Presentation "Viral hepatitis" in medicine - project, report. Viral hepatitis Use of hepatitis B vaccine
Viral hepatitis (lat. Hepatitis viruses) is an inflammation of liver tissue caused by viruses.
Hepatitis can be caused by many things, but hepatitis is most often caused by viruses. Hepatitis viruses belong to different taxa and differ in biochemical and molecular characteristics, but all these viruses have in common the fact that they cause hepatitis in humans.
According to the type of pathogen, hepatitis is: Hepatitis A (Botkin's disease) Hepatitis B (serum hepatitis) Hepatitis C Hepatitis D (delta infection, hepatitis δ) Hepatitis E Hepatitis F Hepatitis G Hepatitis TTV.
Hepatitis A (Botkin's disease) The disease is caused by the hepatitis A virus, which is transmitted by the fecal-oral route, through contaminated food and water. You are more likely to become infected in hot countries. The incubation period ranges from two to six weeks. The disease lasts on average about 40 days. Early symptoms resemble the flu. The patient's temperature rises, he suffers from vomiting and diarrhea, feels body aches, and dull pain in the right hypochondrium. The concentration of liver enzyme in the blood increases significantly. After suffering from the disease, lifelong immunity is developed. Children over 1 year of age usually experience hepatitis A much more easily than adults. There is a vaccine against the disease, which is administered twice with an interval of 6-12 months.
Hepatitis B Hepatitis B can occur in both acute and chronic forms. The incubation period of the disease lasts from 50 to 180 days. Acute hepatitis B lasts about 6-8 weeks. Hepatitis B can be contracted from a sick person, as well as from a virus carrier. The disease is transmitted sexually and through blood. A mother can infect her baby during childbirth. Infection through household means is possible when using shared razors and manicure accessories. Infection can also occur during tattooing or skin puncture for piercing. In the external environment, the hepatitis B virus persists for about a week, even in a dried and invisible blood stain. After hepatitis B, long-term immunity develops. There is a vaccine against the disease, which is administered in three doses with an interval of several months.
Hepatitis C Only 15-20% of patients with hepatitis C recover on their own within a year. The rest develop a chronic form. In this case, the person experiences weakness, decreased ability to work, rapid fatigue, and suffers from sleep disturbances. This condition can last for decades. 20% of patients with chronic hepatitis C develop cirrhosis and liver cancer. The mode of transmission of the virus is similar to hepatitis B. Hepatitis C is common in people who inject drugs. The disease is also transmitted sexually. There is no vaccine against this disease. It has been established that the hepatitis C virus survives in the external environment at room temperature for 16 hours, and possibly longer - up to 4 days.
Hepatitis D This form of hepatitis develops only in the presence of virus B. The disease occurs in an acute form, severely affecting the liver. The routes of transmission are similar to hepatitis B and C. It can become chronic, leading to cirrhosis. The hepatitis B vaccine also protects against hepatitis D.
Hepatitis E, F, G Hepatitis E is similar to hepatitis A in both symptoms and modes of transmission. The disease is most common in Central Asia and African countries. Scientists identify two more types of hepatitis virus - F and G, which are currently quite poorly studied. They are most likely transmitted through sexual contact and blood.
2 Introduction Self-help through knowledge! The information presented here is intended only to help you understand and keep hepatitis C under control. It does not replace consultation with a specialist. Every patient with hepatitis C should consult a doctor for all questions of diagnosis and treatment.
