Hepatitis of the liver

Hepatitis is called a large group of inflammatory liver diseases. The name of the disease already includes an indication of localization and character, so saying "liver hepatitis" is wrong. Obligatory signs of hepatitis are typical changes in the hepatic parenchyma.

At a certain stage of the process, the functions of the organ are disrupted and the person suffers from intoxication with harmful slag substances, loss of protein, vitamins, and disturbed metabolism.

The study of varieties of hepatitis allowed to establish the nature of the disease, identify pathogens of certain types of liver inflammation, develop optimal approaches to treatment, prevent the transition to the stage of cirrhosis.

What are hepatitis?

The existing classification of hepatitis provides for the isolation of varieties for reasons, clinical course, the activity of the inflammatory process. Given the causes of hepatitis, pathology is divided into infectious and non-infectious.

Inflammation of the liver of an infectious nature includes:

• group of viral hepatitis, they are named after the Latin name of the virus (viral hepatitis A, B, C and further to G), each has its own peculiarities, but all are distinguished by a specific selective lesion of hepatic cells (hepatotrophy);
• secondary hepatitis, when the liver affects other viruses (rubella, herpes, influenza, mumps, mononucleosis, yellow fever, AIDS), they do not have a targeted effect and enter the hepatic tissue from other foci;
• bacterial hepatitis caused by pathogens leptospirosis, listeriosis, syphilis, pneumococcus, staphylococcus, streptococcus;
• parasitic hepatitis - can occur with toxoplasmosis, amebiasis, fascioliasis, schistosomiasis, opisthorchiasis.

The liver is forced to withstand the attack of toxic substances and harmful microorganisms

Non-infectious hepatitis include:

• toxic - in turn, is divided into alcohol, medicinal and hepatitis, caused by poisoning chemicals;
• radiation - is an integral part of radiation sickness;
• autoimmune - is more common in women and children, the main mechanism is associated with congenital insufficiency of enzymes that enter the envelope of hepatocytes.

Forms of the disease

The forms of hepatitis are determined by the clinical course, the response of the body to the treatment of liver inflammation. Clinicians distinguish the following forms. Acute hepatitis - is more often caused by poisoning, enteroviruses, pathogenic intestinal bacteria, manifested by severe deterioration of the condition, fever, symptoms of intoxication.

In blood tests, an increase in transaminases, alkaline phosphatase and other indicators indicating a disruption of the liver. Lasts up to three months. In most cases, the disorder can be stopped, the disease is considered curable.

Prolonged form - lasts up to six months, manifestations of hepatitis "go away" gradually, the course is sluggish, but the forecast is favorable. Chronic - can occur with untreated passing acute hepatitis or be an independent form. Acute forms are characterized by such an indicator as the frequency of chronicization.

The insidiousness of the pathology lies in the long secretive period, the gradual transition of inflammatory phenomena to the dystrophy of the liver tissue. Treatment is long (more than 6 months), it is rare to cure the disease. Typical transformation into cirrhosis.

What causes inflammation of the liver?

The causes of hepatitis of an infectious species are most often determined by the nature of the virus. The known pathogens have their own peculiarities in the structure and ways of infection. Necessarily have a nucleus with DNA or RNA determining genetic information.

The greatest difficulty in determining how to treat a patient is the mutant virus (eg, hepatitis C) with its ability to alter the genome. Fecal-oral transmission mechanism is characteristic for viral hepatitis E and A. Microorganisms are stable in the external environment, they come to a person with contaminated water, products, through contact with the patient.

Hepatitis cases are recorded as outbreaks or epidemics in certain areas

Such types of hepatitis as C, B, D and G have a parenteral route of admission. Their activity is lower than the type A virus. The human body is penetrated with blood components during transfusion, with medical manipulations, minor traumas (manicure, tattooing), through common syringes of drug addicts, sexually, through the placenta from mother to fetus.

Getting into the blood of a person from the intestine or by direct infection with a syringe, the viruses move to the liver, enter into the liver cells, multiply inside and destroy them.
Toxic hepatitis, except for alcohol and its surrogates, cause:

• contact at work and at home with compounds of white phosphorus, carbon tetrachloride, industrial poisons;
• poisoning with mushrooms (pale and white toadstool, fly agaric);
• long-term use of medicines (Paracetamol, anti-tuberculosis drugs, methyldopa, Amiodarone, Nifedipine, Azathioprine, tetracycline antibiotics, Clarithromycin, Indomethacin, Ibuprofen, hormones, contraceptives).

Autoimmune hepatitis - annually detected in 15-20 people per 100 thousand. population, is considered an independent disease. The main cause of development - a defect in the human immune system, in which the own liver cells are taken for foreign. Often accompanied by involvement of the pancreas, thyroid and salivary glands.

In this case, the patient does not find markers of viral hepatitis, there is no evidence of alcoholism, but antinuclear and antibodies to smooth muscles, a high level of immunoglobulin such as IgG and hepatic renal microsomal antibodies are found.

