3-4 weeks. Then the disease passes into the next stage - recovery. It is characterized by a gradual decrease in the symptoms of hepatitis A, when the general condition normalizes, appetite appears, urine and stools acquire their usual color.

The yellowness of the skin and heaviness in the hypochondrium remain the longest. At the same time, clinical recovery, that is, a decrease in the signs of hepatitis A, occurs faster than the normalization of laboratory parameters.

Studies of blood, urine, feces are very important for the diagnosis of liver diseases.

Laboratory diagnostics

The causative agent of hepatitis A primarily disrupts the exchange of bilirubin, which manifests itself in the fact that its increase in the blood is noted mainly due to the bound fraction. Urobilinuria is also noted in the urine. The discoloration of feces is due to the absence of stercobilin in it, but the presence of fat, starch grains is noted.

The change in the enzymatic activity of the liver manifests itself in the form of an increase in the activity of transaminases (ALT, AST), aldolase, alkaline phosphatase. Their performance increases by 3-4 times. In this case, the degree of increase indicates the severity of the process. In the blood, there is also a decrease in total protein due to albumin, cholesterol levels. The content of prothrombin is also reduced.

Complete blood count is characterized by a decrease in ESR, leukopenia. An increase in ESR and leukocytosis may indicate the presence of complications of the disease. In severe cases, thrombocytopenia is noted. To clarify the diagnosis, a study of the titer of immunoglobulin M, which increases during the icteric period, and immunoglobulin G, which increases during the recovery period, is carried out.

The most informative analysis is PCR diagnostics of the hepatitis A virus.

anicteric form

Anicteric form has become quite widespread among residents of epidemiologically disadvantaged areas and children. Symptoms of hepatitis A in children in this case are malaise, general weakness, some soreness in the right hypochondrium, subfebrile condition.

In some countries with insufficiently developed sanitary and hygienic conditions, up to 90% of the population had hepatitis A before the age of ten.

On examination, the signs of hepatitis in children in this case are mild subicterism of the sclera and soft palate, sensitive to palpation and a slightly enlarged liver. In the blood, there is an increase in bilirubin, transaminases, a decrease in ESR. According to some researchers, the number of anicteric forms of hepatitis A exceeds the alternative by more than 2 times.

Despite the fact that hepatitis A most often occurs in a mild form, it is dangerous for its complications, such as cholangitis, cholecystitis, and in rare cases, cirrhosis of the liver.

In elderly people with a burdened history, there is a lethal outcome in 2% of cases.

Principles of hepatitis A treatment

Specific treatment for hepatitis A has not yet been developed. Based on the mechanism of hepatitis A development, the following is recommended:

The diet recommended for patients with this disease should include proteins, carbohydrates, and lipotropic substances such as cottage cheese, legumes, and oatmeal. Food should be fortified, especially at the expense of vitamins B, C, A. Such products include vegetables, fruits, yeast. Steamed or boiled food is recommended. Fried, smoked, spicy should be excluded.

Detoxification therapy, depending on the severity of the patient's condition, may include both a plentiful fortified drink and the appointment of drip infusion solutions (for example, 5% glucose solution).

Antispasmodics are prescribed in case of severe pain syndrome and for the prevention of bile stasis.

Hepatoprotectors are drugs that have a beneficial effect on liver function, restoring it.

Currently, the range of these drugs is significantly increasing.

Heptral, Essentiale forte are widely used. The drug Livolin, in addition to the hepatoprotective effect, is enriched with vitamins. Vitamin therapy can also be carried out by injection. The beneficial effect of vitamins of group B (B1, B6, B12), P, C on liver function has been proven, and vitamin K in hemorrhagic manifestations.

After suffering from hepatitis A, a strong immunity is developed. There are no recurrences of the disease. If there is a clear connection with an unfavorable epidemiological situation (breakthrough of sewer pipes into the city water supply or the presence of a sick relative), then immunoglobulin can be administered to prevent the development of the disease.

However, these measures may only be effective for up to 15 days after infection. Subsequently, the symptoms of hepatitis A will no longer keep you waiting.

Hepatitis C is an inflammation of the liver of a viral origin, clinical manifestations of which in most cases are significantly delayed in time or so little expressed that the patient himself may not notice that a “gentle” killer virus has settled in his body, as the hepatitis C virus (HCV) is commonly called.

Once upon a time, and this continued until the end of the 80s of the last century, doctors knew about the existence of a special form of hepatitis that did not fit into the concept of "Botkin's disease" or jaundice, but it was obvious that it was hepatitis that affects the liver in no way less than their own " brethren" (A and B). An unfamiliar species was called hepatitis neither A nor B, since its own markers were still unknown, and the proximity of pathogenesis factors was obvious. It was similar to hepatitis A in that it was transmitted not only parenterally, but suggested other routes of transmission. The similarity with hepatitis B, called serum hepatitis, was that it could also be infected by receiving someone else's blood.

At present, everyone knows that, called neither A nor B hepatitis, is open and well studied. This is hepatitis C, which in its prevalence is not only not inferior to the infamous, but also far exceeds it.

Similarities and differences

Botkin's disease was previously called any inflammatory liver disease associated with a certain pathogen. The understanding that Botkin's disease can represent an independent group of polyetiological pathological conditions, each of which has its own pathogen and the main route of transmission, came later.

Now these diseases are called hepatitis, but a capital letter of the Latin alphabet is added to the name according to the sequence of discovery of the pathogen (A, B, C, D, E, G). Patients often translate everything into Russian and indicate hepatitis C or hepatitis D. However, the diseases assigned to this group are very similar in the sense that the viruses they cause have hepatotropic properties and, when ingested, affect the hepatobiliary system , each in its own way violating its functional abilities.

Different types of hepatitis are unequally prone to chronization of the process, which indicates the different behavior of viruses in the body.

Hepatitis C is considered the most interesting in this regard., which remained a mystery for a long time, but even now, being widely known, it leaves secrets and intrigues, since it does not make it possible to give an accurate forecast (it can only be assumed).

Inflammatory processes of the liver caused by various pathogens do not differ in relation to sex, therefore men are equally affected, and women. There was no difference in the course of the disease, however, it should be noted that in women during pregnancy, hepatitis can be more severe. In addition, the penetration of the virus in recent months or the active course of the process can adversely affect the health of the newborn.

If liver diseases of viral origin still have a clear similarity, then considering hepatitis C, it is advisable to touch on other types of hepatitis, otherwise the reader will think that only the “hero” of our article should be afraid. But through sexual contact, you can become infected with almost every species, although this ability is attributed more to hepatitis B and C, and therefore they are often referred to as sexually transmitted diseases. In this regard, other pathological conditions of the liver of viral origin are usually kept silent, since their consequences are not as significant as the consequences of hepatitis B and C, which are recognized as the most dangerous.

In addition, there are hepatitis of non-viral origin (autoimmune, alcoholic, toxic), which should also be mentioned, because one way or another, they are all interconnected and significantly aggravate each other.

How is the virus transmitted?

Depending on which way the virus could "run across" to a person and what things it will start to "do" in the body of a new "host", different types of hepatitis are distinguished. Some are transmitted in everyday life (through dirty hands, food, toys, etc.), appear quickly and pass, basically, without any consequences. Others, called parenteral, having the potential of chronicity, often remain in the body for life, destroying the liver to cirrhosis, and in some cases to primary liver cancer (hepatocarcinoma).

In this way, hepatitis according to the mechanism and routes of infection are divided into two groups:

• Having an oral-fecal transmission mechanism (A and E);
• Hepatitis, for which the blood-contact (hemopercutaneous), or, more simply, the path through the blood, is the main one (B, C, D, G - a group of parenteral hepatitis).

In addition to the transfusion of infected blood or flagrant non-compliance with the rules for medical manipulations associated with damage to the skin (the use of insufficiently processed instruments, for example, for acupuncture), often there is the spread of hepatitis C, B, D, G and in other cases:

1. Various fashionable procedures (tattoos, piercings, ear piercings) performed by a non-professional at home or in any other conditions that do not meet the requirements of the sanitary and epidemiological regime;
2. By using one needle for several people, this method is practiced by syringe addicts;
3. Transmission of the virus through sexual intercourse, which is most likely for hepatitis B, hepatitis C in such situations is transmitted much less frequently;
4. Cases of infection by the "vertical" route (from mother to fetus) are known. Active disease, acute infection in the last trimester, or HIV carriers greatly increase the risk of hepatitis.
5. Unfortunately, up to 40% of patients cannot remember the source that “gifted” the hepatitis B, C, D, G virus.

The hepatitis virus is not transmitted through breast milk, so women with hepatitis B and C can safely feed their baby without fear of infecting him.

We can agree that the fecal-oral mechanism, water, contact-household, being so interconnected, cannot exclude the possibility of transmitting the virus and sexually just as well as other types of hepatitis transmitted through the blood, have the ability to penetrate into another organism during sex.

