Download Vir Hep 2

Viral Hepatitis
Clinics, diagnostics,
treatment and prophylaxis
Asymptomatic form: the specific markers of
infectious agent and proper immunological
changes are exposed only
Sub-clinical form: immunologic, biochemical and
histological changes, however exposed clinical
signs of illness are absent
Non-jaundice form: appears different clinical
symptoms of illness except jaundice
Jaundice form: appears jaundice, which is the
main sign of hepatitis
Fulminant (malignant) form: extremely severe
Duration of hepatitis:
Acute – till 3 months;
Prolonged – from 3 to 6 months;
Chronic – more than 6 months.
Periods of viral hepatitis, with jaundice:
1. Pre jaundice (initial , prodromal);
2. Jaundice or climax of disease;
3. Period of recovery.
Pathologic syndromes of liver
affection
Cytolytic – ↑ ALT, LDG, Cu;
↓ albumins, protrombin
 Mesenchimal-inflammation – ↑ α-, γ globulins, tymol-test
 Cholestasis – ↑ bilirubin, bile acids,
cholesterine, GGTP, alkaline
phosphatase

Variants of initial period:
1.
2.
3.
4.
5.
Asteno-vegetative: general weakness, fatigue,
headache, insomnia, and change in behavior;
Dyspeptic: anorexia, nausea, vomiting, abdominal
pain, diarrhea;
Catarrhal: influenza, feeling of scratching in
throat, hyperemia of conjunctiva and mucus of soft
palate, dry cough, increase of body temperature;
Artharalgic: characterized by pain in joints
without local inflammatory changes;
Mixed
Criteria for severity of viral hepatitis:
1.
2.
3.
4.
5.
6.
Stage of intoxication;
Intensity of jaundice;
Liver sizes (mild – enlarged from 1 to 2 cm on right
mid-clavicle line, moderate – from 3 to 5 cm, severe
– 6 and more or vice versa decreases);
Level of bilirubin (respectively 85 micmol/l, 86 –
170 micmol/l and >170 micmol/l);
Complications;
Index of albumin transport function.
Clinical peculiarities of viral hepatitis A:
1.
2.
3.
4.
5.
6.
7.
8.
Short incubation period (3 – 6 weeks);
Acute beginning;
Mostly catarrhal syndrome in prodromal period;
Short prodromal period (5 – 7 days);
Quick appearance of jaundice (within some days);
Improvement of self feelings with appearance of
jaundice;
Mild forms are predominant, severe forms occurs
rarely;
Jaundice period persist not more than 1-2 weeks.
Clinical peculiarities if viral hepatitis B:
1.
2.
3.
4.
5.
6.
7.
Long incubation period (more than 45 days,
maximum – 6 months);
Progressive beginning of disease;
Often arthralgic syndrome in prodromal period (20 –
30 %);
Prurience of skin and urticaria in prodromal period;
Prodromal period often persist more than 2 weeks;
Progressive appearance of jaundice, sometimes 2
weeks and more;
Self feelings do not improve with appearance of
jaundice;
Prolonged and severe jaundice period, less than
during hepatitis A;
9. Often exacerbations, remissions and complications
(reason may be hepatitis D infection);
10. Presence of expressed asthenic syndrome during all
clinical periods of disease, prolonged post hepatic
asthenia, sometime years and more;
11. Possible transformation into chronic hepatitis (in 5 –
15% cases) and then into liver cirrhosis (in 15 – 30%
patients of chronic hepatitis);
12. Hepatitis B often run on background of concomitant
diseases.
8.
Rashes in
case of viral
hepatitis
Icteric sclera
Skin jaundice
Skin jaundice
Criteria for without jaundice form of viral
hepatitis :
1.
2.
3.
4.
5.
6.
Concrete epidemiological data (contact with patient
or parenteral manipulations, which according to
time are similar to maximum incubation period);
Typical prodromal period;
Presence of hepatic splenomegaly syndrome;
Brick color of urine (lot of urobilin);
High activity of serum ALT;
Positive data of specific investigation (presence of
infectious agent’s markers).
1.
2.
3.
4.
5.
6.
7.
8.
Signs of cholestatic form of viral hepatitis:
Developed pruritis of skin;
Mild intoxication or absent;
Green or grey-green shade of jaundice;
Liver has normal sizes or little enlarged;
Activity of secretary enzymes is elevated in blood
(alkaline phosphates, gammaglutamiltranspeptidase),
quantity of β-lipoproteins, cholesterol and salts of
bile acids;
Don’t present urobilin in urine and stercobilin in
stools;
Little elevation or normal activity of liver cell’s
enzymes;
Prolonged duration – 3-5 months and more.
Precursors of liver coma:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Quick increase of jaundice and intoxication;
Memory disturbances;
Inversion of sleep;
Complaints about pain in liver region;
Liver smell from mouth;
Elevation in body temperature;
Tremors;
Appearance of hemorrhagic syndrome;
Tachycardia;
Decreasing of liver sizes;
Bilirubin-enzymes dissociation;
Elevation of nitrogen products concentration in blood;
Decreasing of prothrombin index <50%;
Appearance of tyrosine and lucien in urine;
Periods of acute hepatic encephalopathy:
1.
2.
3.
4.
Pre-coma 1, 2.
Initial period of precoma (period of precursors);
Finishing period of precoma (partial disorders of
consciousness);
Coma 1, 2.
Superficial coma (loss of verbal contact with kept
reactions on painful irritations);
Deep coma (disappear pain reaction).
Diagnostic
Preliminary diagnosis of viral hepatitis is
based on epidemiological anamnesis
 finding of the development of the disease,
clinical picture, duration of incubation period
 character of prejaundice period
 presence of typical subjective and objective
signs with account of the patients age

