acute and chronic hepatitis
Introduction
Introduction to acute and chronic hepatitis Acute and chronic hepatitis refers to hepatocyte necrosis and abnormal liver function due to various reasons. The main difference between acute hepatitis and chronic hepatitis is the condition of the disease. Acute hepatitis refers to liver disease caused by infection with hepatitis virus, and the general course of disease is no more than 6 months. Chronic hepatitis is mostly caused by acute hepatitis B, and the course of acute hepatitis C has evolved over half a year. In addition, chronic hepatitis also includes those patients who are not caused by the virus, but whose clinical manifestations are chronic hepatitis, including patients with fatty liver and patients with drug-induced hepatitis. The prognosis of patients with acute inflammation is mostly good, more than 90% of patients can be cured within 3 months, and less than 10% can be converted to chronic persistent hepatitis or chronic active hepatitis, only 1% to 2% of patients Will evolve into cirrhosis or liver cancer. Second, viral hepatitis is contagious and can be transmitted through blood, mother-to-child transmission, and sexual transmission. basic knowledge The proportion of illness: 0.3% Susceptible people: no specific people Mode of transmission: blood transmission, iatrogenic transmission, sexual transmission, mother-to-child transmission Complications: liver cancer, fulminant hepatic failure
Cause
Causes of acute and chronic hepatitis
Type of hepatitis: Type of hepatitis is the type of virus that is infected. Hepatitis A and E generally do not turn into chronic, and even if he is a little longer, he can eventually achieve a complete cure. It is extremely rare for more than 6 months. Type B, hepatitis C is different, and it is easy to evolve into chronic. About 5% to 10% of adults infected with hepatitis B virus, about 50% after infection with hepatitis C virus will become chronic, the original hepatitis B virus infection plus hepatitis B virus infection is called overlapping infection. It is more likely to become chronic, because the virus is not easily cleared and persists in the body for a long time. In addition, there are two factors in the cause of hepatitis:
1. Gender and age: If infants and young children are infected with hepatitis B virus, more than 90% of them will become carriers with long-term virus. Some of them will develop the disease in the future, and older people will become chronic after suffering from acute hepatitis. According to statistics, 22.2% to 40% of people over 40 years old with acute hepatitis will become chronic persistent hepatitis or chronic active hepatitis, while only 6.3% to 8.9% of people under the age of 40 become chronic, in terms of gender. Men are more common than women, but pregnant women are more likely to become chronic after getting hepatitis.
2, rest is not good: after the illness failed to rest or rest well, overworked, emotionally nervous, allergic insomnia, do not think diet is easy to turn into chronic hepatitis.
Prevention
Acute and chronic hepatitis prevention
1, the food should be appropriate: digestive function is weakened in liver disease, eating too much often leads to indigestion, but also increase the burden on the liver. Eating 80% is the best, overeating is not good for liver and gastrointestinal function.
2, the diet is light: cooking should be light, less oil, eat less cold, irritating food, quit smoking and alcohol.
3, the rational application of traditional Chinese medicine tonic: hepatitis patients do not advocate excessive use of tonic, normal diet can provide adequate nutrition. It is best to seek the advice of a Chinese medicine doctor when taking tonics. It is not beneficial to blindly eat tonic.
Complication
Acute and chronic hepatitis complications Complications liver cancer fulminant hepatic failure
More complicated congestive heart failure, shock, liver trauma and heart disease.
Symptom
Acute and chronic hepatitis symptoms Common symptoms Astragalus loss of appetite Total bilirubin high Liver swelling Abdominal bloating spider low heat liver water ascites
Viral hepatitis: common symptoms are fatigue, general malaise, loss of appetite, discomfort or pain in the liver area, abdominal distension, low fever, signs of dull complexion, yellow staining of the sclera, may have spider mites or liver palm, large liver, medium texture or fullness There are pains, severe spleen, may have deepening of jaundice, ascites, lower extremity edema, bleeding tendency and hepatic encephalopathy.