Signs of an unhealthy liver

After infection, the first clinical signs of different forms of the disease appear at different times. For example, the hepatitis A virus declares itself in two (up to 4) weeks, the causative agent of hepatitis B (HBV) is somewhat delayed and manifests itself in the interval from two months to six months. As for hepatitis C, it the pathogen (HCV) can detect itself after 2 weeks, after 6 months, or it can “hide” for years, turning a healthy person into a carrier and source of infection for a rather serious disease.

The fact that something is wrong with the liver can be guessed from the clinical manifestations of hepatitis:

• Temperature. With it and the phenomena of influenza infection, hepatitis A usually begins (headache, pain in the bones and muscles). The onset of HBV activation in the body is accompanied by subfebrile temperature, and with C-hepatitis it may not rise at all;
• Jaundice varying degrees of expression. This symptom appears a few days after the onset of the disease, and if its intensity does not increase, then the patient's condition usually improves. A similar phenomenon is most characteristic of hepatitis A, which cannot be said about hepatitis C, as well as toxic and alcoholic hepatitis. Here, a more saturated color is not attributed to signs of an impending recovery, rather, on the contrary: with a mild form of inflammation of the liver, jaundice may be absent altogether;
• Rashes and itching more characteristic of cholestatic forms of inflammatory processes in the liver, they are caused by the accumulation of bile acids in tissues due to obstructive lesions of the hepatic parenchyma and injury to the bile ducts;
• Decreased appetite;
• Heaviness in the right hypochondrium, possible enlargement of the liver and spleen;
• Nausea and vomiting. These symptoms are more characteristic of severe forms;
• Weakness, malaise;
• Joint pain;
• dark urine, dark beer-like , discolored feces - typical signs of any viral hepatitis;
• Laboratory indicators: liver function tests (AlT, AST, bilirubin), depending on the severity of the course, can increase several times, the number of platelets decreases.

During viral hepatitis, 4 forms are distinguished:

1. Easy, more characteristic of hepatitis C: jaundice is often absent, subfebrile or normal temperature, heaviness in the right hypochondrium, loss of appetite;
2. Medium: the above symptoms are more pronounced, there is pain in the joints, nausea and vomiting, there is practically no appetite;
3. heavy. All symptoms are present in a pronounced form;
4. Lightning (fulminant), which is not found in hepatitis C, but is very characteristic of hepatitis B, especially in the case of coinfection (HDV / HBV), that is, a combination of two viruses B and D that cause superinfection. The fulminant form is the most dangerous, because as a result of the rapid development of massive necrosis of the hepatic parenchyma, the death of the patient occurs.

Hepatitis, dangerous in everyday life (A, E)

In everyday life, first of all, liver diseases that have a predominantly fecal-oral route of transmission can lie in wait, and these are, as you know, hepatitis A and E, so you should dwell a little on their characteristic features:

Hepatitis A

Hepatitis A is a highly contagious infection. Previously, it was simply called infectious hepatitis (when B was serum, and others were not yet known). The causative agent of the disease is a small but incredibly resistant virus containing RNA. Although epidemiologists note susceptibility to the pathogen as universal, it is predominantly children who have stepped over the age of one who are ill. Infectious hepatitis, triggering inflammatory and necrobiotic processes in the hepatic parenchyma, giving symptoms of intoxication (weakness, fever, jaundice, etc.), as a rule, ends with recovery with the development of active immunity. The transition of infectious hepatitis to a chronic form practically does not occur.

Video: hepatitis A in the program “Live healthy!”

Hepatitis E

Its virus also belongs to RNA-containing ones, it “feels good” in the aquatic environment. It is transmitted from a sick person or carrier (in the latent period), there is a high probability of infection through food that has not undergone heat treatment. Mostly young people (15-30 years old) living in the countries of Central Asia and the Middle East get sick. In Russia, the disease is extremely rare. The contact-household route of transmission is not excluded. Cases of chronicity or chronic carriage have not yet been established or described.

Hepatitis B and dependent hepatitis D virus

hepatitis virusB(HBV), or serum hepatitis, is a DNA-containing pathogen with a complex structure that prefers liver tissue for its replication. A tiny dose of infected biological material is enough to transmit the virus, why this form passes so easily not only during medical manipulations, but also during sexual intercourse or in a vertical way.

The course of this viral infection is multivariate. It may be limited to:

• Carrying;
• Give acute liver failure with the development of a fulminant (fulminant) form, often taking the life of the patient;
• When the process is chronic, it can lead to the development of cirrhosis or hepatocarcinoma.

The incubation period of this form of the disease lasts from 2 months to six months, and the acute period in most cases has symptoms characteristic of hepatitis:

1. Fever, headache;
2. Decreased efficiency, general weakness, malaise;
3. Pain in the joints;
4. Disorder of the function of the digestive system (nausea, vomiting);
5. Sometimes rashes and itching;
6. Heaviness in the right hypochondrium;
7. Enlargement of the liver, sometimes - the spleen;
8. Jaundice;
9. A typical sign of liver inflammation is dark urine and discolored feces.

Very dangerous and unpredictable combinations of HBV with the causative agent of hepatitis D (HDD), which was previously called delta infection - a unique virus that is invariably dependent on HBV.

The transmission of two viruses can be simultaneous, which leads to the development co-infections. If the D-causative agent later joined the HBV-infected liver cells (hepatocytes), then we will talk about superinfection. A serious condition, which was the result of such a combination of viruses and the clinical manifestation of the most dangerous type of hepatitis (fulminant form), often threatens to be fatal in a short time.

Video: hepatitis B

The most significant parenteral hepatitis (C)

viruses of various hepatitis

The “famous” C-hepatitis virus (HCV, HCV) is a microorganism with unprecedented heterogeneity. The causative agent contains a single-stranded positively charged RNA encoding 8 proteins (3 structural + 5 non-structural), to each of which corresponding antibodies are produced during the course of the disease.

The hepatitis C virus is quite stable in the external environment, it tolerates freezing and drying well, but it is not transmitted in negligible doses, which explains the low risk of infection by the vertical route and during sexual intercourse. A low concentration of an infectious agent in the secrets released during sex does not provide the conditions for the transmission of the disease, unless other factors are present that "help" the virus "move". These factors include concomitant bacterial or viral infections (HIV in the first place), which reduce immunity, and a violation of the integrity of the skin.

The behavior of HCV in the body is difficult to predict. Having penetrated into the blood, it can circulate for a long time at a minimum concentration, forming in 80% of cases a chronic process that can eventually lead to severe liver damage: cirrhosis and primary hepatocellular carcinoma (cancer).

The absence of symptoms or a slight manifestation of signs of hepatitis is the main feature of this form of inflammatory liver disease, which remains unrecognized for a long time.

However, if the pathogen nevertheless “decided” to immediately start damaging the liver tissue, then the first symptoms may already appear after 2-24 weeks and last 14-20 days.

The acute period often proceeds in a mild anicteric form, accompanied by:

• weakness;
• Joint pains;
• indigestion;
• Slight fluctuations in laboratory parameters (liver enzymes, bilirubin).

The patient feels some heaviness on the side of the liver, sees a change in the color of urine and feces, however, pronounced signs of hepatitis, even in the acute phase, are generally not typical for this species and are rare. It becomes possible to diagnose C-hepatitis when the corresponding antibodies are detected by the method (ELISA) and the RNA of the pathogen by conducting (polymerase chain reaction).

Video: film about hepatitis C

What is Hepatitis G

Hepatitis G is considered the most mysterious today. It is caused by a virus containing single-stranded RNA. The microorganism (HGV) has 5 varieties of genotypes and is structurally very similar to the causative agent of C-hepatitis. One (first) of the genotypes chose the west of the African continent for its habitat and is not found anywhere else, the second has spread throughout the globe, the third and fourth “liked” Southeast Asia, and the fifth settled in southern Africa. Therefore, the inhabitants of the Russian Federation and the entire post-Soviet space have "chance" to meet with a representative of type 2.

For comparison: a map of the spread of hepatitis C

In epidemiological terms (sources of infection and transmission routes), G-hepatitis resembles other parenteral hepatitis. As for the role of HGV in the development of inflammatory liver diseases of infectious genesis, it is not defined, the opinions of scientists differ, and the medical literature data remain contradictory. Many researchers associate the presence of the pathogen with the fulminant form of the disease, and also tend to think that the virus plays a role in the development of autoimmune hepatitis. In addition, a frequent combination of HGV with hepatitis C (HCV) and B (HBV) viruses was noticed, that is, the presence of coinfection, which, however, does not aggravate the course of monoinfection and does not affect the immune response during treatment with interferon.

HGV monoinfection usually proceeds in subclinical, anicteric forms, however, as the researchers note, in some cases it does not pass without a trace, that is, even in a latent state it can lead to morphological and functional changes in the hepatic parenchyma. There is an opinion that the virus, like HCV, can hide, and then strike no less, that is, transform into cancer or hepatocellular carcinoma.

When does hepatitis become chronic?

Chronic hepatitis is understood as a diffuse-dystrophic process of an inflammatory nature, localized in the hepatobiliary system and caused by various etiological factors (viral or other origin).