500 chemical reactions) Bile Immune system Detoxification Blood clotting factors Hormones Capable of self-healing!" title="4 Liver functions Chemistry laboratory (>500 chemical reactions) Bile Immune system Detoxification of toxins Blood clotting factors Hormones Capable of self-healing !" class="link_thumb"> 4 !} 4 Liver functions Chemistry laboratory (>500 chemical reactions) Bile Immune system Detoxification Blood clotting factors Hormones Capable of self-healing! 500 chemical reactions) Bile Immune system Cleansing of toxins Blood clotting factors Hormones Capable of self-healing!" > 500 chemical reactions) Bile Immune system Cleaning of toxins Blood clotting factors Hormones Capable of self-healing!" > 500 chemical reactions) Bile Immune system Cleansing of toxins Blood clotting factors Hormones Capable of self-healing!" title="4 Liver functions Chemical laboratory (>500 chemical reactions) Bile Immune system Cleansing of toxins Blood clotting factors Hormones Capable of self-healing!"> title="4 Liver functions Chemistry laboratory (>500 chemical reactions) Bile Immune system Detoxification Blood clotting factors Hormones Capable of self-healing!"> !}
8 Antibody test Elisa II or III tests Most common tests for HCV RIBA test Usually only done when there are no risk factors A positive test result indicates that the body has been exposed to the virus Does NOT indicate the presence of an active infection A viral test is performed to detect an active infection HCV load
10 IU/ml HCV DNA by P-DNA analysis – > 50 IU/ml TA – > 5-10 IU/ml Why are viral load tests important? Detect the presence of an active infection Help predict response to treatment Show whether le" title="9 Viral load tests HCV DNA by PCR - >10 IU/ml HCV DNA by R-DNA analysis - > 50 IU/ml TA – > 5-10 IU/ml Why viral load tests are important: Detects the presence of active infection Helps predict response to treatment Shows whether treatment is working" class="link_thumb"> 9 !} 9 Viral load tests HCV DNA by PCR - >10 IU/ml HCV DNA by R-DNA analysis - > 50 IU/ml TA - > 5-10 IU/ml Why are viral load tests important? Detects the presence of active infection Helps predict response to treatment Shows whether treatment is giving a positive result ** VIRAL LOAD DOES NOT CORRELATE WITH DISEASE DEVELOPMENT ** 10 IU/ml HCV DNA by P-DNA analysis – > 50 IU/ml TA – > 5-10 IU/ml Why are viral load tests important? Detect the presence of an active infection Help predict response to treatment Show whether le "> 10 IU/ml HCV DNA by P-DNA analysis - > 50 IU/ml TA - > 5-10 IU/ml Why are viral load tests important? Detect presence of active infection Help predict response to treatment Show whether treatment is giving a positive result ** VIRAL LOAD DOES NOT CORRELATE WITH DISEASE DEVELOPMENT ** "> 10 IU/ml HCV DNA by R-DNA analysis – > 50 IU/ml TA – > 5- 10 IU/ml Why are viral load tests important? Detect the presence of an active infection Help predict response to treatment Show whether le" title="9 Viral load tests HCV DNA by PCR - >10 IU/ml HCV DNA by R-DNA analysis - > 50 IU/ml TA – > 5-10 IU/ml Why viral load tests are important: Detects the presence of active infection Helps predict response to treatment Shows whether treatment is working"> title="9 Viral load tests HCV DNA by PCR - >10 IU/ml HCV DNA by R-DNA analysis - > 50 IU/ml TA - > 5-10 IU/ml Why are viral load tests important? Detects the presence of active infection Helps predict response to treatment Shows whether treatment is working"> !}
13 Virus transmission Shared needles Drug paraphernalia Blood transfusions before 1992 – donated blood, blood products, transfusion procedure Through sexual contact (1-3%) Health care workers – accidental pricks with contaminated needles Shared household items – razors and toothbrushes From mother to child
14 Tips for preventing infection Injectable and non-injectable drugs Do not use other people's syringes, autoclaves, straws, tubes, cotton wool - any items that may have been in contact with blood Bleach for disinfection Stable monogamous sexual relationships There is no need to change existing sexual habits, but Be aware of the risk! (US Center for Disease Prevention)
17 Tips for preventing infection Tattoos and piercings In specialized salons, the risk is low Make sure that disposable needles are used, separate bottles of mascara are used, and general safety rules are followed The risk of infection is much higher if the piercing is done in non-specialized conditions For example, in a prison or on the street
18 Personal Care Products At home Cover cuts or sores Do not share personal care products (toothbrushes, razors, etc.) In health care facilities or places that provide hygiene services Follow standard precautions Disposable equipment Bring your own personal care products
21 Development of the disease In 10-25% of carriers of the virus, infection will develop into a serious disease within years Fibrosis Minor scarring Cirrhosis Compensated - uncompensated Steatosis Fatty deposits in the liver
22 Treatment General principles of treatment General health Presence of active infection Elevated ALT levels Compensated liver disease More often positive in: young women Low body mass index (BMI) and weight Less steatosis Low viral load Minimal liver damage With genotypes 2 and 3
