Acute viral hepatitis: symptoms and treatment

Acute viral hepatitis — is an infectious liver disease that causes specific microorganisms. Depending on which bacterium became the source of the disease, the form of hepatitis will be determined. In addition to specific bacteria, the cause of the development of this pathology may be other, unknown microorganisms. There are also a number of predisposing factors that increase the risk of developing the disease.



The clinical picture is different for each type of disease, but clinicians identify a group of the most characteristic manifestations. For example, an increase in the volume of the affected organ, jaundice of the skin and sclera, as well as pain syndrome in the area under the right ribs.

Diagnosis is based on laboratory studies that help differentiate the pathogen, but they must be supplemented by instrumental examinations and physical examination.

Treatment in the vast majority of cases is conservative and is based on the observance of a sparing diet and taking medications.

Etiology

Clinicians identify several of the most common forms of viral liver damage and, accordingly, the viruses that cause them:


  • hepatitis A — HAV causative agent , belongs to the family of picornaviruses and is resistant to the external environment. The carrier of the bacterium is the infected person. In a healthy body can penetrate several ways — bathing in ponds with contaminated water, using common household items with the patient, unprotected sex, eating foods that have already bitten or touched the infected, and also during coughing and sneezing
  • hepatitis B causative agent — HBV . It is transmitted only parenterally — this means that it is sufficient to infect any biological fluid from the patient to the skin or mucous membrane of a healthy person. The main routes of infection are unprotected sex, blood transfusion, the use of common manicure supplies or the use of one toothbrush with an infected
  • hepatitis C — HCV causative agent . Its danger lies in the fact that it is constantly changing. To date, there are more than ten varieties of a similar bacterium. You can get infected through contact with any biological fluid of the patient, unprotected sexual intercourse, the introduction of narcotic substances with an infected needle, blood transfusion and other medical manipulations. It is worth noting that sometimes it is not possible to find out the source of such a variety of viral hepatitis. In such cases, they speak of acute viral hepatitis of unspecified etiology;
  • hepatitis D — HDV . The peculiarity of microorganisms is that it contains the antigen of hepatitis B. It follows that the development of such a form of illness is impossible without leakage or previous hepatitis B. It is one of the most rare and at the same time dangerous types of disease
  • hepatitis E — HEV causative agent . Infection can occur during labor, when visiting a manicure or dental office, in the process of blood transfusions or eating food contaminated foods
  • Hepatitis F — HFV . It is the rarest form of viral liver damage, as it was discovered not so long ago, thanks to the improvement of laboratory diagnostic studies. Often, the bacterium is transmitted through blood transfusions, but infection can also occur due to consumption of food or drinking liquid contaminated with a similar bacterium. Also, the possibility of transmitting the pathogen from the mother to the child, during its intrauterine development or in the process of delivery, is not excluded
  • hepatitis G — HGV pathogens . It is noteworthy that it belongs to the family of flaviviruses and is very similar to HCV, which is why the pathways of infection will be similar.

In addition to the main sources of acute viral hepatitis, there are also certain ailments and microorganisms that can affect the formation of the inflammatory process in the liver. To them it is necessary to carry:


  1. viruses — cytomegalovirus, yellow fever, Epstein-Barr virus, sources of diseases such as measles, chicken pox and rubella
  2. bacteria that affect the onset of actinomycosis, pyogenic abscess or tuberculosis
  3. fungi that cause histoplasmosis or Darling’s disease, cryptococcosis, blastomycosis or coccidiomycosis
  4. The simplest microorganisms, in particular, causing amoebiasis, malaria, toxoplasmosis and visceral leishmaniasis
  5. helminths that cause the development of ascariasis and clonorchosis, echinococcosis and fascioliasis, schistosomiasis and toxocarosis
  6. spirochetes of leptospirosis, syphilis, or relapsing fever
  7. unclear genesis.

In addition, it is worth highlighting the main risk group, which is most susceptible to the development of such a disease. This category includes people who:


  • are close relatives or sexual partners of an infected person
  • abuse of injecting drug use
  • need a blood transfusion, hemodialysis or a transplant of a donor organ, in particular a liver
  • due to their professional activities are forced to contact the infected biological fluids of the patient;
  • have STDs in the medical history;
  • are fond of piercing or drawing tattoos;
  • suffer from other liver diseases
  • are born from mothers with a similar diagnosis.

It follows that absolutely everyone can be infected, regardless of age category, gender and social status. Moreover, the disease has no seasonality or periodicity.

Acute viral hepatitis can result in either recovery or chronicization of the inflammatory process followed by the development of other complications.