The classification of inflammatory processes is complex, however, like other diseases, besides, there is still no universal methodology, therefore, in order not to load the reader with incomprehensible words, we will try to say the main thing.

Given that in the liver, for certain reasons, a mechanism is triggered that causes degeneration of hepatocytes (liver cells), fibrosis, necrosis of the hepatic parenchyma and other morphological changes that lead to a violation of the functional abilities of the organ, they began to distinguish:

1. Autoimmune hepatitis, characterized by extensive damage to the liver, and, therefore, an abundance of symptoms;
2. Cholestatic hepatitis, caused by a violation of the outflow of bile and its stagnation as a result of an inflammatory process affecting the bile ducts;
3. Chronic hepatitis B, C, D;
4. Hepatitis caused by the toxic effects of drugs;
5. Chronic hepatitis of unknown origin.

It is obvious that the classified etiological factors, associations of infections (coinfection, superinfection), phases of the chronic course, do not fully provide a complete picture of inflammatory diseases of the main organ of detoxification. There is no information about the reaction of the liver to the damaging effects of adverse factors, toxic substances and new viruses, that is, nothing is said about very significant forms:

• Chronic alcoholic hepatitis, which is the source of alcoholic cirrhosis;
• Nonspecific reactive form of chronic hepatitis;
• Toxic hepatitis;
• Chronic hepatitis G, discovered later than others.

For this reason, it was determined 3 forms of chronic hepatitis based on morphological features:

1. Chronic persistent hepatitis (CPH), which is usually inactive, manifests itself clinically for a long time, infiltration is observed only in the portal tracts, and only the penetration of inflammation into the lobule will indicate its transition to the active phase;
2. Chronic active hepatitis (CAH) is characterized by the transition of the inflammatory infiltrate from the portal tracts into the lobule, which is clinically manifested by varying degrees of activity: slight, moderate, pronounced, pronounced;
3. Chronic lobular hepatitis, due to the predominance of the inflammatory process in the lobules. The defeat of several lobules with multibular necrosis indicates a high degree of activity of the pathological process (necrotizing form).

Given the etiological factor

Inflammatory process in the liver refers to polyetiological diseases, as it is caused by a number of reasons:

The classification of hepatitis has been revised many times, but experts have not come to a consensus. Currently, only 5 types of liver damage associated with alcohol have been identified, so it hardly makes sense to list all the options, because not all viruses have been discovered and studied yet, and not all forms of hepatitis have been described. Nevertheless, it may be worthwhile to acquaint the reader with the most understandable and accessible division of chronic inflammatory liver diseases according to etiological grounds:

1. Viral hepatitis, caused by certain microorganisms (B, C, D, G) and uncertain - poorly studied, unconfirmed by clinical data, new forms - F, TiTi;
2. autoimmune hepatitis(types 1, 2, 3);
3. Inflammation of the liver (drug-induced), often detected in "chronics", associated with the long-term use of a large number of drugs or the use of drugs that show severe aggression to hepatocytes for a short time;
4. Toxic hepatitis due to the influence of hepatotropic toxic substances, ionizing radiation, alcohol surrogates and other factors;
5. Alcoholic hepatitis, which, together with the drug-induced one, is classified as a toxic form, but in other cases is considered separately as a social problem;
6. Metabolic that occurs in congenital pathology - disease Konovalov-Wilson. The reason for it lies in the hereditary (autosomal recessive type) violation of copper metabolism. The disease is extremely aggressive, quickly ends with cirrhosis and death of the patient in childhood or young age;
7. Cryptogenic hepatitis, the cause of which, even after a thorough examination, remains unknown. The disease is characterized by progression, requires monitoring and control, as it often leads to severe liver damage (cirrhosis, cancer);
8. Nonspecific reactive hepatitis (secondary). It is often a companion of various pathological conditions: tuberculosis, renal pathology, pancreatitis, Crohn's disease, ulcerative processes in the gastrointestinal tract and other diseases.

Considering that some types of hepatitis are very related, widespread and quite aggressive, it makes sense to give a few examples that are likely to be of interest to readers.

Chronic form of hepatitis C

An important question regarding hepatitis C is how to live with it and how many years they live with this disease. After learning about their diagnosis, people often panic, especially if they receive information from unverified sources. However, this is not necessary. With C-hepatitis they live a normal life, but they have it in mind in terms of some diet (you should not load the liver with alcohol, fatty foods and substances toxic to the organ), increasing the body's defenses, that is, immunity, being careful at home and when sexual contacts. You just need to remember that human blood is contagious.

As for life expectancy, there are many cases when hepatitis, even among lovers of good food and drink, has not shown itself in anything for 20 years, so you should not bury yourself prematurely. The literature describes both cases of recovery and the reactivation phase, which occurs after 25 years, and, of course, a sad outcome - cirrhosis and cancer. Which of the three groups you get into sometimes depends on the patient, given that there is currently a drug - synthetic interferon.

Hepatitis associated with genetics and immune response

Autoimmune hepatitis, which occurs in women 8 times more often than in men, is characterized by rapid progression with a transition to portal hypertension, renal failure, cirrhosis, and ends with the death of the patient. In accordance with the international classification, autoimmune hepatitis can occur in the absence of blood transfusions, liver damage from alcohol, toxic poisons, and medicinal substances.

The cause of autoimmune liver damage is believed to be a genetic factor. Positive associations of the disease with antigens of the major histocompatibility complex (HLA leukocyte system), in particular, HLA-B 8 , which is recognized as an antigen of hyperimmunoreactivity, were revealed. However, many may have a predisposition, but not all get sick. Some drugs (for example, interferon), as well as viruses can provoke an autoimmune lesion of the hepatic parenchyma:

• Epstein-Barra;
• Corey;
• Herpes 1 and 6 types;
• Hepatitis A, B, C.

It should be noted that about 35% of patients who were overtaken by AIH already had other autoimmune diseases.

The vast majority of cases of autoimmune hepatitis begin as an acute inflammatory process (weakness, loss of appetite, severe jaundice, dark urine). After a few months, signs of an autoimmune nature begin to form.

Sometimes AIT develops gradually with a predominance of symptoms of asthenovegetative disorders, malaise, heaviness in the liver, slight jaundice, rarely the onset is manifested by a significant increase in temperature and signs of another (extrahepatic) pathology.

The following manifestations may indicate a detailed clinical picture of AIH:

1. Severe malaise, loss of working capacity;
2. Heaviness and pain on the side of the liver;
3. Nausea;
4. Skin reactions (capillaritis, telangiectasia, purpura, etc.)
5. Itching of the skin;
6. Lymphadenopathy;
7. Jaundice (intermittent);
8. Hepatomegaly (enlargement of the liver);
9. Splenomegaly (enlargement of the spleen);
10. In women, the absence of menstruation (amenorrhea);
11. In men - an increase in the mammary glands (gynecomastia);
12. Systemic manifestations (polyarthritis),

Often AIH is a companion of other diseases: diabetes mellitus, diseases of the blood, heart and kidneys, pathological processes localized in the organs of the digestive system. In a word, autoimmune - it is autoimmune and can manifest itself in any, far from hepatic pathology.

Any liver "does not like" alcohol ...

Alcoholic hepatitis (AH) can be considered as one of the forms of toxic hepatitis, because they have one reason - a negative effect on the liver of irritating substances that have a detrimental effect on hepatocytes. Hepatitis of alcoholic origin is characterized by all the typical signs of inflammation of the liver, which, however, can take place in a sharply progressive acute form or have a persistent chronic course.

Most often, the onset of an acute process is accompanied by signs:

• Intoxication: nausea, vomiting, diarrhea, aversion to food;
• weight loss;
• Jaundice without itching or with itching due to the accumulation of bile acids in the cholestatic form;
• A significant increase in the liver with its compaction and soreness in the right hypochondrium;
• Tremor;
• Hemorrhagic syndrome, renal failure, hepatic encephalopathy with fulminant form. Hepatorenal syndrome and hepatic coma can cause the death of the patient.

Sometimes, in the acute course of alcoholic hepatitis, a significant increase in body temperature is observed, bleeding and the addition of bacterial infections are possible, causing inflammation of the respiratory and urinary tract, gastrointestinal tract, etc.

Chronic persistence of hypertension is oligosymptomatic and often reversible if a person manages to stop in time. Otherwise the chronic form becomes progressive with transformation into cirrhosis.

… And other toxic substances

For the development of acute toxic hepatitis a single dose of a small dose of a toxic substrate is sufficient, which has hepatotropic properties, or a large number of substances that are less aggressive towards the liver, for example, alcohol. Acute toxic inflammation of the liver manifests itself by its significant increase and pain in the right hypochondrium. Many people mistakenly believe that the organ itself hurts, but this is not so. Pain is caused by stretching of the liver capsule due to an increase in its size.

