jaundice hepatitis
Introduction
Introduction to Jaundice The time from the start of the patient's symptoms to the appearance of jaundice is approximately several days to two weeks. At the onset of the disease, the patient often feels chills and fever, and the body temperature is about 38 °C. A few patients can continue to heat for several days. The more prominent symptoms are fatigue, loss of appetite, nausea, vomiting, especially disgusting greasy food. The upper abdomen is full of suffocation, yellow urine is like strong tea, and stool is thin or constipated. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: 1, mother-to-child transmission 2, iatrogenic infection 3, transfusion transmission 4, close contact with life 5, sexual transmission Complications: liver damage liver abscess
Cause
Causes of jaundice hepatitis
Jaundice hepatitis is caused by hepatitis virus, liver cell destruction, liver tissue destruction and remodeling, and bile duct obstruction, resulting in increased blood binding to bilirubin and unconjugated bilirubin, resulting in skin, mucous membrane and eye sclera. The symptoms of yellowing. Usually, when the blood bilirubin concentration is higher than 2-3 mg/dL, these parts will have a color that can be discerned by the naked eye.
Prevention
Jaundice prevention
Early detection and isolation of patients, strengthening of food management, disinfection of medical equipment, selection of blood donors, protection of susceptible populations.
Complication
Jaundice hepatitis complications Complications liver injury liver abscess
Liver abscess, primary liver cancer.
Symptom
Symptoms of jaundice hepatitis Common symptoms Nausea and vomiting Abdominal pain Liver enlargement High total bilirubin
Early stage
At this stage, due to individual differences, patient performance is complex and diverse, it is easy to be misdiagnosed. Special attention should be paid to patients with upper respiratory tract inflammation, similar to a cold. Some patients may be mistaken for rheumatism with joint pain. There are also a few people who have severe abdominal pain and mistaken for acute abdomen. There are also a few people who can wait for measles. At the end of this period, the body can be found in the liver area with sputum pain and tenderness. More than half of the patients can touch the liver under the costal margin, serum alanine aminotransferase (ALT) is significantly elevated, and urinary bilirubin is positive. Hepatitis B surface antigen positive, hepatitis B core antibody immunoglobulin M (anti-HBcIgM) positive. In this period, the blood, urine, and vomit of the patient contain a large amount of hepatitis virus, which is highly contagious.
Yellow period
After the heat retreat, jaundice occurs. The common sclera is yellow-stained first, and then the whole body is yellow, reaching a peak within a few days to 2 to 3 weeks. Most are mild to moderate jaundice. At this time, the symptoms of the digestive tract are aggravated, the liver is swollen, there is tenderness and snoring pain; a small number of spleen enlargement can be reached under the help of the spleen. Some patients are accompanied by itchy skin, bradycardia, abdominal pain and rash. After a few days of rest, the patient's nausea was relieved, vomiting disappeared, and appetite gradually improved. The white blood cell count is generally normal or slightly lower, and the differentially enumerated lymphocytes are high, and a small number of abnormal lymphocytes may appear. Urinary bilirubin, urinary bilirubin positive (yellow sputum is very deep, stool grayish white, urinary biliary may be temporarily negative). Serum ALT activity is significantly elevated, often above 400u, and this period lasts 2 to 6 weeks or longer.
Recovery period
In this period, the jaundice gradually regressed, hepatomegaly and other various symptoms gradually subsided, and the appetite returned to normal, but still felt mild liver pain. This period lasts an average of one month. A small number of cases of jaundice are significant, lasting for several months, fatigue, liver pain and gastrointestinal symptoms are not obvious, liver function shows obstructive jaundice, ALT only mild or moderate rise, known as cholestatic hepatitis. Complications: a small number of cases can be complicated by myocarditis, pericarditis, miliary viral pneumonia, pancreatic necrosis, diabetes, meningoencephalitis, acute polyneuritis, acute hemolytic anemia, whole blood cell reduction, aplastic anemia, thrombosis A salty species of phlebitis, nephritis, orchitis, papular dermatitis, polyarthritis, and the like.
Examine
Examination of jaundice hepatitis
1. If the patient's routine red blood cell (RBC) and hemoglobin (Hb) values decrease, urine occult blood test is positive, urobilinogen is increased and urinary bilirubin is negative, TB is elevated, DB is basically normal, ALT, AST, ASP, GGT, ALB and PT are normal, should be considered as hemolytic jaundice, and further can be related to the examination of hemolytic disease, at this time the patient should go to the hematology department for further examination and treatment.