23 Treatment – clinical data Prospective – well-conducted clinical trials with measurable outcomes Gold standard Retrospective – review of data from previous clinical trials Important for identifying directions and planning future research
26 Treatment - standard regimens Schering - PEG-Intron + Rebetol (800 mg) For genotype 1 - sustained virological response (SVR) in 41% (after 48 weeks of treatment) For genotypes - in 75% (after 48 weeks of treatment) Roche – Pegasys + Copegus (mg) Genotype 1 – SVR in 44-51% (48 weeks of treatment) Genotype 2 and 3 – SVR in 82% (24 weeks of treatment) Genotype – SVR in 70% (48 weeks of treatment) * See insert US Federal Food and Drug Administration
27 Side effects Interferon Chronic fatigue Muscle and joint pain Nausea Headaches Anxiety Depression Skin irritations And others... Ribavirin Increases the side effects of interferon, especially chronic fatigue and anemia ** (both men and women should use contraceptives)
28 Dealing with side effects Injections before bed Drinking as much as possible (water) Ibuprofen or acetaminophen in small doses Painkillers Light exercise Moisturizing the skin Varying injection sites Antidepressants Adequate rest Eating small amounts of food frequently The main thing: full support - doctors, family, friends, colleagues
32 Your own lawyer! Try to learn as much as you can about hepatitis C Build a trusting relationship with your doctor Bring an advocate to your doctor's appointments Ask questions Keep copies of all medical tests Keep a diary Don't limit yourself to the usual limits
33 Resources – HCV Advocate Fact Sheet Educational materials in English, Spanish, Russian, French, German, Chinese, Vietnamese and Tagalog Articles by Medical Writers Circle Factual information pages in English, Spanish, French and Russian List of support groups Recommended links Information about hepatitis C and B, and HIV/HCV co-infection
To use presentation previews, create a Google account and log in to it: https://accounts.google.com
Slide captions:
Hepatitis B
What is hepatitis B? Hepatitis B is a dangerous infection caused by the hepatitis B virus that affects the liver. Chronic or long-term hepatitis B infection can lead to severe liver damage, cirrhosis (scarring of the liver), and hepatocellular carcinoma (liver cancer)
Information about hepatitis B Hepatitis B is a global health problem 350–400 million people worldwide are infected with chronic hepatitis B virus, despite the availability of a vaccine Hepatitis B has an infection rate 100 times higher than that of the human immunodeficiency virus (HIV) Hepatitis B is ranked tenth ranking among the most common causes of death worldwide
How is hepatitis B transmitted? Hepatitis B is a highly infectious disease that is transmitted through contact with the body fluids of an infected person: Direct contact of the blood of an infected person with the blood of an uninfected person Unprotected sexual contact Use of unsterile needles From an infected mother to her child during childbirth Other ways of infection: Sharing such objects with an infected person , such as razors, toothbrushes, earrings, piercings, as well as tattooing and acupuncture with non-sterile needles. Hepatitis is not transmitted ACCIDENTALLY, that is, by sneezing, coughing or eating food prepared by a person infected with the hepatitis B virus (HBV).
Who is at risk of contracting hepatitis B? Family members of someone with hepatitis B virus People with multiple sex partners Children born to infected mothers Adopted children from countries with a high prevalence of hepatitis B Health care and public safety workers People who inject drugs Tourists who have visited areas with a high prevalence of hepatitis B B Immigrants from countries with a high prevalence of hepatitis B People with tattoos or piercings
STAGES OF THE DISEASE After the hepatitis B virus enters the body, the disease sequentially passes through several stages: infection, incubation period, acute and finally chronic hepatitis. It should be noted that not all infected people develop acute hepatitis or the disease becomes chronic. Incubation period - the disease cannot be detected even with the help of blood tests. Acute hepatitis B Symptoms of acute hepatitis are malaise, weakness, nausea, joint pain, fever, jaundice. They may not be clearly expressed or be completely absent, there may be no jaundice, so the acute phase of hepatitis is not always diagnosed. During this period, tests reveal viral DNA, indicators of the acute phase of infection (virus antigens and some antibodies), and liver enzymes are significantly elevated.
Chronic infection with the hepatitis B virus can last for years. Its most severe consequences are the formation of cirrhosis and liver cancer. It should be remembered that chronic HBV infection is a dynamic process. It is characterized by a relatively rapid change in the stages of the disease. In this regard, constant monitoring of laboratory and clinical parameters is required. Can the body cope with hepatitis on its own? Yes. But only with acute hepatitis. If hepatitis has become chronic, you will no longer be able to recover on your own - you definitely need the help of a doctor. Why does hepatitis become chronic? This depends on the characteristics of the body, the strength of the immune system and the amount of virus that has entered the body. When the immune system cannot cope with the infection, hepatitis becomes chronic, that is, permanent.