Alcoholic hepatitis: obvious abdominal distension, general fatigue, loss of appetite, diarrhea, nausea and vomiting, abdominal pain, weight loss, fever in some patients, characterized by jaundice, hepatomegaly and tenderness, a few with splenomegaly, dull complexion, Ascites, edema, spider mites, etc. When there is liver dysfunction, the ascites is obvious, and some have neuropsychiatric symptoms.
Drug-induced hepatitis: often fever, aversion to cold, urticaria-like or measles-like rash, itching, joint pain or swollen lymph nodes. Severe cases resemble acute or subacute hepatic necrosis, bleeding tendency, ascites formation, hepatic coma and even death.
Autoimmune hepatitis: Most patients show chronic hepatitis. About 34% of patients have no symptoms. They only see liver function abnormalities due to physical examination. 30% of patients have cirrhosis at the time of presentation; 8% of patients have hematemesis and Or) the performance of decompensated cirrhosis such as melena; some patients with acute or even fulminant onset (about 26%), their transaminase and bilirubin levels are high, the clinical process is dangerous.
Ischemic hepatitis: This disease is more common in postoperative cardiac surgery, especially in the simultaneous implementation of multiple valves of artificial valve replacement, acute myocardial infarction or severe arrhythmia caused by left heart failure, severe infection and sepsis. Occasionally, upper gastrointestinal bleeding occurred on the basis of chronic liver disease.
Examine
Acute and chronic hepatitis check
1, serum test
(1) Serum enzymology test: the concentration of alanine aminotransferase (ALT) in hepatocytes is 104 times higher than that of serum. As long as 1% hepatocyte necrosis can increase serum concentration by 1 time, the acute hepatitis positive rate is up to 80% to 100%. Aspartate aminotransferase (AST) has the highest concentration in the myocardium, so when determining the effect on liver function, the impact of heart disease should be excluded first. AST 80% in the mitochondria of liver cells, in general, liver damage is mainly caused by elevated ALT. If serum AST is significantly increased, it often indicates severe necrosis of liver cells. In mitochondria, AST is released into the blood, and the degree of serum transaminase increase is roughly parallel with the severity of the lesion. However, in severe hepatitis, bilirubin may increase continuously, while transaminase may decrease, that is, bile enzyme separation, suggesting that hepatocyte necrosis is serious.
(2) Serum protein detection: serum protein is often used as a biochemical indicator of liver protein metabolism. In chronic hepatitis cirrhosis, serum albumin is often decreased, globulin levels are elevated, and -globulin is elevated. .
(3) Detection of serum bilirubin: The liver has uptake and transport in bilirubin metabolism, combined with excretion function, liver function damage leads to elevated bilirubin levels, in addition to cholestatic hepatitis, bilirubin levels and liver damage The severity is proportional.
(4) Prothrombin time (PT): It can sensitively react to the synthesis of blood coagulation factors II, VII, IX and X in the liver. The length of PT in liver disease is positively correlated with the degree of liver injury.
2. Hepatitis virus logo detection
(1) Hepatitis A: In patients with acute hepatitis, serum anti-HAVIgM positive can be diagnosed as a recent infection of HAV, and anti-HAV-IgG positive indicates previous infection and immunity.
(2) Hepatitis B:
1HBsAg and anti-HBs: HBsAg positive indicates that HBV is currently in the infection stage, and anti-HBs positive for immunoprotective antibodies have already produced immunity against HBV. The diagnosis of chronic HBsAg carriers is based on the absence of any clinical signs and symptoms, normal liver function, and HBsAg persistent positive for more than 6 months.
2HBeAg and anti-HBe: HBeAg positive is an indicator of HBV active replication and strong infectivity. The detection of serum from HBeAg positive to anti-HBe positive indicates that the disease has reduced the infectivity.
Diagnosis
Diagnosis and diagnosis of acute and chronic hepatitis
1. Liver biopsy: It is the main indicator for the diagnosis of various types of viral hepatitis. It is also the definitive evidence for the diagnosis of early cirrhosis. However, it is not the first choice because of the traumatic examination.
2, ultrasound and computed tomography (CT): Ultrasound examination is widely used, the diagnosis of chronic hepatitis, hepatitis cirrhosis, has been clear and can help identify liver cirrhosis and liver cancer and jaundice. CT examination is also of great value to the above diagnosis.
