hepatitis
Introduction
Introduction to hepatitis Hepatitis (Hepatitis) is inflammation of the liver. The causes of hepatitis are different, the most common is caused by the virus, in addition to autoimmune. Alcoholism can also cause hepatitis. Hepatitis is divided into acute and chronic hepatitis. The hepatitis caused by the virus is divided into six types of viral hepatitis according to the virus series: hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E and hepatitis G. Early symptoms and manifestations of hepatitis, such as: loss of appetite, poor digestion, bloating after eating, no hunger; tired of eating greasy food. There is no effective preventive measure for hepatitis, and early detection and early diagnosis is the key to the prevention and treatment of this disease. Fatty liver is an important cause of hepatitis. In recent years, liver diseases have increased significantly, often coexisting with obesity and diabetes. To stay away from fatty liver, start with a diet. Controlling the fat diet is of course necessary. Prevention of fatty liver also advocates exercise, exercise can consume excess body fat. basic knowledge The proportion of illness: 0.3% Susceptible people: no specific population Mode of infection: 1, mother-to-child transmission 2, iatrogenic infection 3, transfusion transmission 4, close contact with life 5, sexual transmission Complications: liver cirrhosis
Cause
Cause of hepatitis
Virus infection (25%):
Caused by a variety of hepatitis viruses. It is characterized by strong contagiousness, complex transmission routes, wide range of epidemics, and high incidence. At present, viral hepatitis is mainly divided into five types: hepatitis A, B, C, D and E. In recent years, hepatitis C and hepatitis G have been found. Among them, hepatitis A and E are self-limiting, generally do not turn chronic, and a few can develop cirrhosis. Chronic hepatitis B is closely related to the occurrence of primary hepatocellular carcinoma.
Drug or chemical poison (20%):
Many drugs and chemical poisons can cause liver damage, drug-induced hepatitis or toxic hepatitis. Such as bisphenol phenate, methyldopa, tetracycline and arsenic mercury, carbon tetrachloride and the like. The degree of damage to the liver depends on the time of administration or exposure to the drug or chemical poison, as well as differences in individual quality. Long-term use or repeated exposure to drugs and chemical poisons can lead to chronic hepatitis and even cirrhosis.
Alcohol abuse (26%):
Alcohol can cause hepatitis. Mainly due to the direct damage of liver cells caused by the toxicity of alcohol (ethanol) and its metabolite acetaldehyde. According to the study, if you drink more than 150g of alcohol per day, for more than 5 years, 90% of all kinds of liver damage can occur; more than 10% of chronic hepatitis occurs in more than 10 years, and about 25% develop cirrhosis. There are more alcoholics in Europe and the United States, and alcoholic cirrhosis accounts for about 50% to 90% of all liver cirrhosis. In China, the situation is better.
Other (20%):
Many systemic infectious diseases can invade the liver, such as EB virus, typhoid fever in bacterial infections, etc., can cause elevated serum transaminase or other abnormal liver function. However, because these diseases have their own special performance, and the inflammation of the liver is only a part of the disease, it is not difficult to diagnose, and it is less misdiagnosed as "hepatitis."
Prevention
Hepatitis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Fatty liver is an important cause of hepatitis. In recent years, liver diseases have increased significantly, often coexisting with obesity and diabetes. To stay away from fatty liver, start with a diet. Controlling the fat diet is of course necessary, but the total amount of sugar-containing foods should also be controlled, including rice noodles, because too much sugar can also evolve into fat in the human body. Prevention of fatty liver should also promote exercise, exercise can consume excess body fat, and even people who have already suffered from fatty liver, with diet control, exercise, can consume body heat, control weight gain, and after obesity is alleviated, The fat in the liver will also subside, and the liver function will return to normal without drug treatment.
Complication
Hepatitis complications Complications liver cirrhosis
It is easy to be converted into liver cirrhosis and liver cancer.
Symptom
Hepatic symptoms common symptoms fatigue liver appetite loss dyspepsia nausea collateral circulation circatransferase increased portal collateral circulation formation abnormal bloating transaminase increased
Early symptoms and manifestations of hepatitis, such as: loss of appetite, poor digestion, bloating after eating, no hunger; eating greasy food, if you eat, it will cause nausea, vomiting, and fatigue after activity.
Alcoholic hepatitis
Alcoholic hepatitis is a clinical syndrome that develops mainly after long-term, heavy drinking to the main manifestations of jaundice and even liver failure. Alcoholic hepatitis may have no obvious symptoms in the early stage, but the liver has pathological changes. The typical age of onset is concentrated between 40 and 60 years old. More men than women. Studies have shown that alcoholic hepatitis is also a clinical classification of alcoholic liver disease. It is a group of clinical pathological syndromes caused by massive necrosis of liver cells in a short period of time. It can occur on the basis of with or without cirrhosis, mainly due to loss of appetite. Nausea, vomiting, general fatigue, fever, abdominal pain and diarrhea, upper gastrointestinal bleeding and psychiatric symptoms, elevated serum ALT, AST and serum total bilirubin increased significantly. Severe alcoholic hepatitis refers to the manifestation of liver failure in patients with alcoholic hepatitis. For example, coagulopathy, jaundice, hepatic encephalopathy, acute renal failure, upper gastrointestinal bleeding, etc., often accompanied by endotoxemia.