Who is at risk for developing chronic hepatitis B? The risk of developing a chronic infection depends on the person's age at the time of infection with the hepatitis B virus. In 90-95% of patients infected with the hepatitis B virus in adulthood, the symptoms of the disease disappear on their own, biochemical tests become normal, and protective immunity is formed in 90% of children infected with the virus. hepatitis B infection will develop chronic hepatitis B infection 50% of young children infected with hepatitis B virus between the ages of 1 and 5 years will develop chronic hepatitis B infection
Global impact of hepatitis B World population 6 billion 2 billion people with evidence of HBV infection 350–400 million people with chronic hepatitis B (CHB) 15–40% (75–160 million) die from cirrhosis (scarring of the liver) or liver cancer 3
Surveillance and control Vaccination Hepatitis B is a disease that can be prevented through vaccination. Vaccination is the most effective way to prevent HBV transmission More than 1 billion people have been vaccinated worldwide Taking the initiative to get tested is the first step to ensuring a healthy future
Who should get vaccinated? Vaccination against hepatitis B is recommended for everyone. Groups of people who should be vaccinated against hepatitis B: newborns; teenage children; persons whose family members are infected with hepatitis B; patients who frequently receive intravenous medications; persons who frequently change sexual partners (more than one in 6 months); men having homosexual contacts; medical workers; patients receiving hemodialysis.
Surveillance and control Surveillance Established guidelines will guide direct treatment based on test results for the presence of HBV in the body Typically, patients with chronic hepatitis B are tested AT LEAST every 6 to 12 months Lifestyle criteria to prevent infection People infected with HBV should follow several guidelines to reduce the risk of transmitting infection to other people. Infected people should not share razors, toothbrushes, or any other items that could become infectious from the blood. The HBV virus can survive for more than a week in dried blood. Infected people should always use appropriate condoms during sexual intercourse. Infected people should not donate blood or organs.
Facts about chronic hepatitis B Hepatitis B is a serious and highly infectious disease Anyone who carries the hepatitis B virus can infect other people. With active treatment, the effects of hepatitis B can be eliminated or at least slowed down.
THANK YOU FOR YOUR ATTENTION! BE HEALTHY!
Presentation on the discipline
“Infectious diseases with a course on HIV infection and epidemiology”
on the topic: “Viral hepatitis B, C, D.”
2013
VIRAL HEPATITIS
A group of anthroponotic viral diseases,united predominantly by hepatotropy
pathogens and leading clinical manifestations:
1) liver damage with the development of general toxicity
syndrome,
2) hepatosplenomegaly,
3) impaired liver function and the appearance of jaundice.
Structure of the liver
Liver functions
Chronic viral hepatitis (parenteral hepatitis)
Chronic viral hepatitis(CVH) is a chronic inflammation
liver caused by hepatotropic
viruses, continuing without trend
to improvement for at least 6 months.
The vast majority of cases of chronic hepatitis
caused by hepatitis B, C and D viruses.
Viral hepatitis B
Hepatitis B is one of the mostcommon infections. In the world
number approximately 300-500 million.
patients with chronic hepatitis B.
To regions with high
prevalence (10-20%) include
South Asia, China, Indonesia, countries
tropical Africa, Pacific Islands
ocean, Alaska.
Etiology
The causative agent of HBV infection is a DNA virusfrom the family Hepadnaviridae.
The HBV genome is incomplete
double-stranded circular DNA molecule.
There are 9 genotypes of the virus (from A to H).
The virus is stable in the external environment.
Epidemiology
Source: sick person.Mechanism of infection:
1) parenteral
2) sexual
3) vertical
4) straight
The main route of transmission is parenteral
(injection, blood transfusion), as well as through
damaged mucous membranes and skin.
Natural receptivity is high. For hepatitis
Characterized by high contagiousness, infection
possible upon contact with damaged skin or
negligible mucous membranes
infected material (0.0001 ml of blood).
Risk group
People who have multiple sexual partners(prostitutes).
Men who practice homosexual acts.
Sexual partners of infected persons.
Persons who use injection drugs.
Family members of a patient with chronic hepatitis B.
Children born from infected mothers.
Honey. workers.
Patients on hemodialysis ("artificial kidney") or
receiving frequent blood transfusions.
