cholestatic hepatitis
Introduction
Introduction to cholestatic hepatitis Cholestatic hepatitis is a syndrome characterized by partial or complete biliary tract blockade due to a variety of causes of hepatocyte and/or capillary bile duct bile secretion disorders. It accounts for 2 to 8% of jaundice hepatitis. Viral cholestatic hepatitis accounts for about 3% of patients with viral hepatitis. It can be caused by hepatitis A, B, and E. It occurs more than a few weeks after the onset of acute hepatitis. Cholestatic jaundice is common in autoimmune hepatitis (cholecystosis), primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced hepatitis, and viral cholestatic hepatitis. The signs of cholestatic hepatitis are liver enlargement, gallbladder is not full: due to cholestatic liver enlargement, and bile excretion is not smooth, the gallbladder is not filled with bile, the hepatomegaly is thicker, so the liver area is sore, gallbladder The stimulation of the salt makes the skin itchy. The basic principle of cholestatic hepatitis treatment is similar to that of common hepatitis, but the main purpose is to eliminate jaundice. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: liver cirrhosis
Cause
Cause of cholestatic hepatitis
Cause (70%):
Cholestatic hepatitis is caused by a variety of causes of hepatocytes and/or capillary bile duct bile secretion, leading to partial or complete biliary flow block. It often occurs several weeks after the onset of acute hepatitis. Cholestatic jaundice is common in autoimmune hepatitis (cholecystosis), primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced hepatitis, and viral cholestatic hepatitis.
Prevention
Cholestatic hepatitis prevention
1. Actively treat acute hepatitis or other liver diseases.
2, a reasonable diet, should increase protein supply to ensure vitamin supply. Supply sufficient liquid. Increase the intake of fresh vegetables and fruits.
3, taboo alcoholism. Taboo overeating, especially excessive meat and sugar. Use spicy and other irritating foods with caution.
Complication
Cholestatic hepatitis complications Complications liver cirrhosis
It can cause liver cirrhosis and liver cancer.
Symptom
Cholestatic hepatitis symptoms common symptoms liver enlargement jaundice skin sclera yellow dyed mouth dry nausea bloating appetite loss liver capsule tension urine red liver spleen
Symptoms are mild and jaundice: Because hepatic cell necrosis of cholestatic hepatitis is not heavy, and cholestatic is the main cause, the symptoms are relatively light, and jaundice can be deep.
The urine is dark yellow and the stool color is shallow: due to inflammation of the biliary system, obstruction, and reduced bile content excreted into the intestine, the stool is light in color and looks like clay color, so it is called clay color stool, and stagnant bilirubin flows back to The blood is discharged from the urine, so the urine is extremely dark.
The signs of cholestatic hepatitis are liver enlargement, gallbladder is not full: due to cholestatic liver enlargement, and bile excretion is not smooth, the gallbladder is not filled with bile, the hepatomegaly is thicker, so the liver area is sore, gallbladder The stimulation of the salt makes the skin itchy.
Examine
Cholestatic hepatitis check
Laboratory tests for cholestatic hepatitis showed a "six-high" phenomenon: elevated serum total bilirubin, mainly elevated bilirubin (direct bilirubin) (>70%); alkaline phosphatase ( ALP) increased; -glutamyltransferase (1 - GT) increased; cholesterol (cH) increased; bile acid (TBA) increased; beta globulin increased.
Pathological examination of cholestatic hepatitis showed microtuberculosis, bile duct hyperplasia, capillary bile duct dilation under electron microscope, bile thrombus formation in capillary bile duct, microvilli lesions, and hepatocyte necrosis was not prominent.
Diagnosis
Diagnosis and diagnosis of cholestatic hepatitis
Symptoms: Astragalus is progressively aggravated and lasts for more than 3 weeks. The patient's skin is itchy. After the scratch, there are fine bleeding spots and ecchymoses. The urine is dark yellow, the stool color becomes lighter, and it can be grayish white in a short time. The liver is big. Slightly weak, oropharyngeal dry.
Acute cholestatic hepatitis is similar to acute jaundice hepatitis.
Diagnosis of acute cholestatic hepatitis
1. The clinical diagnosis is consistent with acute viral hepatitis, and the hepatitis pathogen test is positive.
2. The jaundice is deep and lasts for more than 3 weeks. It has the characteristics of three separations, that is, the jaundice is heavy and the gastrointestinal symptoms are mild. Huang Qi is heavy and ALT is rising at a low rate. However, ALT can be significantly increased at the beginning of the disease, and then jaundice is deep, ALT is decreased, jaundice is heavy, and PT and PTA are not clear.