With toxic liver damage, the symptoms of alcoholic hepatitis are characteristic, however, depending on the type of toxic substance, they can be more pronounced, for example:

1. Feverish state;
2. progressive jaundice;
3. Vomiting with an admixture of blood;
4. Nose and gingival bleeding, hemorrhages on the skin due to damage to the vascular walls by toxins;
5. Mental disorders (excitation, lethargy, disorientation in space and time).

Chronic toxic hepatitis develops over a long period of time when small but constant doses of toxic substances are ingested. If the cause of the toxic effect is not eliminated, then after years (or only months) complications can be obtained in the form cirrhosis of the liver and liver failure.

Markers for early diagnosis. How to deal with them?

Viral hepatitis markers

Many have heard that the first step in the diagnosis of inflammatory liver diseases is a study on markers. Having received a piece of paper with the answer to the analysis for hepatitis, the patient is unable to understand the abbreviation if he does not have a special education.

Viral hepatitis markers determined with the help of and, inflammatory processes of non-viral origin are diagnosed by other methods, not excluding ELISA. In addition to these methods, biochemical tests, histological analysis (based on liver biopsy material) and instrumental studies are carried out.

However, we should return to the markers:

• Infectious hepatitis A antigen can be determined only in the incubation period and only in the feces. In the phase of clinical manifestations, class M immunoglobulins (IgM) begin to be produced and appear in the blood. HAV-IgG synthesized somewhat later indicate recovery and the formation of lifelong immunity, which these immunoglobulins will provide;
• The presence or absence of the causative agent of viral hepatitis B are determined by the “Australian antigen” - HBsAg (surface antigen) detected from time immemorial (though not by modern methods) and the inner shell antigens - HBcAg and HBeAg, which became possible to identify only with the advent of laboratory diagnostics by ELISA and PCR. HBcAg is not detected in the blood serum, it is determined using antibodies (anti-HBc). To confirm the diagnosis of HBV and monitor the course of the chronic process and the effectiveness of treatment, it is advisable to use PCR diagnostics (detection of HBV DNA). The patient's recovery is evidenced by the circulation of specific antibodies (anti-HBs, total anti-HBC, anti-HBe) in the serum of his blood in the absence of the antigen itselfHBsAg;
• Diagnosis of C-hepatitis without detection of virus RNA (PCR) is difficult. IgG antibodies, having appeared at the initial stage, continue to circulate throughout life. The acute period and the reactivation phase are indicated by class M immunoglobulins (IgM), the titer of which increases. The most reliable criterion for diagnosing, monitoring and controlling the treatment of hepatitis C is the determination of virus RNA by PCR.
• The main marker for the diagnosis of hepatitis D(delta infection) class G immunoglobulins (anti-HDD-IgG) are considered to persist throughout life. In addition, to clarify monoinfection, super (association with HBV) or coinfection, an analysis is carried out that detects class M immunoglobulins, which remain forever with superinfection, and disappear with coinfection in about six months;
• The main laboratory study of hepatitis G is the determination of viral RNA using PCR. In Russia, antibodies to HGV are detected using specially designed ELISA kits that can detect immunoglobulins to the E2 envelope protein, which is a component of the pathogen (anti-HGV E2).

Hepatitis markers of non-viral etiology

Diagnosis of AIH is based on the detection of serological markers (antibodies):

In addition, the diagnosis uses the determination of biochemical parameters: protein fractions (hypergammaglobulinemia), liver enzymes (significant activity of transaminases), as well as the study of the histological material of the liver (biopsy).

Depending on the type and ratio of markers, types of AIH are distinguished:

• The first is more often manifested in adolescents or in adolescence, or “waits” up to 50;
• The second most often affects childhood, has high activity and resistance to immunosuppressors, quickly transforms into cirrhosis;
• The third type used to stand out as a separate form, but now it is no longer considered in this perspective;
• Atypical AIH representing cross-hepatic syndromes (primary biliary cirrhosis, primary sclerosing cholangitis, chronic viral hepatitis).

Direct evidence of the alcoholic origin of liver damage does not exist, therefore there is no specific analysis for hepatitis associated with the use of ethanol, however, some factors that are very characteristic of this pathology have been noticed. For example, ethyl alcohol, which acts on the hepatic parenchyma, promotes the release of alcoholic hyaline called Mallory bodies, which leads to the appearance of ultrastructural changes in hepatocytes and stellate reticuloepithelial cells, indicating the degree of negative impact of alcohol on the "long-suffering" organ.

In addition, some biochemical indicators (bilirubin, liver enzymes, gamma fraction) indicate alcoholic hepatitis, but their significant increase is characteristic of many pathological conditions of the liver when exposed to other toxic poisons.

Clarification of anamnesis, identification of a toxic substance that affected the liver, biochemical tests and instrumental examination are the main criteria for the diagnosis of toxic hepatitis.

Can hepatitis be cured?

Treatment of hepatitis depends on the etiological factor that caused the inflammatory process in the liver. Of course , hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment .

Viral hepatitis A and E, although of infectious origin, are acute and, as a rule, do not give chronicity. The human body in most cases is able to resist them, therefore it is not customary to treat them, except that sometimes symptomatic therapy is used to eliminate headaches, nausea, vomiting, and diarrhea.

The situation is more complicated with inflammation of the liver caused by viruses B, C, D. However, given that delta infection practically does not occur on its own, but obligately follows HBV, B-hepatitis has to be treated first of all, but with increased doses and lengthened course.

It is not always possible to cure hepatitis C, although the chances of a cure nevertheless appeared with the use of interferons-alpha (a component of the immune defense against viruses). In addition, at present, to enhance the effect of the main drug, combined regimens are used that involve combinations of prolonged interferons with antiviral drugs, for example, ribavirin or lamivudine.

It should be noted that not every immune system adequately responds to the intervention of immunomodulators introduced from the outside into its work, therefore, interferon, for all its advantages, can produce undesirable effects. In this regard, interferon therapy is carried out under the close supervision of a doctor with regular laboratory monitoring of the behavior of the virus in the body. If it is possible to completely eliminate the virus, then this can be considered a victory over it. Incomplete elimination, but the cessation of replication of the pathogen is also a good result, allowing you to "lull the enemy's vigilance" and delay the likelihood of hepatitis turning into cirrhosis or hepatocellular carcinoma for many years.

How to prevent hepatitis?

The expression “It is easier to prevent a disease than to cure” has long been hackneyed, but not forgotten, since many troubles can really be avoided if preventive measures are not neglected. As for viral hepatitis, special care will not be superfluous here either. Compliance with the rules of personal hygiene, the use of specific protective equipment when in contact with blood (gloves, fingertips, condoms) in other cases may well become an obstacle to the transmission of infection.

Medical workers in the fight against hepatitis specifically develop action plans and follow them every point. Thus, in order to prevent the incidence of hepatitis and the transmission of HIV infection, as well as reduce the risk of occupational infection, the Sanitary and Epidemiological Service recommends adhering to certain prevention rules:

1. Prevent "syringe hepatitis" common among people who use drugs. To this end, organize points for the free distribution of syringes;
2. Prevent any possibility of transmission of viruses during blood transfusions (organization of PCR laboratories at stations for transfusion and quarantine storage of drugs and components obtained from donor blood at ultra-low temperatures);
3. Minimize the likelihood of occupational infection to the maximum, using all available personal protective equipment and complying with the requirements of the sanitary and epidemiological surveillance authorities;
4. Pay special attention to departments with an increased risk of infection (hemodialysis, for example).

We should not forget about the precautions for sexual intercourse with an infected person. The chance of sexually transmitting hepatitis C virus is negligible, but for HBV it increases significantly, especially in cases associated with the presence of blood, such as menstruation in women or genital trauma in one of the partners. If you can’t do without sex, then at least you shouldn’t forget about a condom.

There is a higher chance of getting infected in the acute phase of the disease, when the concentration of the virus is especially high, so for such a period it would be better to abstain from sexual relations altogether. Otherwise, carrier people live a normal life, give birth to children, remembering their peculiarities, and be sure to warn doctors (ambulance, dentist, when registering at a antenatal clinic and in other situations that require increased attention) about what is included in risk group for hepatitis.

Increasing resistance to hepatitis

Hepatitis prevention also includes vaccination against a viral infection. Unfortunately, a vaccine against hepatitis C has not yet been developed, but available vaccines against hepatitis A and B have significantly reduced the incidence of these types.

The hepatitis A vaccine is given to children 6-7 years of age (usually before school entry). A single use provides immunity for a year and a half, revaccination (re-vaccination) extends the protection period to 20 years or more.

The HBV vaccine is administered to newborn babies still in the maternity hospital without fail, for children who for some reason have not been vaccinated, or for adults there are no age restrictions. To ensure a full-fledged immune response, the vaccine is administered three times over several months. The vaccine was developed on the basis of the surface ("Australian") HBs antigen.