Pathogenesis
The virus enters the human body, thenhematogenously disseminates to the liver, where
fixed on hepatocytes due to
surface receptors containing HBsAg.
In this case, the pathogen does not have a direct
cytopathic effect on liver cells.
Virions multiply and
antigens. Dystrophic and
necrobiotic changes in hepatocytes,
focal necrosis occurs, and in severe cases
massive necrosis in the liver parenchyma.
Hepatitis B Clinic
The duration of the incubation period is from 30 to 180 days (usually 2-3 months).The following variants of the clinical course of viral hepatitis B are distinguished:
A. According to the cyclicity of the flow:
I. Cyclic forms:
1. Acute hepatitis B - asymptomatic (inapparent and subclinical), anicteric, icteric
(with a predominance of cytolysis or cholestasis);
2. Acute hepatitis with cholestatic syndrome.
II. Persistent forms:
1. Carriage of HBV - chronic asymptomatic form (carriage of HBsAg and other
virus antigens);
2. Chronic viral hepatitis B, integrative phase.
III. Progressive forms:
1. Fulminant (fulminant) hepatitis;
2. Subacute hepatitis;
3. Chronic viral hepatitis B, replicative phase (including with cirrhosis of the liver).
IV. Viral hepatitis B, acute or chronic mixed, in combination with viral hepatitis
A, C, D, E, G.
B. According to the severity of the disease: mild, moderate, severe.
Hepatitis B Clinic
Pre-icteric period (prodromal):lasts 3-15 days. and is characterized by symptoms
intoxication (fever, general weakness, lethargy,
apathy, irritability, sleep disturbance, decreased
appetite), arthralgia, pain in the right hypochondrium.
In some cases, a skin rash is observed. IN
the last 1-2 days of the period occur
discoloration of stool and dark urine.
Hepatitis B Clinic
The icteric period lasts from 10-14 to 3040 days. Jaundice staining at firstappears on the mucous membranes, then on the skin.
Symptoms of intoxication after the appearance of jaundice
usually intensify. Liver and spleen (in 30-50%
cases) are increasing. Bradycardia appears
decreased blood pressure, weakened heart sounds. At
in severe forms, CNS depression develops
varying degrees of severity, dyspeptic,
hemorrhagic syndromes.
Hepatitis B Clinic
The convalescence period beginsafter the jaundice disappears and
ends after complete clinical and laboratory resolution of the disease, which
usually occurs 3 months after
started it.
Viral hepatitis C
Hepatitis C is the most common formchronic liver diseases in
most European countries and
North America.
Etiology
The causative agent of HCV infection is an RNA virus from the familyFlaviviridae. The genome of the virus is formed
single-stranded RNA. HCV is genetic
heterogeneous: there are 6 main
genotypes (1-6) and at least 50 subtypes.
Epidemiology
According to WHO, there are noless than 170 million are infected with HCV.
The prevalence of HCV infection is also
varies significantly in different regions,
averaging 0.5 – 2% (up to 6.5% in
countries of tropical Africa). HCV-
infection causes approximately 40
% of cases of chronic liver pathology.
The total number of HCV-infected people in
Russia – 1 million 700 thousand people.
Epidemiology
The source of infection is a sick person or a virus carrier.Mechanism of infection:
1) parenteral
2) sexual
3) vertical
4) straight
Transmission routes:
1) when transfusing contaminated blood and blood products and when
organ transplantation;
2) with injections with contaminated syringes and injuries from an injection
needle in medical institutions;
3) when using injecting drugs;
4) a newborn child from a person infected with hepatitis C
mother.
Pathogenesis
The virus enters the body in the same way as the virushepatitis B. Having tropism for hepatocytes,
the virus has a direct impact on them
cytopathic effect. Due to
genetic heterogeneity of the hepatitis virus
It has many antigenic variants,
which makes it difficult to implement adequate
immune response. Virus particles
enter the cells of the macrophage system
body and cause a certain reaction
on their part, aimed at eliminating
virus.
Pathogenesis
Due to the fact that the antigenic composition of the viralparticles are similar to the antigenic composition of hepatocytes,
and on the surface of hepatocytes there are also
fragments of viral particles synthesized on
viral RNA for subsequent assembly into a virus, then
there is an autoimmune mechanism
hepatocyte damage. Moreover, don't
direct mutagenic effect of the virus is also excluded
hepatitis C on macrophages, changing their properties
so that they become able to react with
histocompatibility antigens of the HLA system and
thereby causing an autoimmune reaction.