3, with obstructive jaundice characteristics, skin itching, clay color stool, serum bile acid concentration increased significantly, up to 10 times the normal level, and lasts for a long time. Serum AKP, R-GT, total cholesterol and serum lipoprotein X may be mild to moderately elevated and urinary biliary significantly reduced or disappeared.
4. Excluded drugs and other causes and extrahepatic obstructive jaundice caused by primary or secondary tumors.
5. Liver histology is consistent with the histological features of acute cholestatic hepatitis.
Diagnosis of chronic cholestatic hepatitis
1. Clinically consistent with the diagnosis of chronic active hepatitis or cirrhosis. Most of the antigens of hepatitis B or hepatitis C virus, antibody serological indicators or HBV-DNA/HCV-DNA positive.
2, the clinical features of obstructive jaundice and excluding extrahepatic obstruction or other causes of intrahepatic obstructive jaundice.
3, liver biopsy meets the histological changes of chronic active hepatitis or cirrhosis, and has the morphological characteristics of cholestatic hepatitis.
Differential diagnosis
Hepatic jaundice, cholestasis of jaundice, congenital jaundice, hemolytic jaundice. Clinically, the two types are more common in the past. The two are generally easy to identify. Hepatocellular jaundice is associated with symptoms and signs of hepatocellular failure, such as abnormal fatigue, loss of appetite, spider mites, liver palm and liver function. The biochemical changes of damage, etc., total bilirubin (TBlL) is generally below 200umol / l, a small number of patients with hepatic cell failure TBIL can be above 200umol / l. Congenital jaundice is a type of disease of hereditary physiological disorders, mostly neonates or children. Hemolytic jaundice refers to a sudden increase in the production of bilirubin by the destruction of a large number of red blood cells in the body, which exceeds the rate at which hepatocytes remove metabolic bilirubin. It is characterized by a significant increase in unconjugated bilirubin (indirect bilirubin IBIL). Common in blood type inferior blood transfusion, snake bites, drug side effects, bone marrow ineffective hematopoiesis, pulmonary infarction. The main features of cholestasis jaundice are: the patient's sclera is dark yellow, the skin is itchy, the urine is like brown, the stool is light or even white clay; the acute one has hepatomegaly, and the chronic one has splenomegaly. Total bilirubin (TBIL) in patients with cholestasis is generally >200umol/l, but in patients with symptomatic relief, it can be around 100umol/l. When cholestasis is combined, bilirubin (direct bilirubin DBIL) can be increased greatly. More than 50% of TBIL; elevated plasma cholesterol levels, mainly free cholesterol rise, plasma cholesterol often exceeds 7.76mmol / L in most cases. When cholestasis occurs, the ALP value is more than 2.5 times higher than normal, and ALT is often mildly elevated. Cholestatic jaundice is common in autoimmune hepatitis (cholecystosis), primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced hepatitis, and viral cholestatic hepatitis.
It is also necessary to identify jaundice caused by obstruction of the intrahepatic or extrahepatic biliary tract during cholestasis. This jaundice is called obstructive jaundice, such as bile duct stones and tumors around the ampulla. Common bile duct stones may have right upper quadrant cramps, tumors around the ampulla often have upper abdominal pain or back pain, can be seen in the upper abdomen and lumps, B-ultrasound often provides a more accurate basis for diagnosis. Cholestatic hepatitis intrahepatic bile duct sclera is common golden yellow; while primary biliary cirrhosis and extrahepatic cholestasis sclera yellow-green. Generally speaking, obstructive jaundice is weak, abdominal distension is not obvious, and acute viral hepatitis cholesterol type ALT is significantly increased, early abdominal distension, fatigue, less food is more obvious, this hepatic jaundice actually exists in varying degrees The intrahepatic cholestasis shows that the transient stool is light or even white clay. Chronic cholestatic viral hepatitis is relatively mild and clinically rare. Hepatic jaundice caused by severe hepatitis, prothrombin activity is significantly reduced, and high fatigue is characteristic. All kinds of jaundice patients can be as high as 600umol/L or more, and most patients are difficult to recover.
Some cases of extrahepatic cholestasis and obstructive jaundice are suitable for surgical treatment, while hepatic jaundice and intrahepatic cholestasis are treated with medical treatment. This section focuses on the treatment of intrahepatic cholestasis hepatitis.