The liver is a delicate organ

Treating hepatitis on your own means taking full responsibility for the outcome of the inflammatory process in such an important organ, therefore, in the acute period or in the chronic course, it is better to coordinate any of your actions with the doctor. After all, anyone understands: if the residual effects of alcoholic or toxic hepatitis can neutralize folk remedies, then they are unlikely to cope with the rampant virus in the acute phase (meaning HBV and HCV). The liver is a delicate organ, albeit a patient one, so home treatment should be thoughtful and reasonable.

Hepatitis A, for example, does not require anything other than diet, which is necessary, in general, in the acute phase of any inflammatory process. Nutrition should be as sparing as possible, since the liver passes everything through itself. In the hospital, the diet is called the fifth table (No. 5), which is also observed at home for up to six months after the acute period.

In chronic hepatitis, of course, it is not advisable to offer strict adherence to a diet for years, but it would be right to remind the patient that one should not irritate the organ once again. It is advisable to try to eat boiled foods, exclude fried, fatty, pickled, limit salty and sweet. Strong broths, strong and weak alcoholic and carbonated drinks, the liver also does not accept.

Can folk remedies save?

Folk remedies in other cases help the liver cope with the load that has fallen on it, raise natural immunity, and strengthen the body. but they cannot cure hepatitis, therefore, to engage in amateur activities, to treat liver inflammation without a doctor is unlikely to be correct, because each of the types has its own characteristics that must be taken into account in the fight against it.

"Blind" sounding

Often the attending physician himself, when discharging a convalescent from the hospital, recommends simple home procedures for him. For example - "blind" probing, which is done on an empty stomach in the morning. The patient drinks 2 chicken yolks, throwing away the proteins or using them for other purposes, after 5 minutes he drinks it all with a glass of still mineral water (or clean from the tap) and puts it on the right barrel, putting a warm heating pad under it. The procedure takes an hour. You should not be surprised if after it a person runs to the toilet to give away everything unnecessary. Some use magnesium sulphate instead of yolks, however, this is a saline laxative, which does not always provide such comfort to the intestines as, say, eggs.

Horseradish?

Yes, some people use finely grated horseradish (4 tablespoons) as a treatment, diluting it with a glass of milk. Drinking the mixture immediately is not recommended, so it is first heated (almost to a boil, but not boiled), left for 15 minutes so that a reaction occurs in the solution. Use the medicine several times a day. It is clear that such a remedy will have to be prepared every day if a person tolerates a product such as horseradish well.

Soda with lemon

They say that in the same way some people lose weight . But still we have another goal - to treat the disease. Squeeze the juice of one lemon and pour a teaspoon of baking soda into it. After five minutes, the soda will be extinguished and the medicine is ready. Drink for 3 days three times a day, then rest for 3 days and repeat the treatment again. We do not undertake to judge the mechanism of action of the drug, but people do it.

Herbs: sage, mint, milk thistle

Some say that milk thistle, known in such cases, which helps not only with hepatitis, but also with cirrhosis, is absolutely ineffective against hepatitis C, but in return, people offer other recipes:

• 1 tablespoon peppermint;
• Half a liter of boiling water;
• Infused for a day;
• Strained;
• Used throughout the day.

Or another recipe:

• Sage - a tablespoon;
• 200 - 250 grams of boiling water;
• A tablespoon of natural honey;
• Honey is dissolved in sage with water and infused for an hour;
• Drink the mixture on an empty stomach.

However, not everyone adheres to a similar point of view regarding milk thistle and offers a recipe that helps with all inflammatory liver diseases, including C-hepatitis:

1. A fresh plant (root, stem, leaves, flowers) is crushed;
2. Put in the oven for a quarter of an hour to dry;
3. Remove from the oven, lay out on paper and place in a dark place to complete the drying process;
4. Select 2 tablespoons of dry product;
5. Add half a liter of boiling water;
6. Insist 8-12 hours (preferably at night);
7. Drink 3 times a day, 50 ml for 40 days;
8. Arrange a break for two weeks and repeat the treatment.

Video: viral hepatitis in the “School of Dr. Komarovsky”

Hepatitis A, which is also called Botkin's disease, is a viral disease of liver cells that manifests itself with jaundice and intoxication. Unlike other forms of hepatitis, hepatitis A does not contribute to the chronicity of the processes of damage to liver cells and is very rarely the cause of death in people. You can defeat the symptoms of the disease after 2 weeks, and it will also take about one to two months to normalize the structure and functions of the liver after the disease.

Among the population there is no certain group of people who would be more susceptible to the disease than the rest, absolutely everyone, under equal conditions, is at risk of the disease: children, men, women of different social status and age. Moreover, in children aged from one to 10 years, there is a particularly easy transfer of symptoms of the disease, and the elderly and babies of the first year of life get sick in a complicated form.

What it is?

Hepatitis A is an RNA virus belonging to the family Picornoviridae, genus Enteroviruses. Its size is 27-30 nm. The virus has no shell. Typing was carried out in 1973. Further, four more human virus genotypes and three monkey genotypes were identified.

It has been established that, regardless of genotypes, all type A viruses have similar antigenic, immunogenic and protective properties. That is, one serotype, the virus, is determined by the same standard sets of reagents, can be prevented by the same vaccines.

Kinds

The following forms of viral hepatitis A are known:

• icteric;
• with obliterated jaundice;
• anicteric.

The subclinical (inapparent) form is singled out separately, which is diagnosed only on the basis of the results of laboratory tests.

The course of the disease can be acute, protracted, subacute and chronic (extremely rare). Acute infectious hepatitis according to the severity of clinical manifestations can be mild, moderate and severe.

How is hepatitis A transmitted?

The source of infection are sick people at the stages of subclinical course and initial manifestations of the disease, including those with anicteric form. After staining the sclera and skin, contagiousness is significantly reduced. In the third week of pathogenesis, a dangerous virus is isolated only in 5% of patients.

The period of contagiousness, taking into account the incubation period, lasts about a month, less often up to one and a half months.

Proven sources of the spread of the virus, in descending order:

1. Seed food. This method of transmission is of great epidemic importance. However, it is almost impossible to establish the type of dangerous food due to the long incubation period.
2. Direct contact with the patient. It is typical for people with undeveloped hygiene skills and people who are professionally in contact with them. This is how the pathogen is transmitted in preschool and school groups, boarding schools for people with disabilities.
3. Faeces, urine, discharge from the nasopharynx. This method of transmission is called fecal-oral. The main proven factors of transmission of the hepatitis A virus include direct contact between a healthy person and a sick person. The virus can also be transmitted with food, water, airborne droplets (some authors exclude), sexual contact, non-sterile intravenous injections, and through flies - mechanical carriers of the virus.

Meanwhile, products have been identified that are more likely to be factors in the transmission of the virus:

1. Garden berries in fresh and frozen (after thawing) form, especially if shellfish, slugs are found in the beds, next to berry plants, which can accumulate the virus if the beds are watered with fertilizer from human feces.
2. Products prepared without heat treatment or consumed after storage (salads, vinaigrettes, cold appetizers, dried fruits and berries, especially from Kazakhstan and Central Asia);
3. Aerosol. It is hypothetically possible in children's groups with a layering of outbreaks of respiratory diseases in groups with reduced resistance. The virus is transmitted by coughing, sneezing with discharge from the nasopharynx of a sick person.
4. Water. It is typical for territories with undeveloped communal infrastructure, poor organization of water supply, sewerage and wastewater disposal. Significantly increase the risk of infection during accidents and natural disasters.
5. parenteral. Transmission of the virus during blood transfusions, intravenous injections of solutions is not excluded, especially in an environment that precludes the observance of sterility (drug addicts).
6. Transmissible (transmission of the virus through flies). Researchers do not exclude the possibility of transmission of infection through flies, but the prevalence of this factor has not been studied.
7. Sexual. In the literature, it is indicated as a possible transmission factor in homosexuals, while the causal relationship between homosexuality and hepatitis A is not deciphered.

Stages of development

There are several variants of the course of hepatitis A. The disease can occur with a typical clinical picture and asymptomatically. In the case of manifest (flowing with vivid symptoms) forms, several stages are distinguished in the development of the disease.

Incubation period	It lasts 35-55 days, with no symptoms.
prodromal period	Lasts 3 - 10 days. It is manifested by symptoms of general intoxication: weakness, fatigue, lack of appetite, moderate fever. Often, patients develop dyspeptic manifestations in the form of nausea, vomiting, stool disorders, a feeling of heaviness in the right hypochondrium.
icteric period	It has a different degree of severity, lasts 15 - 20 days. In mild cases, yellowing of the visible mucous membranes occurs, with severe jaundice, skin color changes. With the development of jaundice, most patients feel better. Urine darkens, its color is compared with dark beer or tea leaves. Some patients have discolored feces.
convalescence period	Comes after the disappearance of jaundice, lasts 2-4 weeks. At this time, normalization of the functional parameters of the liver occurs, the liver itself decreases to a normal size.

After the transfer of the infection, a stable lifelong immunity is formed. Can you get hepatitis A again? This is excluded, after the transfer of the disease, the body produces cells that protect against re-infection.