Hepatitis C Clinic
From the moment of infection to clinical manifestationslasts from 2-3 weeks to 6-12 months.
In case of acute onset of the disease, the initial period
lasts 2-3 weeks, accompanied by joint pain,
fatigue, weakness, indigestion.
A rise in temperature is rarely observed. Jaundice as well
little characteristic. Acute hepatitis C is diagnosed very
rarely and more often by accident.
After the acute phase of the disease, a person may
recover, the disease may become chronic
form or into virus carriage. In most patients
(in 70–80% of cases) a chronic course develops.
The transition from acute to chronic hepatitis C occurs
gradually: increases over several years
damage to liver cells, fibrosis develops. Function
the liver may persist for a long time. A
first symptoms (jaundice, abdominal enlargement,
spider veins on the skin of the abdomen, growth
weaknesses) can appear already with cirrhosis of the liver.
Viral hepatitis D
Hepatitis D (hepatitis delta) - viralanthroponotic infection with parenteral
mechanism of infection for which
characterized by an inflammatory lesion
liver.
Etiology
The disease is caused by an incomplete RNA virus (HDV, δ-virus), for the expressionwhich requires HBV with genome size
19 nm. Belongs to the Deltavirus family.
Epidemiology
The reservoir and source of the pathogen is man,sick or virus carrier. In distribution
virus, the main concern is for persons with
chronic forms of viral hepatitis B,
simultaneously infected with a viral
hepatitis D. Period of infectiousness of sources
infection indefinitely long, but sick
most dangerous during the acute period of the disease.
Mechanism of infection:
1) parenteral
2) sexual
3) vertical
Epidemiology
The risk of infection is especially high for permanent recipientsdonated blood or its preparations, for persons exposed to frequent
parenteral interventions, as well as for drug addicts injecting
intravenous drugs.
Transplacental transmission of viral hepatitis D is possible from
pregnant fetus.
High incidence of infection among people involved in
promiscuity (especially among homosexual men), gives reason to believe that sexual intercourse is also possible
route of infection.
Natural receptivity is high. To viral hepatitis D
All persons with viral hepatitis D or
are carriers of viral hepatitis B. Most likely
development of viral hepatitis D in chronic carriers of HBsAg.
Populations in hyperendemic areas are especially susceptible
for viral hepatitis B. Severe forms of the disease can occur
even in children.
Pathogenesis
The pathogen is integrated into the genome of the hepatitis B virus, affectingon its synthesis and enhancing the replication of the latter. The disease may
manifest as co-infection when simultaneously infected with viruses
viral hepatitis B and viral hepatitis D and superinfection in cases
when the hepatitis D virus enters the human body, previously
infected with the hepatitis B virus. Replication of the viral hepatitis B virus
hepatitis D occurs in liver cells.
Pathomorphologically, viral hepatitis D has no specific
signs that distinguish it from viral hepatitis B, and is characterized by
a pronounced picture of necrosis, which prevails over the inflammatory
reaction. Massive necrosis and small droplets are observed in hepatocytes
obesity. Interaction between hepatitis B viruses and viral
hepatitis D aggravates the pathological process and leads to the development of acute
liver failure or chronicity.
Viral hepatitis D clinic
Incubation period. Similar to that forviral hepatitis B. In cases of coinfection
the clinical course of the disease is similar
clinical manifestations of viral hepatitis B, but with
the predominance of a severe course. In case of superinfection
observed a sharp worsening of the course of the viral
hepatitis B with severe insufficiency of function
liver and the development of a large number of chronic forms,
leading to the rapid formation of liver cirrhosis.
1. Dyspeptic syndrome is associated with
violation of detoxification function
liver, concomitant pathology of the duodenum and pancreas.
2. Asthenic syndrome (weakness,
fatigue, decreased performance,
irritability) is expressed in greater or
to a lesser extent in patients with chronic hepatitis.
Clinical manifestations of chronic viral hepatitis
Signs of liver damage:enlargement, hardening and tenderness of the liver;
jaundice;
telangiectasia and palmar erythema (due to
an increase in estrogen concentration and a change in
sensitivity of vascular receptors
portal hypertension (ascites, splenomegaly,
varicose veins of the esophagus) appear and
signs of liver failure progress.
amenorrhea, gynecomastia, decreased libido
associated with disturbances in the metabolism of sex hormones in
liver (usually in the stage of cirrhosis).