What are the symptoms of hepatitis?

Symptoms of liver inflammation are divided into hepatic and extrahepatic, early and late. To hepatic manifestations of hepatitis include: abdominal pain with localization in the hypochondrium to the right and in the epigastrium, nausea, eructation, yellowing of the skin and mucous membranes, enlargement of the liver and spleen.

Extrahepatic signs of liver inflammation are formed due to the influence of hepatitis-induced disorders on the functions of various organs and systems (brain, metabolism, vessels, endocrine glands). These include:

• hepatic encephalopathy;
• rash on the skin, painful itching;
• vascular "stars" (telangiectasias), capillaries;
• bleeding gums, nasal bleeding, women with prolonged menstrual flow;
• red palms and "crimson" language;
• gastric bleeding from the enlarged esophagus;
• infertility.

In the photo, icteric sclera, usually with it begins jaundice

The signs of each disorder are explained by the characteristic morphological and functional changes, are confirmed by diagnostic methods (biochemical tests, biopsy specimen examination with puncture of the liver). Therefore, they are combined in typical for hepatitis syndromes.

A feature of some types of chronic hepatitis is a prolonged asymptomatic course (for example, with viral hepatitis B and C). Practically the first symptoms of hepatitis can not be seen. In a retrospective survey, patients note periodic weakness, vague rashes on the skin, a feeling of heaviness in the hypochondrium right after eating.

For the diagnosis of infectious hepatitis, it is important that during this period, patients are already contagious to others. The task to identify and treat is caused not only by preventing serious complications in the patient, but also by preventing the spread of the disease.

The first signs of hepatitis can indicate pain in the muscles, increased fatigue at work, periodic temperature rises, deterioration of appetite. Late symptoms are caused by a developing complication. Revealed on the basis of cirrhosis of the liver, bleeding from the esophagus, liver failure, suspected malignant neoplasm.

What syndromes indicate inflammation of the liver?

Diagnosis of hepatitis requires the inclusion of a combination of clinical picture, biochemical and immunological laboratory indicators, the results of morphological studies of tissue biopsy. Not all liver functions are disrupted at the same time. The development of inflammation is accompanied by a predominant lesion and manifests itself in certain clinical and laboratory syndromes.

Cytolysis syndrome - associated with dystrophy, and then necrosis of hepatocytes, caused by direct exposure to infectious agents, toxic substances, toxins. The clinic can detect elevated temperature, pain and liver enlargement (especially after physical exertion), it is possible to increase the spleen, urine becomes dark, and feces are gray.

Laboratory features are:

• increased levels of hepatic transaminases (alanine and aspartic), enzymes (glutamyltranspeptidase, lactate dehydrogenase, cholinesterase, arginase), these data are considered markers of the cytolysis process;
• increase in the concentration of total bilirubin due to unconjugated (indirect), to a lesser extent - direct.

The syndrome of cholestasis - the main disturbance is the failure of synthesis and excretion through the intrahepatic ducts of bile into the duodenum. As a result, non-mechanical stagnation is formed (without blocking the moves with stones).

Bile should normally enter the small intestine

Symptoms of cholestasis are revealed during examination and examination of the patient:

• on the skin of the face and body, yellow-brown spots (xanthomas), on the eyelids of xantelasm in the form of small warts;
• intense yellowing of sclera, skin, mucous in the mouth;
• darkening of urine and fecal discoloration;
• blunt pains in the hypochondrium on the right strengthen after eating;
• bleeding is associated with the cessation of vitamin K synthesis;
• deterioration of vision at dusk and at night because of a lack of vitamin A;
• increased dryness of the skin, itching.

Among the biochemical tests are found:

• growth in the blood of direct bilirubin, cholesterol, bile acids, lipoproteins, triglycerides, phospholipids, alkaline phosphatase enzyme, gamma-glutamyltranspeptidase, copper;
• impaired coagulation causes changes in the coagulogram;
• the blood content of calcium and fat-soluble vitamins (E, A, D, K) decreases.

Immunoinflammatory syndrome - is not clinically manifested, but is found when checking immunity indices. Characteristic increase in the level of gamma globulins (decrease albumin-globulin coefficient), the presence of antibodies to DNA or RNA, to smooth muscle fibers.

For the study, enzyme immunoassay, immunoblotting, and radioimmunoassay are used. Methods allow to calculate the viral load in infectious hepatitis. With the help of polymerase chain reaction, genetic information on the type of virus is revealed.

Hepatic-cell failure - the syndrome is formed with the death of a part of hepatocytes and the loss of liver functions of synthesis and detoxification. The main laboratory signs of hepatic insufficiency:

• a decrease in protein in the blood due to albumins, proconvertin, prothrombin;
• fall in the indicators of fat metabolism (cholesterol, triglycerides, phospholipids, lipoproteins);
• positive thymol and sulemic samples;
• carrying out of functional tests (bromsulfaleinic, antipyrine, ammonia, phenolic) gives a positive result.