Symptoms of Hepatitis A

Viral hepatitis A usually has an acute onset. The prodromal period can proceed in different clinical variants: dyspeptic, febrile or asthenovegetative.

The febrile (flu-like) form of the prodromal period is characterized by:

• increase in body temperature;
• general weakness;
• headache and muscle pain;
• sore throat, dry cough;
• rhinitis.

In the dyspeptic variant of the preicteric period, the manifestations of intoxication are weakly expressed. Typically, patients complain of various digestive disorders (belching, bitterness in the mouth, bloating), pain in the epigastric or right hypochondrium, defecation disorders (constipation, diarrhea, or their alternation).

The asthenovegetative form of the prodromal period in viral hepatitis A is not specific. Manifested by weakness, lethargy, adynamic and sleep disorders.

1. The transition of the disease to the icteric stage is characterized by an improvement in the general condition, normalization of body temperature against the background of the gradual development of jaundice. However, the severity of dyspeptic manifestations in the icteric period not only does not weaken, but, on the contrary, increases.
2. In severe cases of viral hepatitis A, patients may develop hemorrhagic syndrome (spontaneous nosebleeds, hemorrhages on the skin and mucous membranes, petechial rash).

Palpation reveals a moderately painful liver protruding from the hypochondrium. In about 30% of cases, there is an increase in the spleen. As jaundice progresses, lighter stools and darker urine occur. After some time, the urine becomes a rich dark color, and the feces become light gray in color (acholic stools).

The icteric period is replaced by the stage of convalescence. There is a gradual normalization of laboratory parameters and an improvement in the general condition of patients. The recovery period can last up to six months.

Diagnostics

Diagnosis of hepatitis A is based on clinical signs of the disease: liver enlargement, jaundice and other symptoms. The doctor also takes into account epidemiological factors, that is, how they become infected (drinking unboiled water, products of unknown purity, and so on).

Laboratory studies are of decisive importance. Disease specific tests:

• polymerase chain reaction to detect viral genetic material;
• enzyme immunoassay for the detection of antibodies to the IgM class pathogen.

If only IgG antibodies are detected in the body, this indicates a previous disease or immunity to it. The chronic form of the disease does not occur, but there are cases of healthy virus carriers.

Nonspecific laboratory signs of the disease in women and other groups of patients are necessary to assess the severity of the infectious process and the effectiveness of prescribed drugs:

• ALT and AST;
• bilirubin and its fractions (direct, indirect);
• serum protein level, fibrinogen.

Ultrasound is used to determine the size of the liver.

Complications

Hepatitis A rarely gives complications, usually the disease ends with a complete recovery. The most severe complication of Botkin's disease is liver failure. After recovery from hepatitis A, strong immunity is usually maintained and re-infection is not possible. However, if the treatment is not completed, and full recovery has not occurred, a second wave of the disease, a relapse, may occur. This happens in 15% of patients with Botkin's disease and can be repeated repeatedly.

Liver failure is a rare and potentially life-threatening complication of hepatitis in which the liver can stop functioning normally. It usually affects the following groups of people:

• people with weakened immune systems (as a result of a chronic disease such as diabetes or a side effect of certain treatments, such as chemotherapy).
• people with pre-existing liver disease, such as cirrhosis or hepatitis C (a more severe type of hepatitis);

Some symptoms of liver failure are similar to those of hepatitis A and include jaundice, nausea, and vomiting.

Hepatitis A treatment

Patients diagnosed with Hepatitis A are subject to immediate hospitalization in the infectious diseases department. The duration of isolation of patients is at least four weeks.

During periods of development and peak of the disease, bed rest is mandatory. Patients are prescribed a diet consisting of easily digestible foods enriched with vitamins. In case of hemorrhagic phenomena, vikasol is prescribed intramuscularly, and vitamin K is administered orally. In the case of a protracted severe course of the disease, as well as in the presence of itching, corticosteroids are prescribed (most often prednisolone), and a glucose solution is administered subcutaneously and intravenously. In complicated cases, as well as in the presence of concomitant diseases, antibiotics are prescribed (terramycin, penicillin, etc.). To improve the outflow of bile, repeated duodenal sounding is performed.

The treatment of patients with toxic dystrophy is complex, including glutamic acid, corticosteroid hormones, neomycin, a low-protein diet with plenty of fluids.

In most recorded cases, Hepatitis A ends in complete recovery, and this also applies to severe cases. However, there are patients in whom this disease acquires a chronic course, characterized by periodic exacerbations with impaired adequate functioning of the liver.

Chronic Hepatitis A can be acquired due to late hospitalization, various violations of dietary and hygienic regimens, mental and physical overstrain, alcohol consumption, as well as in the case of associated diseases (gastroenterocolitis, influenza, etc.). These forms with symptoms of liver failure for patients can be fatal.

Vaccination

Fortunately, there is a vaccine that can reduce the sensitivity of people to the hepatitis A virus, but it is not included in the mandatory vaccination calendar due to its high cost. There are two types of preventive vaccines, these are:

• solution based on a neutralized disease provocateur virus;
• immunoglobulin containing antibodies to hepatitis and other diseases (infections) derived from donated blood. It is administered by droppers to people living in the same area with the patient, urgently on the first days of the discovery of the disease. This procedure greatly reduces the risk of infection.

Immunoglobulin is administered to populations most at risk of infection:

• military personnel;
• refugees;
• medical workers;
• people working on the mass production of food;
• traveling to third world countries where many cases of the disease are recorded.

Diet

The basis of the treatment of all diseases of the digestive system is a balanced diet. The hepatitis A diet begins during the development of the disease and continues after recovery for several more months.

How do patients eat?

1. You can not reduce the amount of proteins, fats and carbohydrates, their ratio must be correct. Only some indigestible animal fats are limited: beef, pork and mutton.
2. You can not reduce the caloric content of food, calories must correspond to the physiological norm.
3. You need to drink the optimal amount of fluid - 2-3 liters of water per day.
4. Five small meals a day are recommended for patients with hepatitis A.

This dietary regimen must be followed for another six months after recovery. We must not forget that all harmful and spicy foods are prohibited so as not to create a burden on the liver.

Disease prevention

Vaccination can prevent or significantly reduce the risk of contracting hepatitis A. A vaccine is a preparation containing non-viable viruses, the introduction of which into the body causes the production of antibodies and the activation of immunity. For the formation of protection for several years, a single vaccination is sufficient.

To achieve a longer immunity, for 20-25 years, the vaccine must be applied twice every 1-1.5 years.

Hepatitis A - what is it and how is it transmitted? Hepatitis A is the same “jaundice” that parents warn every child about. The disease is often considered a “disease of dirty hands”, since the main route of its spread is fecal-oral. The disease is often severe, and in some cases can be fatal. Therefore, everyone should be well aware of what hepatitis A is, what it is and how it is transmitted, the symptoms, the causes of the disease.

What is hepatitis A

The disease has been known since ancient times, but before doctors did not know what hepatitis A is, what kind of disease it is. It was thought to be caused by blockage of the bile ducts. Only at the end of the 19th century, the famous Russian doctor S.P. Botkin suggested the infectious nature of the disease. In his honor, hepatitis A is also sometimes called Botkin's disease. Currently, medicine has accumulated a lot of data about hepatitis A, what it is and how it is transmitted, how to treat, and how to avoid the disease.

The causative agent of the disease was discovered only in the 1960s of the 20th century. It turned out to be a virus of the picornavirus family. "Pico" - translated from Latin means "small", which is the main characteristic of this infectious agent. It is really very small, its diameter is only 30 nm. Outwardly, the virus is a protein ball, inside of which is an RNA molecule. It is still not known exactly how the virus enters the liver cells once in the body. However, it does such a thing without much difficulty and, by transferring its genetic code to the ribosomes of hepatocytes, causes them to produce new viruses. The result is the death of liver tissue. And the viruses produced by hepatocytes enter the bile and from there - into the human intestine.

The virus is highly resistant to adverse conditions. It does not die in an acidic environment (for example, in the stomach), it can be preserved for years in sea or lake water, when frozen to -20 ° C. On food it lasts up to 10 months, on household items - a week, when heated to +60 ° C - for 12 hours.

Powerless against the virus and many antiseptics, such as ethyl alcohol. Can deactivate the virus:

• formalin,
• bleaching powder,
• potassium permanganate,
• boiling for 5 minutes.

Hepatitis A accounts for approximately 40% of all cases of viral hepatitis. The disease is mainly characteristic of hot developing countries, where there are no clean sources of drinking water, and the hygienic culture of the population leaves much to be desired. A large number of cases is due to the illiteracy of the local population. People do not know anything about hepatitis A, what kind of disease it is, what symptoms the disease has. It is believed that 90% of the population in third world countries have been ill with this disease in childhood.

In developed countries, people have a lot of information about hepatitis A, what it is and how the disease is transmitted. This is largely why the incidence rate in Europe and North America is relatively low. What makes this circumstance dangerous enough for an individual. After all, there is a high risk that the disease will strike a person in old age, when the likelihood of a severe pathology is much higher.