Diagnostics
1. Epidemiological history data(indications for parenteral
interventions, contact with the patient,
intravenous drug administration
periods corresponding to incubation
period).
2. Clinical examination (detection
characteristic cyclicality of the disease and
clinical and biochemical syndromes).
Laboratory research
Mandatory examination methods:UAC: possible ESR, leukopenia,
lymphocytosis, with the fulminant form of AVH
– leukocytosis.
OAM: with OVH and exacerbation of CVH
possible appearance of bile pigments
(mainly direct bilirubin),
urobilin.
Laboratory research
Blood chemistry:- cytolysis syndrome: increased levels of ALT, AST;
- cholestasis syndrome: increased content of total
bilirubin, cholesterol, alkaline phosphatase, γglutamyl transpeptidase, usually observed with
jaundice;
- mesenchymal inflammation syndrome: increased
immunoglobulin content, increased thymol
samples, decrease in sublimate test;
- liver cell failure syndrome:
decrease in prothrombin index, concentration
serum albumin, cholesterol, total
bilirubin: detected in severe forms of chronic hepatitis. Markers:
Hepatitis B virus:
HBsAg is detected 1-10 weeks after
infection, its appearance precedes
development of clinical symptoms and
increased ALT/AST activity. At
If there is an adequate immune response, it disappears
4-6 months after infection
HBeAg indicates viral replication in
hepatocytes; found in serum
almost simultaneously with HBsAg;
Anti-HBe (AT to e-Ag) in combination with anti-HBc
IgG and anti-HBs indicate complete
completion of the infectious process. Anti-HBc (Ab to nuclear Ag) – important
diagnostic marker of infection. AntiHBc IgM is one of the earliest serum
markers of CHBV and a sensitive marker of HBV infection. Indicates virus replication and
activity of the process in the liver; his disappearance
serves as an indicator of either the sanitation of the body from
pathogen, or the development of the integrative phase
HBV infections.
Anti-HBc IgG persists for many years;
indicate existing or previously
past infection.
HBV DNA and DNA polymerase – diagnostic
markers of virus replication. Hepatitis C virus:
HCV RNA is the earliest biochemical marker
infection occurs within a period of several days to 8
weeks after infection. In cases
recovery from CVHS, viral RNA disappears from
blood within 12 weeks after the first appearance
symptoms.
Anti-HCV is determined in the blood no earlier than after 8
weeks after infection. It is present in the blood
approximately half of patients with clinical
manifest OVHS at the onset of the disease. At
subclinical infections AT usually appear
much later.
Hepatitis D virus: anti-HDV IgM, HDV RNA (marker
HDV replication).
Additional examination methods:
Stool analysis: decreased content orlack of stercobilin due to discontinuation
the flow of bile into the intestines; appearance
stercobilin in feces during the icteric period
WHG is evidence of resolution of jaundice.
Blood concentration of α-fetoprotein
(screening for hepatocellular carcinoma).
This research needs to be carried out in
dynamics.
Instrumental studies
Required Methodsexaminations:
Ultrasound of the liver and spleen:
characterized by increased echogenicity
parenchyma, compactions along the
liver vessels;
Liver biopsy is necessary for
assessing the degree of liver damage.
Additional Methods
examinations:
CT scan of the abdominal cavity;
FEGDS.
Treatment
1. Patients with viral hepatitis are subject to mandatoryhospitalization in an infectious diseases hospital (department,
hospital).
2. Long-term, possibly lifelong dietary
mode (table No. 5).
Acute viral hepatitis: treatment preferentially
symptomatic – detoxification infusion
therapy, enterosorbents, ursodeoxycholic acid for
severe cholestasis, in severe cases - GCS.
Specific antiviral therapy is indicated for
OVGS. Interferon alpha is usually used at 3 million
IU subcutaneously for 12-24 weeks in combination with
ribavirin, which can significantly reduce the risk
development of CHC.
Treatment
Chronic viral hepatitis B:-Interferon alpha at a dose of 5 million IU/day subcutaneously or 10 million IU
3 times a week for 4-6 months.
- Peginterferon alfa-2a (PEGASIS) dose 180 mcg, subcutaneously 1
once a week. Duration of treatment – 1 year.
-Lamivudine is prescribed 100 mg/day orally.
The duration of treatment is 1 year.
