Viral hepatitis

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Hepatitis is an inflammatory disease of liver tissue of viral origin. Different types of this disease include hepatitis A - G, TTV. HBV is a DNA virus, the others are RNA viruses.

With all types of hepatitis, the infection can be of varying intensity: it often occurs inapparently, abortively (briefly, influenza or dyspeptic syndrom). Viral hepatitis can be acute or chronic (duration of the disease over 6 months). The typical (symptomatic) form is icteric, however, generally, the anicteric form is more common.

Hepatitis should be considered with any liver disease, the cause and severity of liver disease should be determined. During viral hepatitis, the prodromal stage, the stage of liver damage and the stage of convalescence should be monitored. The infection can also lead to asymptomatic carriers.

Histological evaluation includes grading (the intensity of inflammatory changes - infiltration)and staging (the progression of fibrosis).

The cholestatic form resembles obstructive jaundice, which can make the diagnosis difficult. The malignant or fulminant form is characterised by liver failure, high mortality. The stage of liver damage lasts for 2-8 weeks, if there is no improvement, we refer to this condition as prolonged course, which can become chronic.

During the convalescence period, functional disorders of the gastrointestinal tract are common (loss of appetite, intolerance to fatty foods, etc.), often also posthepatic hepalgia (pain in the liver region - caused by adhesions between the liver capsule, diaphragm and peritoneum).

Diagnostics

 * 1) Serology - determination of viral antigens and antibodies in serum (EIA);
 * 2) Molecular genetic testing - determination of viral nucleic acid in serum (PCR, hybridisation);
 * 3) liver biopsy – evaluates grading and staging, does not identify the causative agent, indicated in chronic hepatitis, not acute;
 * 4) Biochemistry – the first biochemical change in VH is the increase in transaminases – in prodromal stage (with acute VH, ALT increases more than AST), bilirubin.

Transmission

 * 1) By feces orally - A, E (acute only)
 * 2) By blood, or sexual intercourse - B, C, D, G (acute or chronic)

Symptoms

 * 1) Prodromal stage - fatigue, weakness, loss of appetite, joint pain;
 * 2) Symptomatic stage - hepatic jaundice (↑ indirect bilirubin, bilirubin and urobilinogen in urine, dark urine, hypocholic stool), dyspepsia, epigastric pain, hepatomegalia.

Complications

 * 1) Fulminant hepatitis (liver failure, encefalopathy);
 * 2) liver cirhosis;
 * 3) hepatocellular carcinoma

Anamnesis
As part of the family history, we focus on the occurrence of diseases of liver, bile ducts, familial hyperbilirubinemia and hemolytic conditions. We determine the same in the personal history of the patient as well as diseases that could affect the course of VH -diabetes, immunodeficiency, surgeries, blood transfusions. Epidemiological anamnesis is also important - we are looking for contact with the infection, other infections in the patient’s surroundings, vaccinations, the possibility of infection by sexual intercourse, stay in nature (harmful water sources,…). For the pharmacological history, we specifically ask about the use of contraception and hormonal preparations, antidepressants, analgetics. The history of substance abuse is crucial.

ALT Dynamics

 * The highest values of transferases occur in viral hepatitis (prodromal stage - 2x, increased up to 50x after two weeks, they normalise around week 8).
 * It is characterised by a rapid rise (approximately 30x) - toxic liver damage.
 * In drug and alcohol intoxications, there is a slight increase.

Therapy of viral hepatitis
The basis of the therapy is rest and diet. The treatment of acute hepatitis is symptomatic and supportive, except in VHC, where early treatment with interferon may prevent the transition to chronicity. The patients leave the Infectious Diseases Department after jaundice disappears and the transferases fall below 3x the norm, followed by a check-up at hepatology.

TTV virus infection

 * DNA virus transmitted parenterally and faecally-orally;
 * only viral DNA can be detected, not an antibody response;
 * is similar to HGV (combination with HBV or HCV, both acute and chronic infection)

Other viruses associated with hepatitis

 * CMV,
 * EBV,
 * HSV,
 * adenovirus,
 * enterovirus.

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