Classification

Currently, there are several types of this disease, depending on the nature of the course. Thus, the pathology proceeds in such forms:


  1. icteric — is one in those cases where, in addition to the main symptomatology, specific jaundice manifestations are expressed
  2. jaundiced — based on the name, it follows that there are no signs of jaundice
  3. subclinical — Symptoms are either not observed or expressed so poorly that they are written off to completely different disorders
  4. erased — observed in people with strong immunity. In such cases, clinical signs are not expressed, and the disease takes the form of a virus carrier, while the person remains dangerous to others.

The severity of the course of acute viral hepatitis is divided into:


  • light — is expressed in a slight manifestation of symptoms that have little effect on the patient’s well-being
  • moderate — characterized by worsening of symptoms and the appearance of jaundice
  • severe — in addition to a vivid expression of symptoms, often leads to complications
  • fulminant — differs in its malignancy, as it develops at lightning speed and often causes death.

The duration of the incubation period, ie, the time from the moment of infection to the appearance of the first clinical signs, each of the types of pathology has different:


  1. hepatitis A — from one week to fifty days, but often is one month
  2. hepatitis B — from 1.5 months to 6 months, but usually lasts about two to four months
  3. hepatitis C — from two to twenty-six weeks;
  4. hepatitis D — from 42 days to six months, but may be shorter — about twenty days
  5. hepatitis E — two to eight weeks
  6. hepatitis F — from two weeks to a month
  7. hepatitis G — about a month.

For a typical clinical picture, the following stages of the progression of acute viral hepatitis are characteristic:





  • incubation period;
  • The pre-egg period is the time of expression of the first symptoms
  • icteric period — in some cases may be absent;
  • the period of height of symptoms;
  • post-jaundice period;
  • period of convalescence or chronic inflammation in the liver

Symptoms

As mentioned above, depending on which virus was the source of the pathology, the clinical picture will differ.

Hepatitis A is characterized by such symptoms:


  1. a sharp rise in temperature — after a few days the indicators come back to normal. It is noteworthy that such a symptom will not be present in all patients
  2. general weakness and malaise
  3. muscle aches and body aches
  4. headaches of varying intensity;
  5. aversion to food
  6. Attacks of nausea that do not lead to vomiting, but with the development of the disease, frequent vomiting can occur;
  7. sleep disorder;
  8. discomfort and heaviness in the abdomen
  9. bloating
  10. severe tenderness in the area under the right ribs
  11. burp, accompanied by an unpleasant odor
  12. alternating diarrhea and constipation
  13. Persecution in the throat.

Symptoms of hepatitis B are:


  • fatigue and lethargy;
  • loss of appetite;
  • a slight increase in temperature;
  • head and throat pain
  • cough and runny nose
  • violation of the defecation process
  • nausea and vomiting
  • pain in the projection of the affected organ
  • increase in the volume of the abdomen;
  • strong dizziness;
  • periods of unconsciousness
  • the swelling of the lower limbs;
  • nasal hemorrhage

Hepatitis C has the following symptoms:


  1. unreasonable weakness and fatigue
  2. persistent drowsiness;
  3. increased gas formation;
  4. nausea, which always ends with vomiting;
  5. decreased appetite
  6. pain syndrome with localization under the right ribs
  7. temperature increase.

When acute viral hepatitis D occurs, the symptoms do not differ from the clinical picture of hepatitis B. In cases of hepatitis E, the symptomatology will be similar to hepatitis A. This feature is that the above forms depend on each other, while they speak of a viral liver injury Mixed etiology.

Signs of hepatitis F are:


  • fatigue and malaise
  • disorder of defecation;
  • chills and increased sweat
  • Depression development
  • bleeding gums;
  • nausea and vomiting
  • bloating and rumbling in the intestines
  • tenderness in the projection of the liver.

Despite the fact that in the vast majority of cases, hepatitis G is completely asymptomatic, its acute course is characterized by the following manifestations:


  1. degradation of performance, which occurs against the background of increased fatigue and weakness
  2. persistent drowsiness;
  3. a slight chill;
  4. increased thirst;
  5. profuse sweating
  6. gradual increase in temperature;
  7. belching and heartburn;
  8. pain and weakness in the muscles
  9. Lack of appetite
  10. lethargy or depression
  11. Discomfort in the right hypochondrium.

If the inflammation of the liver against a background of acute leaks turns into an icteric form, then the symptomatology will be presented:


  • Hepatosplenomegaly — there is an increase in the size of not only the liver but also the spleen
  • the appearance of rashes by the type of urticaria
  • the presence of a bitter taste in the mouth
  • the lagging of the tongue with a touch of a yellowish white hue
  • the acquisition of the skin and visible mucous membranes of a yellowish hue — the intensity of the expression of jaundice will vary for each patient
  • Clarification or decolorization of stools
  • darkening of urine
  • severe itching.