Autoimmune hepatitis
Autoimmune hepatitis is a chronic disease, accounting for about 70%, and a small number can be acute, accounting for about 30%. Patients often present with symptoms such as fatigue, jaundice, hepatosplenomegaly, itchy skin and insignificant weight loss. After the disease progresses to cirrhosis, ascites, hepatic encephalopathy, and esophageal varices bleeding may occur. Patients with autoimmune hepatitis are also often associated with extra-hepatic systemic immune diseases, most commonly thyroiditis, ulcerative colitis.
Examine
Hepatitis check
First, laboratory inspection
1. Blood routine: The total number of white blood cells in the early stage of acute hepatitis is normal or slightly higher, generally not exceeding 10×109/L. The total number of white blood cells in the jaundice stage is normal or slightly lower, and the number of lymphocytes is relatively increased. In severe hepatitis, white blood cells can rise, red blood cells drop, and hemoglobin decreases. Hepatitis cirrhosis with hypersplenism may have the "three less" phenomenon of platelet, red blood cell and leukopenia.
2, urine routine: the detection of urinary bilirubin and urobilinogen is a simple and effective method for early detection of hepatitis, and also contribute to the differential diagnosis of jaundice. Hepatocyte jaundice was positive in both cases, hemolytic jaundice was mainly in the original, and obstructive jaundice was mainly urinary bilirubin. Patients with deep jaundice or fever may have protein, red, white blood cells or casts in addition to bilirubin.
3, liver function test
Second, serum enzyme determination
1. Alanine ammoniaase (ALT, formerly known as glutaminase GPT): It is the most commonly used indicator on liver function in forestry. ALT is released into the bloodstream when hepatocytes are damaged. Elevated serum ALT is more specific for the diagnosis of liver disease than aspartate (AST) because ALT levels in other organs are much lower than AST. ALT was significantly elevated in acute hepatitis, AST/ALT was often less than 1, and ALT began to decrease after jaundice appeared. ALT is mildly or moderately elevated or repeatedly abnormal in chronic hepatitis and cirrhosis, and AST/ALT is often greater than 1. The higher the ratio, the worse the prognosis, and the lower the AST/ALT ratio during the course of the disease, suggesting that the hepatocyte mitochondria were not damaged and the prognosis was better. Patients with severe hepatitis may have a rapid decline in ALT, elevated bilirubin enzymes, and biliary separation, suggesting massive necrosis of liver cells.
2. Aspartate aminotransferase (AST, formerly known as aspartate aminotransferase GOT): This enzyme has the highest myocardial content, followed by liver, skeletal muscle, kidney and pancreas. In the liver, AST 80% is present in hepatic fine cell mitochondria, only 20% in the cytosol. In patients with liver disease, serum AST is elevated, which is positively correlated with the severity of liver disease. When the lesion is persistent and severe, AST is released into the bloodstream in the mitochondria, and its value can be significantly increased. If AST continues to be high in acute hepatitis, there is a possibility of switching to chronic hepatitis. When the other organs of the myocardium are damaged, the AST is also elevated and should be identified to prevent such diseases from being masked by hepatitis symptoms.
3, lactate dehydrogenase (LDH): liver disease can be significantly increased, but can also be elevated in myopathy, must be identified with clinical.
4, Y-glutamyl-fetal enzyme (Y-GT): Hepatitis and liver cancer patients can be significantly elevated, more obvious in the case of biliary obstruction, YGT activity changes and liver disease pathological changes have a good consistency.
5, cholinesterase: synthesized by hepatocytes, its activity suggests that hepatocytes have been significantly damaged, the lower the value, suggesting that the disease is heavier.
6. Alkaline phosphatase (ALP or AKP): ALT in normal human serum is mainly derived from liver and bone tissue. ALP measurement is mainly used for clinical diagnosis of liver disease and bone disease. When intrahepatic or extrahepatic bile excretion is blocked, tissue-expressed ALP cannot be excreted and returned to the blood, resulting in elevated serum ALP activity.
Diagnosis
Hepatitis diagnosis
Viral hepatitis The hepatitis caused by the virus is divided into six types of viral hepatitis A, B, C, D, E and G according to the virus series. It can cause swelling of liver cells and is one of the most widespread infectious diseases in the world. In 1908, it was discovered that the virus is also one of the causative factors of hepatitis. In 1947, the original infectious hepatitis was called Hepatitis A (HA); and the serum hepatitis was called Hepatitis B (HB). In 1965, humans first detected the surface antigen of hepatitis B.
In addition, viral hepatitis is also hepatitis C, hepatitis D, hepatitis E and hepatitis G. The virus that was previously designated as hepatitis B virus is now identified as a genus of hepatitis B virus, so hepatitis B does not exist. In the vaccine for viral hepatitis, vaccines of type A, type B and type D have been successfully developed; there are currently no vaccines for type C, type E and type F.