Fulminant liver failure as a syndrome is characterized by a rapid course, with the development of encephalopathy, paresis of vascular tone, coagulopathy. The patient suddenly has nausea, vomiting, increasing weakness, jaundice.

At the same time, blood pressure drops, palpitations and breathing increase, the temperature rises, consciousness is disturbed (the patient falls into a coma). The condition is so heavy that it is impossible to do anything. The lethal outcome is caused by the edema of the brain.

Laboratory diagnosis allows differentiating pathology

The syndrome of hepatic encephalopathy - is revealed on the grounds of neurological and psychic changes. Patient:

• disturbed coordination of movements;
• reveal common apathy, disappearance of interest in close people;
• behavior changes to a tendency to irritability or inhibition;
• the speech function is violated;
• there is involuntary bowel movement, incontinence;
• from the mouth, the surrounding feel a specific odor (hepatic);
• there is a tremor and cramps in the limbs;
• consciousness is gradually lost, becomes a coma.

The syndrome of portal hypertension is caused by the development of cirrhosis and increased pressure in the portal vein system. In this case, the patient appears:

• persistent nausea;
• bloating;
• unstable stools;
• bleeding, a tendency to gastric and intestinal bleeding;
• pain and a feeling of heaviness in the epigastrium and right hypochondrium after eating;
• splenomegaly;
• increases the volume of the stomach due to fluid accumulation (ascites);
• dilated veins of the esophagus, stomach, rectum, subcutaneous around the navel.

If hepatitis occurs with a predominant accumulation of fluid in the cavities (pleural, abdominal) and tissues, the syndrome is called edematous. Usually it develops as a consequence of portal hypertension, in the late stage of the disease. Ascites are swollen on the limbs, face (anasarka). Breathing is difficult due to effusion into the pleural cavity.

Not only the lower extremities swell, but also the hands

Hepatorenal syndrome - represents a simultaneous cessation of the functioning of the liver and kidneys. Clinically, signs of hepatic insufficiency aggravate the symptoms of impaired renal excretion.

There are taste perversions, oliguria with a daily diuresis of up to 500 ml, changes in the shape of the fingers ("drumsticks") and nails ("watch glass"), a significant increase in the liver and spleen, in men there is growth of the mammary glands.

Laboratory parameters of not only liver tests are changing, but the accumulation of creatinine and residual nitrogen is increasing. Protein leaves the urine, but in the blood, it falls even more. Electrolyte losses increase due to the cessation of reabsorption in the renal tubules.

How are hepatitis stages differentiated and the degree of activity?

Inflammatory activity is assessed for each type of hepatitis by a combination of biochemical parameters (in the case of non-infective lesion) and viral load. Separately, decoding morphological changes in the study of biopsy.

To select the tactics of therapy, it is necessary to identify the phase of activity of immune cells in response to the damaging factor. It serves as an indicator of the severity of the autoaggression mechanism. At 1 degree of activity - lymphocytes and macrophages lie along the intrahepatic vessels, it is possible to find immune cells inside the lobules, but there is no damage to the terminal plate.

The picture corresponds to 1 degree of the general activity of the pathological process, in the case of viral damage, the stage of propagation of the pathogen. 2 degree - the proliferation of immune cells destroys the terminal membrane of the hepatic lobules and is directed to the central zone. Especially aggressive lymphocytes are introduced into the cytoplasm of hepatocytes.

The morphological picture coincides with the 2 degree of hepatitis activity. 3 degree - the changes are characterized by extensive areas of destruction, cell necrosis. During the course of viral hepatitis, 4 stages are distinguished:

• incubation;
• pre-jaundice (prodromal);
• icteric;
• convalescence (recovery).

What methods exist in the treatment of hepatitis?

In the treatment of hepatitis necessarily use a sparing diet, bed rest. To counteract the damaging factors and support the hepatic cells, the patient is prescribed:

• intravenously solutions with detoxification properties (Glucose 5%, Hemodez, Trisol electrolytes, Lactosol);
• hepatoprotective preparation Heptral;
• intramuscularly needed large doses of vitamins;
• In viral hepatitis, the only etiologic treatment is Interferon-alpha, Ribaverin;
• bacterial hepatitis will require the use of antibiotics;
• dosage of corticosteroids depends on the activity of the process.

To somehow remove symptomatic disorders, the doctor prescribes cholagogue preparations, with anemia medications containing iron, complex vitamins and trace elements.

New drugs (Telaprevir, Ladipasvir, Sofosbuvir and Bocepreviros) are only suitable for patients with a specific type of virus

When toxic hepatitis should stop contact with the poisonous substance. For people with alcoholism, it is important to give up all kinds of alcohol. Identify the exact cause of hepatitis can be difficult, so you need to start screening and symptomatic treatment for early signs of the disease.