Diagnostic
Routine blood test – lymphocytosis,
anemia and leucopenia, ESR is slightly
decreased
 In urine - urobilin and bile pigments
 In blood serum - bilirubinemia (direct
fraction) increasing activity of ALT, ACT,
testifying about the presence of
cytolytic processes in the liver

Diagnostic
Revealing of specific antigens and
antibodies to antigens in the blood
 Discovery of antibodies of class IgM
testifies about acute disease
 Discovery antibodies of other classes
of immunoglobulins testifies about
chronic course of viral hepatitis

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Differential diagnosis
Influenza
Food born toxic infections
Acute appendicitis
Leptospirosis
Infection mononucleosis
Pseudo-tuberculosis
Malaria
Toxic hepatitis
Pregnancy toxicosis
Hemolytic jaundice
Sub-hepatic mechanical jaundice
Pigmented hepatosis ( syndrome ZhielberMailengrkht, Krigler-Nayar, Dabin-Jhonsen and
Rotor)
Treatment
Bed regime
 Diet № 5
 Polyvitamines (A, B, E)
 Desensitizing drugs: calcium gluconate,
Diazolin, Diprazin or Tavegil
 Ferment drugs: Festal, Digestal,
Enzystal, Panzinorm, Pancurmen,
Allochol, Cholenzym.

Treatment
Plentiful drink
 In Vein - 5 % solution of glucose, saline
solutions, Ringer’s solution, Trisault,
Quartasault, 20 % solution of Sorbit (or.
Sorbitoli), donor Albumin
 Enterosorbents of different brands:
Carbaphosfer, Carbosilan, Sillard P,
Enterosgel, Polyphepan
 Drugs for improving of metabolism in
hepatocytes: ascorbinic acid, Thiamin
chlorid, pyridoxine hydrochloride,
cocarboxylase, potassy Orotat, Riboxin,
Citochrom C, Lipamid, Calcy Pangamat

Treatment:
Etiotropic: antiviral preparations (lamivudin); natural
interferon (velferon, human leukocytes interferon,
leukinferon); recombinant interferon (intron A, roferon,
reaferon, laferon); inductors of endogenous interferon
stimulators (cycloferon, amikain).
Pathogenetic: disintoxication therapy; entero-sorbents,
immunomodulators methods; glucocorticoids; hepatoprotectors (bioflavonoids, analogue of amino acids,
essential phospholipids);
Symptomatic: regulators of motor function; enzymes
preparations; cholekinetics; choleretics; herbal therapy;
vitamin therapy.
Prophylaxis

Hepatitis А и Е
Medical observation in epidemic spot during 35 days; laboratory
examination of contact persons (blood analyses of bilirubin level,
alaninaminotrasferase activity, bile pigments in urine)
Children under 10 and pregnant women - injection of human
immunoglobuline, for others - amizon, mephenamine acid;
Current and final desinfection;
Sanitary control measures;
Active immunization – HAV-Vax;

Parenteral hepatitis (В, С, D)
Use of disposable medical instruments, thorough sterilisation of nonexpendable instruments
Clinical and laboratory examination of blood and organ donors;
Specific prophylaxis - vaccination against B hepatitis HB-Vax, Ingerix-B