Hepatitis A - Treatment
Hepatitis A (Botkin's disease, infectious hepatitis) - an acute infectious disease that occurs with the general intoxication and predominantly affects the liver.In the early twentieth century, the disease called catarrhal jaundice, t. To. On assumptions, it developed due to blockage of the common bile duct by mucus in inflammatory processes, taking place in the duodenum.SPBotkin disagreed with this suggestion and put forward his theory about the possible causes of the disease, as indicated in the infectious origin, which was confirmed by quite weighty arguments (affects not only the liver, but also the nervous system, kidneys, spleen, and increasedetc.).However, despite this, only in 1940, the efforts of outstanding national figure M.P.Konchalovskogo medicine, in honor of the author, first discovered the origin of infectious jaundice, this disease was called "disease Botkin»
Causes Hepatitis A
causative agentHepatitis A is located in swabs from nasopharynx, blood a
sick person is the main source of infection.It can infect others with both Latter-day incubation period, and throughout the course of illness, but is considered to be most contagious the first week of the disease and prodromal period.Carriers of the virus are a very dangerous source of spread of the disease as essentially being relatively healthy, they do not respect the basic measures that can prevent the disease from both their families and the people around them.
of hepatitis A is through food, contaminated water and contact - by household.First of all, the virus enters the food from the hands, contaminated when using a telephone, secretions when visiting the toilet, handrails tram, bus and so on. In most cases, the infection occurs in two ways:
- the transfusion of plasma, blood and serum;for injection is not enough sterilized needles and syringes, with preventive vaccination
- when consuming contaminated water or food (by mouth)
The most common infectious hepatitis observed in the spring, in the early winter and late fall months.The incubation period is from two to fourteen days.Syringe vaccination or disease Botkin considered less contagious, is characterized by a prolonged course of the incubation period (from three to eleven months) and can occur throughout the year.Not excluded the transfer of infection from an infected mother to the fetus.
Upon infection through the mouth, the hepatitis A virus enters the gastrointestinal tract, and in injectable form in the lymph or blood, and in both cases it reaches the liver, it starting to multiply.Epidemic hepatitis causes degenerative and inflammatory changes to the violation of the integrity of the bile capillaries and the collapse of the liver cells, resulting in bile initially enters the flow of lymph and then into the bloodstream.Almost simultaneously with the liver effects on endocrine and nervous system, gallbladder and reticulo - endothelial tissue of the spleen.Occasionally, due to the fact that the blood is sucked elements decay of hepatic cells (proteins), various allergies
Symptoms and signs of hepatitis A
In their clinical course, Hepatitis A is divided into three stages: prodromal (predzheltushnogo) ictericand the stage of recovery.
predzheltushnogo period often begins feverishly - dyspeptic syndrome.Patients complain of loss of appetite, weakness, malaise, pain in the liver, nausea and vomiting, belching.Often there is a total increase of body temperature to 37 - 38.5 * C.In duration, preicteric period ranges from several days to two - three weeks.
during the height of the disease, or jaundiced period comes soon enough.After the come less distinct improvement in general condition, quite suddenly there is jaundice.First of all, patients have jaundice of sclera, then soft and hard palate, the skin of the face and body, and a little later and limbs.In most cases, fully developed jaundice reaches the fourth - the seventh day.In patients develop headaches, weakness, there is itching, insomnia, irritability appears.Pulse becomes rare, blood pressure is lowered.At the same time increases the liver, often exposed to an enlarged spleen.The urine becomes dark due to the fact that it starts as urobilin partially allocated lingering bilirubin in the blood.Feces on the contrary, is bleached, because the small enough bilirubin into the intestine.
According to statistics, the average duration of jaundice two - three weeks, but sometimes it is delayed up to two - three months.The patient recovered after formally considered the normalization of the liver and spleen size, disappearance of jaundice, under generally satisfactory condition and at the termination of dyspeptic complaints.However, despite the external recovery after discharge from the hospital, each patient should be under the supervision of polyclinic.
Botkin's disease in its flow can be mild, moderate and severe.
Mild (outpatient) form hepatitis A, jaundice can hardly affect the overall health of the patient and to be very short (two - three days).Cases where acute infectious hepatitis occurs even without jaundice.In such cases, for the diagnosis of this disease is used to determine the activity of the enzyme aldolase (its activity is increased to seven times).
In severe infective hepatitis, there are disorders of the nervous - psychic sphere: in patients marked drowsiness and lethargy.Symptoms of jaundice is very intense on the skin appear petechiae, there is expansion of the boundaries of the heart, weakening of the heart sounds, and tachycardia.
When malignant form Hepatitis A, which still bears the name of the liver, there is a massive diffuse hepatic necrosis in conjunction with the progressive loss of parenchyma.This form is characterized by jaundice, a rapid decrease in the liver, bleeding, fever, increasing liver failure and severe general condition with a number of symptoms that indicate the presence of deep changes in the central nervous system.Ultimately, all of which can lead to hepatic coma.
pace of development and the time of occurrence of toxic liver disease are different.In some cases, patients after the appearance of jaundice observed symptoms of liver failure, and the disease takes a very formidable for rapid, leading to death within a few days.However, in most cases, degeneration of the liver is not developing as fast.A few weeks later, after at least safely flowing infective hepatitis, liver failure occurs.Symptoms of this disease are nausea, vomiting (often repeated), persistent anorexia, lethargy, increasing general weakness, insomnia at night and daytime sleepiness, apathy.Before that significantly increased the liver begins to decrease rapidly, the edge is testovatoy and mild, and the region is reduced hepatic dullness.Quite often there is a specific mouth sweet smell.For most of the picture of a typical buildup of brain phenomena (tremor, increased tendon reflexes, excitation).Over the next two - three days, the patient falls into a state of unconsciousness, which then goes into a coma
Treatment of Hepatitis A
Patients diagnosed with Hepatitis A are subject to immediate hospitalization in infectious disease clinic.The duration of the isolation of patients with at least four weeks.In periods of development and the height of the disease, bed rest is required.Patients were assigned a diet consisting of easily digestible foods enriched with vitamins.When hemorrhagic phenomena intramuscularly administered menadione, and inside - vitamin K. In the case of prolonged severe course of the disease, as well as the presence of itching, appointed corticosteroids (most commonly prednisone), and subcutaneous and intravenous glucose solution.In complicated cases, as well as the presence of concomitant diseases, prescribe antibiotics (terramycin, penicillin and so forth.).To improve the flow of bile, a second duodenal intubation.
Treatment of patients with toxic dystrophy complex, including a glutamic acid, corticosteroids, neomycin, low-protein diet with plenty of fluids.
In most reported cases, Hepatitis A ends in complete recovery, and this applies to severe cases.However, there are patients in whom the disease becomes chronic, characterized by periodic exacerbations in violation of the proper functioning of the liver.Chronic Hepatitis A can acquire due to late hospitalization, various violations of dietary and hygienic conditions, mental and physical stress, alcohol consumption, and in case of acceding diseases (gastroenterocolitis, flu and so on.).These forms with symptoms of liver failure patients can be fatal.
great importance to prevent the spread of hepatitis A have certain hygiene measures, especially if there is an epidemic outbreak.To protect against infection with the hepatitis epidemic of food, should be taken against contamination by flies.Before the use of fruits and vegetables, they should first be thoroughly cleaned, then pour over boiling water (water should be boiled before it about fifteen minutes).
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