2. If the patient's liver function is normal, hepatic (TB), direct bilirubin (DB), transaminase (ALT and AST), alkaline phosphatase (ALP) and -glutamyltransferase (GGT) are increased. DB/DT is between 30% and 40%, prothrombin time (PT) is prolonged, albumin (Alb) is decreased, and urinary bilirubin and urobilinogen are elevated in urine. It can be considered as hepatic jaundice, which can cause hepatic jaundice diseases such as viral hepatitis and cirrhosis.
3, when the patient's TB increased, DB increased significantly, DB / DT was greater than 50%, ALP, GGT increased significantly, urine urinary bilirubin also increased significantly, but urinary bile reduced or disappeared, should consider obstructive The possibility of jaundice may have been examined by B-ultrasound CT, MRI, ERCP and liver biopsy to determine intrahepatic cholestasis or liver obstruction.
Diagnosis
Diagnosis and differentiation of jaundice hepatitis
First, the blood: the total number of white blood cells is normal or slightly lower, the lymphocytes are relatively increased, and occasionally abnormal lymphocytes appear. Platelets can be reduced in some patients with chronic hepatitis.
Second, the jaundice index and bilirubin quantitative test were significantly increased. Urinary examination showed a significant increase in bilirubin, urobilinogen and urobilin.
Third, serum enzyme determination
1. Transaminase: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) can be elevated in the latent stage of hepatitis, early onset and latent infection, which is helpful for early diagnosis.
2. Other enzymes -glutamyltranspeptidase (-GT) can be slightly elevated.
Fourth, cholesterol, cholesterol ester, choline lipase determination of severe hepatitis patients with cholesterol, cholesterol esters, cholinesterase can be significantly reduced, suggesting a poor prognosis.
V. Serum immunological examination
1. Hepatitis A: Determination of anti-HAV-IgM has early diagnostic value for hepatitis A.
2. Hepatitis B: HBV markers (HBsAg, HBeAg, HBcAg, and anti-HBs, anti-HBe, anti-HBc) are of great significance in determining the presence or absence of hepatitis B infection. The determination of HBV-DNA, DNA-P and PHSA receptors is of great value in determining the presence or absence of HBV replication in patients with hepatitis B. High titer anti-HBc-IgM positive is conducive to the diagnosis of acute hepatitis B. The pre-S1 (Pre-S1) and pre-S2 genes of HBsAg were obtained by genetic engineering. Histochemistry and solid-phase radioimmunoassay can be used to study the localization of pre-S antigen in hepatocytes in patients with acute and chronic hepatitis B. The liver tissue with HBV replication often contains pre-S1 and pre-S2 of HBsAg. Anti-pre-Sl and anti-pre-S2 can be assayed in serum, the former appearing in the incubation period and the latter appearing before the viral replication is terminated. Therefore, anti-pre-Sl positive can be used as an early diagnostic indicator of acute hepatitis B, and anti-pre-S2 can be an indicator of hepatitis recovery.
3, hepatitis C often depends on the exclusion of type A, B, E and other viruses (CMV, EBV) and diagnosis, serum anti-HCV-IgM positive can be diagnosed.
4, the diagnosis of hepatitis E depends on serum anti-HEV-IgM positive or immunoelectron microscopy in the feces to see 30 ~ 32nm virus particles.
5. Serological diagnosis of hepatitis D depends on serum anti-HDV-IgM positive or HDAg or HDV cDNA hybridization positive; HDAg positive or HDV cDNA hybridization positive in liver tissue can be confirmed.
6. Determination of serum protein and amino acid
1. Protein electrophoresis -globulin (9-18%) Chronic active hepatitis is often >26%, and -globulin can be >30% in cirrhosis.
2, serum protein electrophoresis before albumin (synthesized by the liver) acute hepatitis and chronic active hepatitis patients with serum prealbumin value decreased by 83 to 92% with the recovery of the disease and returned to normal.
3. The ratio of plasma branched-chain amino acid (BCAA) to aromatic amino acid (AAA) decreases or reverses, which reflects liver parenchymal dysfunction. It has reference significance for judging the prognosis of severe hepatitis and evaluating the efficacy of branched-chain amino acids.