Chronic viral hepatitis C:
Combination therapy is usually carried out:
- peginterferon alfa-2a 180 mcg/kg subcutaneously once a week with
ribavirin or peginterferon alfa-2b 1.5 mcg/kg subcutaneously
Once a week with ribavirin, the dosage of which depends on
body weight.
Monotherapy with peginterferon alfa-2a or alfa-2b is carried out
if there are contraindications to taking ribavirin.
Treatment
Chronic viral hepatitis D:treatment of chronic hepatitis D before
currently remains unresolved
problem. Recommended to use
interferon-alpha in high doses (9-10
million IU subcutaneously every other day for no
less than 48 weeks), but the effectiveness is the same
therapy is quite low.
Prevention
1. Nonspecific prevention:a) maintaining hygiene, personal and public;
b) if there is a threat of infection, use individual means
protection, disinfection and sterilization
medical instruments;
c) hospitalization and treatment of chronic patients,
infected with hepatitis B C D viruses or their combinations,
separately from other patients;
d) cultural and educational work with the population;
d) because the likelihood of infection and development of the virus is significant
depends to a large extent on the initial state of the organism, then as
prevention measures can be considered to improve health and
strengthening one’s own immune defense, including
phytohealth (immunomodulatory preparations and
adaptogens).
Prevention
2. Specific prevention:Specific prevention of viral hepatitis
divided into pre-infection prevention and prevention
after possible infection.
Specific prevention before infection today
carried out only for hepatitis B. Method
immunization with hepatitis B vaccine (med.
all employees).
A vaccine against the hepatitis C virus is being developed.
Specific prevention after possible
infection is an urgent appointment
antiviral drugs in combination with
interferon.
Clinical examination
At least 1 year.Regular examinations of patients with
mandatory determination in blood
main biochemical indicators:
bilirubin, protein and its fractions,
activity of aminotransferases, prothrombin,
HBsAg markers. Assigned basic or
other treatment options.
Hepatitis is a viral infectious inflammatory disease of the liver. The patient’s likelihood of recovery depends on the form and type of disease. Hepatitis is a viral infectious inflammatory disease of the liver. The patient’s likelihood of recovery depends on the form and type of disease.
The hepatitis A virus is transmitted fecally, orally, through water and food. The virus enters the human body through contaminated food, water, and household items. The hepatitis A virus is transmitted fecally, orally, through water and food. The virus enters the human body through contaminated food, water, and household items.
Hepatitis B provokes both acute and chronic forms of hepatitis. Hepatitis B provokes both acute and chronic forms of hepatitis. Sources of infection are patients with acute and chronic forms of hepatitis, as well as virus carriers. The virus is transmitted through blood, natural and artificial means. Sources of infection are patients with acute and chronic forms of hepatitis, as well as virus carriers. The virus is transmitted through blood, natural and artificial means.
Hepatitis C is transmitted through contact with blood. Hepatitis C can lead to the development of chronic hepatitis, resulting in liver cirrhosis and liver cancer. Hepatitis C is transmitted through contact with blood. Hepatitis C can lead to the development of chronic hepatitis, resulting in liver cirrhosis and liver cancer.
The source of the D virus is a sick person or a virus carrier. Infection with the D virus occurs when the virus enters directly into the blood. The routes of transmission are similar to those for hepatitis B or C. The source of the D virus is a sick person or a virus carrier. Infection with the D virus occurs when the virus enters directly into the blood. The routes of transmission are similar to those of hepatitis B or C.
Hepatitis E causes symptoms similar to those of hepatitis A, although it can sometimes develop into a fulminant form, especially in pregnant women. The routes of transmission are the same as for hepatitis A (that is, through contaminated food and water). Hepatitis E causes symptoms similar to those of hepatitis A, although it can sometimes develop into a fulminant form, especially in pregnant women. The routes of transmission are the same as for hepatitis A (that is, through contaminated food and water).
Hepatitis G has been recently identified. Possible routes of transmission are blood and sexual contact. Its primary reproduction in the liver has not yet been proven. Hepatitis G has been recently identified. Possible routes of transmission are blood and sexual contact. Its primary reproduction in the liver has not yet been proven.
Routes of infection Donor blood transfusion. Using the same needle by different people greatly increases the risk of infection with hepatitis B, C, D, G. Viruses B, C, D, G can be transmitted through sexual contact. From mother to child Hepatitis B, C, D, G viruses are transmitted through tattooing, acupuncture, and ear piercing with unsterile needles.