All of the above symptomatology of this or that form of the disease applies to both adults and children, but it is worth remembering that in the second case the disease develops faster and takes more severe course. Complicated or fulminant current is most often observed in women during pregnancy.

Diagnostics

Any form of ailment, including unspecified viral hepatitis, when establishing the correct diagnosis requires an integrated approach based on laboratory research.

The first stage of diagnosis is performed directly by the gastroenterologist and includes:


  1. acquaintance with the life history and history of the patient’s illness — to establish the main pathway of infection or other disease that could lead to the development of such a pathology
  2. a thorough physical examination aimed at assessing the condition of the skin, mucous membranes and sclera, measuring temperature and palpation of the anterior wall of the abdominal cavity, to establish the presence of hepatosplenomegaly
  3. a detailed patient survey — to establish the degree of severity with which the symptoms of the disease are expressed. This will also allow the clinician to establish the nature of the course of the inflammatory process.

Laboratory studies suggest execution:


  • a general clinical blood test — will show an increase in lymphocyte count and a decrease in ESR
  • blood biochemistry — will indicate an increase in bilirubin and a decrease in total protein
  • A blood test — to study its ability to clot;
  • general urine analysis
  • microscopic studies of stools
  • PCR diagnostics
  • Specific tests for assessing the activity of AST and ALT, APF and HS
  • ELISA and PHA analyzes — to search for antibodies to the pathogen of inflammation

Instrumental surveys include:


  1. Ultrasound and MRI of the affected organ
  2. Liver SPECT;
  3. Puncture biopsy

Treatment

To stop the inflammatory process in the liver, the following conservative therapies are used:


  • taking medications;
  • adherence to a gentle diet.

Medication for acute viral hepatitis requires the use of:


  1. hepatoprotectors — to protect liver cells
  2. Antibacterial drugs
  3. detoxification substances
  4. Symptoms, in particular antipyretics, antiemetics and anti-diarrhea drugs
  5. Vitamin Complexes.

Dietotherapy is aimed at complete exclusion from the diet:


  • oily and spicy food
  • sweets and salted dishes
  • smoked products and marinades
  • Canned and confectionery products
  • dairy products with high fat content
  • legumes and cabbage, mushrooms and radishes, sorrel and radish, onions and garlic
  • soda and liquor
  • strong black tea and coffee.

At the same time, the patient menu should be enriched:


  1. porridges and pasta cooked on water or milk basis;
  2. dietary meats and fish;
  3. vegetable and milk soups
  4. fruits and vegetables that have been thermally processed by cooking or steaming, quenching or baking
  5. a steam omelet and hard boiled eggs
  6. Kissels, compotes and herbal decoctions
  7. homemade jam and honey
  8. marshmallow and marmalade
  9. dried fruit and jelly
  10. Cocoa on milk or on water.

Often, surgical treatment for acute viral hepatitis is not treated, but in the severe course of the disease without a donor organ transplant is indispensable.

Complications

The most frequent consequence of ignoring the symptoms and the lack of therapy is the transition of the disease to a chronic form, and in such cases it is more difficult to get rid of it.

In addition, complications of acute viral hepatitis can be represented:


  • spread of inflammation to nearby tissues
  • hepatic encephalopathy
  • Liver cirrhosis
  • liver failure or coma
  • primary liver cancer
  • internal bleeding;
  • impaired functioning of the brain, kidney and heart
  • sepsis.

Prevention and Forecast

Only some varieties of acute viral hepatitis have specific prevention. It’s about hepatitis A and B — a special vaccine has been developed against the viruses. In addition, such immunization reduces the likelihood of developing hepatitis E, G, F and D.

General preventive measures include the following rules:


  1. complete rejection of bad habits;
  2. keeping an active lifestyle
  3. Proper and balanced nutrition
  4. excluding contact with an infected person and household items that he uses;
  5. Occupation only by protected sex
  6. careful heat treatment of products
  7. drinking only purified water
  8. compliance with personal protection guidelines when working with patient’s body fluids
  9. refusal to carry out piercings and tattoos by using questionable tools
  10. earlier detection and full treatment of those viral diseases, the causative agents of which can also cause inflammation of the liver
  11. Regularly undergo a complete examination in a medical facility.

The most favorable prognosis is hepatitis A and E, after recovery, a person acquires persistent immunity. Vaccination provides a positive outcome of hepatitis B, D, G and F.




Hepatitis C and viral unspecified hepatitis have an unfavorable prognosis. The development of complications, regardless of the form of the disease, can lead to the death of the patient.