In Russia and the CIS countries, 20-50 cases of the disease per 100,000 people are recorded annually. The peak incidence is in August-late September.

The disease has only an acute form, the chronic form is absent. This is due to the fact that the immune system neutralizes the virus, and it disappears from the body. At the same time, a person who has been ill with hepatitis retains lifelong immunity.

With proper treatment and care, mortality from hepatitis is low. It is 0.5% in children and 1.5% in people over 60 years of age. In older people, the disease is generally more severe. Most of the deaths from the disease are associated with the presence of other viral hepatitis (B or C), severe somatic diseases, and immunodeficiency states in the patient. A fatal outcome is also possible due to improper treatment or the patient's lifestyle (for example, drinking alcohol).

How hepatitis A is transmitted: transmission factors and routes of infection

The cause of the disease is the entry of a virus into the body. Any person who has not previously suffered from this disease and has not been vaccinated against it can become infected with the hepatitis A virus.

The virus is transmitted, as a rule, by the oral-fecal route. Since the virus can persist for a long time under adverse conditions, it is found in large quantities in various water bodies. Therefore, the main reason for contracting the disease is the use of unboiled water contaminated with the virus. Moreover, not only drinking, but also water used for other procedures, such as brushing teeth, washing hands, dishes, vegetables and fruits. Infection is also possible after swimming in polluted waters.

If uninfected people are in the same room with the patient, then the virus can be transmitted through household items (door handles, dishes, towels).

Hematogenous infection is also possible, but such cases are rare. This mode of distribution is more typical for developed countries. In particular, it affects people who inject drugs. It is also possible to get infected during anal sex.

Terms of the disease

The disease is usually treated for a period of 1 week to 1.5-2 months. The duration of the disease depends on many factors:

• patient's age;
• the amount of the virus that has entered the body;
• state of immunity;
• methods of treatment;
• the presence of concomitant diseases in the patient, especially the liver.

Gradually, the symptoms of the disease disappear, and the patient recovers. However, in rare cases, relapses can also occur, when an outwardly recovered person may again have one or two more episodes of exacerbation.

Incubation period

The period starting from the moment of infection and ending with the appearance of the first clinical signs is called the incubation period. The incubation period of the disease can last from 7 to 50 days, most often 14-28 days. It should be noted that during the incubation period the patient is a virus carrier and poses a danger to others as a source of infection.

Forms of hepatitis A

The disease can have both icteric and anicteric forms. In the anicteric form, the disease is much more difficult to identify by its manifestations than in the icteric form. The anicteric form is more typical for children under 6 years of age, approximately 90% of them carry the disease in a similar form. In adults, the anicteric form is observed only in 30% of cases.

Also, in addition to the acute form of hepatitis A, there is also a fulminant form of the disease. It is extremely rare in children and young people, but in the elderly it makes up a few percent of all cases of the disease. As already mentioned, in the acute form, mortality is relatively low, which cannot be said about the fulminant form. With a fulminant form, acute liver failure quickly develops and a fatal outcome is very likely.

How does it manifest

After the incubation period, during which there are no signs of the disease, the prodromal period begins, when the first clinical symptoms appear.

Unfortunately, many people know little about the disease - what it is, how it is transmitted, the symptoms of the disease. According to a common misconception, the very first manifestation of Botkin's disease is jaundice. But in fact, the signs of hepatitis A initially resemble those of the flu - high fever, headaches. The temperature usually rises to values ​​of + 38-39 ° С. However, in many cases there is no such symptom.

Then there are signs of indigestion - nausea, vomiting, stool disorders, pain in the abdomen. Bitterness appears in the mouth, the color of urine and feces changes. Due to the presence in the urine of the bile pigment - bilirubin, the urine becomes dark in color. What can not be said about feces, since, on the contrary, it becomes discolored due to a lack of the stercobilin pigment supplied with bile, which is normally responsible for the dark color of excrement. Unpleasant sensations may appear in the region of the right hypochondrium - heaviness or dull pain, as well as pain in muscles and joints, skin itching.

The next stage in the development of signs of the disease is the appearance of jaundice, which occurs only on the 5-10th day. Due to an excess of bilirubin in the blood, the skin, mucous membranes and eyeballs of the patient become yellow. A similar phenomenon is observed with an increase in the concentration of bilirubin in the blood to 200-400 mg / ml. After the onset of jaundice, the temperature usually subsides. This syndrome will soon pass.

By the time jaundice appears, the patient ceases to secrete viruses and be contagious to others. Therefore, bed rest for the patient can be changed to half-bed. The icteric period lasts from 5 to 30 days and ends with a recovery period.

In severe cases of the disease, nosebleeds, hemorrhages on the skin can be observed, which should be feared, as they are evidence of a hemorrhagic syndrome.

Also, with hepatitis A, an increase in the liver is usually observed, and in 30% of cases, an increase in the spleen. The latter is associated with an increased load on the immune system, an important component of which is the spleen.

Diagnostics

When diagnosing, it is important to separate other infectious diseases from hepatitis A due to its increased contagiousness. Diagnosis is complicated by the fact that the disease has symptoms similar to those of other types of hepatitis. And it is not always possible to say with certainty that such symptoms appear precisely with hepatitis A, and not, say, with the serum form of the disease. To identify the disease, it is usually not enough just to examine the patient. Although many characteristic signs (jaundice, liver enlargement) indicate an inflammatory process in the liver, however, they may not always accompany the disease.

Various methods are used to determine the type of hepatitis, such as a blood test for antibodies. There is also a more reliable PCR method, but it requires expensive equipment and cannot be carried out everywhere.

Biochemical and general blood tests are also carried out. An elevated level of liver enzymes - bilirubin, AST and ALT indicates pathological processes in the liver. With the disease, there is also an increase in the prothrombin index, an increase in ESR, and leukocytosis. Ultrasound, radiography, CT and MRI methods allow us to assess the physical condition of the liver and adjacent organs.

Hepatitis A - how to treat and how to avoid

Treatment of the disease and its prevention are issues that are most important from a practical point of view. How to treat and how to avoid the disease? Treatment is usually carried out at home, except in cases aggravated by severe liver failure. Children under one year of age and elderly patients are also hospitalized. The disease is usually treated by an infectious disease specialist. Sometimes self-medication is practiced, which should be avoided, since only an experienced specialist knows everything about hepatitis A, what it is and how to treat it.

There are no specific antiviral drugs directed against the hepatitis A virus. However, in severe cases, interferon injections can be made to the patient. In general, in most cases, the body copes with the disease on its own. It is important to provide the patient with bed rest. He also needs to drink plenty of water - to detoxify the body. Medicines are prescribed to the patient only by a doctor. A large number of drugs can create problems for a patient's diseased liver. In particular, according to WHO recommendations for hepatitis A, paracetamol should not be used to reduce fever.

To restore liver function impaired due to hepatitis, vitamin complexes, hepatoprotectors can be prescribed. Enterosorbents are used to remove toxins from the intestines, enzyme preparations are used to improve digestion, and cholagogues and antispasmodics are used to speed up the excretion of bile.

diet for hepatitis

Diet is also an important element of treatment. From the patient's diet, it is necessary to exclude fried, salty and spicy foods, canned food, indigestible foods, mushrooms, animal fats (fatty meats and fish), fresh bread, pastries, coffee and chocolate, carbonated drinks.

Food should be taken in small portions, but often (5-6 times a day).

Diets should be followed not only during hepatitis, but also during the recovery period (about six months).

Prevention

In order to avoid the disease, all people must be well aware of the disease, know what it is, how it is transmitted, the symptoms of the disease.

Measures to provide the population with clean drinking water, as well as to dispose of wastewater and food waste, control over compliance with sanitary and hygienic standards by employees of public catering establishments and medical personnel contribute to reducing the incidence of hepatitis across countries and regions.

The family of a person with hepatitis A must be careful in dealing with him to avoid infection. The patient should be allocated a separate room. The bed linen of the patient must undergo a disinfection procedure before washing (boiling in 2% soapy water for 15 minutes). The dishes from which the patient ate should also be boiled in a 2% soda solution for 15 minutes. Floors, doorknobs and other surfaces should be washed with a warm 2% soap or soda solution.

In general, measures to prevent hepatitis A are simple. They include:

• refusal to use raw unboiled water, not only for drinking, but also for washing dishes or brushing your teeth;
• washing hands regularly, especially after going to the toilet;
• washing vegetables and fruits.

Particular caution should be exercised by those who visit southern countries and taste local exotic food. In particular, the hepatitis A virus can live in some shellfish caught in contaminated water. Therefore, one should make it a rule in such conditions not to eat any food that has not undergone sufficient heat treatment.

If there is no access to clean, disinfected water, then water from unsafe sources must be boiled for at least 10 minutes.

Hepatitis A vaccination

Also, for preventive purposes, vaccination against hepatitis A is possible. The vaccine contains neutralized viruses. There are several categories of citizens who are vaccinated on a mandatory basis - doctors, workers in the food industry and catering establishments, the military, who spend a lot of time in field camps. Vaccinations are also recommended for people traveling to hot countries.

Immunity after vaccination against hepatitis A is not formed immediately, but after 3-4 weeks. Re-vaccination is necessary to enhance the effect. It is done 6 months after the first. A series of two vaccinations, however, does not provide lifelong immunity. It is usually valid for 8 years.

Forecast and consequences

The prognosis of hepatitis is favorable. However, complete recovery from the effects of the disease can take a long time.

The recovery period after an active period of hepatitis can last up to 6 months. During this period, the patient must follow a sparing diet.

After the disease, the patient remains immune for life, so re-infection with hepatitis is unlikely. However, an active disease can cause some harm to the liver and the consequences of hepatitis can be felt by a person who has had it all his life.

Possible complications of hepatitis A include:

• biliary dyskinesia,
• cholecystitis,
• chronic,
• cholangitis.

Viral hepatitis A(Botkin's disease) is an acute infectious lesion of the liver, characterized by a benign course, accompanied by necrosis of hepatocytes. Viral hepatitis A is included in the group of intestinal infections, since it has a fecal-oral infection mechanism. In the clinical course of viral hepatitis A, there are pre-icteric and icteric periods, as well as convalescence. Diagnosis is carried out according to the data of a biochemical blood test, the results of RIA and ELISA. Hospitalization of patients with viral hepatitis A is necessary only in severe cases. Outpatient treatment includes diet and symptomatic therapy.

General information

Viral hepatitis A(Botkin's disease) is an acute infectious lesion of the liver, characterized by a benign course, accompanied by necrosis of hepatocytes. Botkin's disease refers to viral hepatitis, transmitted by the fecal-oral mechanism, and is one of the most common intestinal infections.

Exciter characteristic

The hepatitis A virus belongs to the genus Hepatovirus, its genome is represented by RNA. The virus is quite stable in the environment, persisting for several months at 4 °C and for years at -20 °C. At room temperature, it remains viable for several weeks, dies when boiled after 5 minutes. Ultraviolet rays inactivate the virus after one minute. The pathogen may survive for some time in chlorinated tap water.

Hepatitis A is transmitted by the fecal-oral mechanism, predominantly by water and alimentary routes. In some cases, it is possible to become infected by household contact when using household items, utensils. Outbreaks of viral hepatitis A in the implementation of the water route of infection usually occur when the virus enters public water tanks, the food route of infection is possible both when eating contaminated vegetables and fruits, and raw shellfish that live in infected water bodies. The implementation of the contact-household path is typical for children's groups, where insufficient attention is paid to the sanitary and hygienic regime.

The natural susceptibility to the hepatitis A virus in people is high, the greatest is in children of prepubertal age, post-infection immunity is tense (slightly less tension is characteristic after a subclinical infection) and long. Infection with viral hepatitis A most often occurs in children's groups. Among adults, the risk group includes employees of catering departments of preschool and school nurseries, as well as medical and preventive and sanatorium-resort institutions, food processing plants. Currently, collective outbreaks of infection among drug addicts and homosexuals are increasingly noted.

Symptoms of viral hepatitis A

The incubation period of viral hepatitis A is 3-4 weeks, the onset of the disease is usually acute, the course is characterized by a successive change of periods: pre-icteric, icteric and convalescence. The preicteric (prodromal) period proceeds in various clinical variants: febrile, dyspeptic, asthenovegetative.

The feverish (flu-like) variant of the course is characterized by a sharply developed fever and intoxication symptoms (the severity of the general intoxication syndrome depends on the severity of the course). Patients complain of general weakness, myalgia, headache, dry cough, sore throat, rhinitis. Catarrhal signs are moderately expressed, reddening of the pharynx is usually not observed, their combination with dyspepsia (nausea, loss of appetite, belching) is possible.

The dyspeptic variant of the course is not accompanied by catarrhal symptoms, intoxication is not very pronounced. Patients complain mainly of digestive disorders, nausea, vomiting, bitterness in the mouth, belching. Often there is a dull moderate pain in the right hypochondrium, epigastrium. Perhaps a defecation disorder (diarrhea, constipation, their alternation).

The preicteric period proceeding according to the asthenovegetative variant is not very specific. Patients are lethargic, apathetic, complain of general weakness, suffer from sleep disorders. In some cases, prodromal signs are not observed (latent variant of the preicteric period), the disease begins immediately with jaundice. If there are signs of several clinical syndromes, they speak of a mixed variant of the course of the preicteric period. The duration of this phase of infection can be from two to ten days, on average, the prodromal period usually takes a week, gradually moving into the next phase - jaundice.

In the icteric period of viral hepatitis A, the signs of intoxication disappear, the fever subsides, and the general condition of patients improves. However, dyspeptic symptoms, as a rule, persist and worsen. Jaundice develops gradually. First, darkening of the urine is noted, the sclera, mucous membranes of the frenulum of the tongue and soft palate acquire a yellowish tint. In the future, the skin turns yellow, acquiring an intense saffron shade (hepatic jaundice). The severity of the disease may correlate with the intensity of skin staining, but it is preferable to focus on dyspeptic and intoxication symptoms.

In severe hepatitis, there may be signs of hemorrhagic syndrome (petechiae, hemorrhages on the mucous membranes and skin, nosebleeds). On physical examination, a yellowish coating on the tongue and teeth is noted. The liver is enlarged, moderately painful on palpation, in a third of cases there is an increase in the spleen. The pulse is somewhat slowed down (bradycardia), blood pressure is lowered. Feces brighten up to complete discoloration at the height of the disease. In addition to dyspeptic disorders, patients may complain of asthenovegetative symptoms.

The duration of the icteric period usually does not exceed a month, averaging 2 weeks, after which a period of convalescence begins: there is a gradual regression of clinical and laboratory signs of jaundice, intoxication, and the size of the liver normalizes. This phase can be quite long, the duration of the convalescence period usually reaches 3-6 months. The course of viral hepatitis A is predominantly mild or moderate, but in rare cases, severe forms of the disease are noted. Chronization of the process and virus carrying for this infection are not typical.

Complications of viral hepatitis A

Viral hepatitis A is usually not prone to exacerbations. In rare cases, an infection can provoke inflammatory processes in the biliary system (cholangitis, cholecystitis, biliary tract and gallbladder dyskinesia). Sometimes hepatitis A is complicated by the addition of a secondary infection. Severe liver complications (acute hepatic encephalopathy) are extremely rare.

Diagnosis of viral hepatitis A

In the general analysis of blood, a reduced concentration of leukocytes, lymphocytosis, ESR is increased. Biochemical analysis shows a sharp increase in the activity of aminotransferases, bilirubinemia (mainly due to conjugated bilirubin), a low content of albumin, a low prothrombin index, an increase in sublimate and a decrease in thymol samples.

Specific diagnosis is carried out on the basis of serological methods (antibodies are detected using ELISA and RIA). In the icteric period, an increase in Ig M is noted, and in the convalescent period, IgG. The most accurate and specific diagnosis is the detection of virus RNA in the blood using PCR. Isolation of the pathogen and virological examination is possible, but due to the complexity of general clinical practice, it is impractical.

Treatment of viral hepatitis A

Botkin's disease can be treated on an outpatient basis, hospitalization is carried out in severe forms, and also according to epidemiological indications. During the period of severe intoxication, patients were prescribed bed rest, diet No. 5 (in the version for the acute course of hepatitis), and vitamin therapy. Nutrition is fractional, fatty foods are excluded, products that stimulate the production of bile are encouraged, dairy and vegetable components of the diet are encouraged.

A complete exclusion of alcohol is necessary. Etiotropic therapy for this disease has not been developed, a set of therapeutic measures is aimed at alleviating symptoms and pathogenetic correction. For the purpose of detoxification, a plentiful drink is prescribed, if necessary, infusion of crystalloid solutions. In order to normalize digestion and maintain intestinal normobiocenosis, lactulose preparations are prescribed. Antispasmodics are used to prevent cholestasis. If necessary, prescribe drugs UDCA (ursodeoxycholic acid). After clinical recovery, patients are under dispensary observation by a gastroenterologist for another 3-6 months.

In the vast majority of cases, the prognosis is favorable. With complications from the biliary tract, the cure is delayed, but with false therapy, the prognosis is not aggravated.

Prevention of viral hepatitis A

General preventive measures are aimed at ensuring high-quality purification of drinking water sources, control over wastewater discharge, sanitary and hygienic requirements for the regime at public catering establishments, in the food units of children's and medical institutions. Epidemiological control is carried out over the production, storage, transportation of food products, in case of outbreaks of viral hepatitis A in organized groups (both children and adults), appropriate quarantine measures are taken. Patients are isolated for 2 weeks, their infectivity after the first week of the icteric period comes to naught. Admission to study and work is carried out upon the onset of clinical recovery. Contacts are monitored for 35 days from the date of contact. In children's groups, quarantine is assigned for this time. In the focus of infection, the necessary disinfection measures are taken.