Hepatitis: what is it and how to treat

Hepatitis: detailed review (100,000 words)

I. What is hepatitis: definition, types and general characteristics

Hepatitis, in the broadest sense, is a liver inflammation. This condition can be caused by various factors, including viral infections, alcohol abuse, toxins, certain drugs and autoimmune diseases. Inflammation of the liver caused by hepatitis can disrupt the normal function of the organ, which leads to a wide range of symptoms and potentially serious complications.

A. Viral hepatitis: main types

The most common cause of hepatitis around the world is viral infections. There are five main types of viral hepatitis, designated by the letters A, B, C, D and E. Each type of hepatitis is caused by a separate virus and has unique characteristics in relation to transmission, the course of the disease and prevention.

• Hepatitis A (HAV):

  • The causative agent: Hepatitis A virus (HAV), RNA virus.
  • Transmission path: Fecal-oral path. It usually spreads through contaminated food or water, as well as through close personal contact with an infected person.
  • The course of the disease: Usually an acute infection, which is permitted by itself for several weeks or months. The chronic course does not develop.
  • Symptoms: They can vary from the lungs (fatigue, loss of appetite, nausea) to more severe (jaundice, darkening of urine, light stool). Many people, especially children, can be asymptomatic.
  • Diagnosis: Detection of IGM antibodies to HAV in the blood.
  • Prevention: Vaccination, compliance with hygiene rules (careful hand washing), safe preparation and storage of food.
  • Treatment: Supporting, aimed at alleviating symptoms. There is no specific antiviral treatment.
  • Geographical distribution: Widely distributed all over the world, especially in regions with poor sanitary conditions.

• Hepatitis B (HBV):

  • The causative agent: Hepatitis B virus (HBV), DNA virus.
  • Transmission path: It is transmitted through contact with infected blood, sperm or other biological fluids. The main transmission routes include:
    • Sexual contact.
    • Joint use of needles for injection.
    • Transfer from mother to child during childbirth (vertical transmission).
    • Medical procedures using non -sterile equipment.
  • The course of the disease: Both acute and chronic infection can occur.
    • Acute hepatitis B: In most adults, it passes on its own, but in a small part it can lead to fulminant hepatitis (acute liver failure).
    • Chronic hepatitis B: It can lead to cirrhosis of the liver, liver cancer and liver failure.
  • Symptoms: Both in acute and chronic hepatitis B, symptoms can vary from lungs to severe. Many people with chronic hepatitis B can be asymptomatic for many years.
  • Diagnosis: Detection of the surface antigen of hepatitis B (HBSAG), antibodies to nuclear antigen hepatitis B (Anti-HBC), HBV DNA in the blood.
  • Prevention: Vaccination (highly effective), safe sex, avoiding joint use of needles, screening of pregnant women.
  • Treatment:
    • Acute hepatitis B: Supporting treatment.
    • Chronic hepatitis B: Antiviral drugs (for example, Entkavir, tenofovir) to suppress viral replication and slow down the progression of the disease.
  • Geographical distribution: Widely distributed all over the world, especially in Africa, Asia and Eastern Europe.

• Hepatitis C (HCV):

  • The causative agent: Hepatitis C (HCV), RNA virus.
  • Transmission path: It is transmitted mainly through contact with infected blood. The main transmission routes include:
    • Joint use of needles for injection (the most common transmission path).
    • Blood transfusion or organs transplant (rarely in countries with a developed screening system).
    • Medical procedures using non -sterile equipment.
    • Sexual contact (less common than with hepatitis B).
    • Transfer from mother to child during childbirth (rarely).
  • The course of the disease: Often proceeds as a chronic infection.
    • Acute hepatitis C: In most people, it proceeds asymptomatic or with mild symptoms.
    • Chronic hepatitis C: It can lead to cirrhosis of the liver, liver cancer and liver failure.
  • Symptoms: Both in acute and chronic hepatitis C, symptoms can be mild or absent.
  • Diagnosis: Detection of antibodies to HCV (Anti-HCV), HCV RNA in the blood.
  • Prevention: Avoiding joint use of needles, blood and organs, safe medical procedures.
  • Treatment: Direct antiviral drugs (DAA) with high efficiency (more than 95% cure). Treatment is usually carried out for several weeks or months.
  • Geographical distribution: Widely distributed all over the world, especially in Africa, Asia and Eastern Europe.

• Hepatitis D (HDV):

  • The causative agent: Hepatitis D (HDV), RNA virus. This is a defective virus that can infect only people already infected with hepatitis B.
  • Transmission path: Like hepatitis B, it is transmitted through contact with infected blood, sperm or other biological fluids.
  • The course of the disease: It can occur as coinfection (simultaneous infection of HBV and HDV) or superinfection (infection of HDV in a person with chronic HBV).
    • Coinepection: It can lead to a more severe course of acute hepatitis, but is more often allowed independently.
    • Superfection: Often leads to the progression of liver disease and faster development of cirrhosis.
  • Symptoms: It can be more severe than with hepatitis B, especially with superinfection.
  • Diagnosis: Detection of antibodies to HDV (anti-HDV), HDV RNA in the blood.
  • Prevention: Hepatitis B vaccination (prevents HBV infection and, therefore, HDV).
  • Treatment: Treatment is more complicated than with hepatitis B. Interferon alpha can be effective, but often causes side effects.
  • Geographical distribution: It is common all over the world, but most often found in the Mediterranean region, in the Middle East and in some parts of Africa and South America.

• Gepatite E (Hev):

  • The causative agent: Hepatitis E (Hev), RNA Virus.
  • Transmission path: Basically, the fecal-oral path, often through contaminated water.
  • The course of the disease: Usually an acute infection, which is permitted on its own. The chronic course is rare, but can develop in people with weakened immunity (for example, in organs recipients).
  • Symptoms: Similar to hepatitis A, but can be more severe in pregnant women. Hepatitis E in pregnant women is associated with a high risk of liver failure and death.
  • Diagnosis: Detection of IGM antibodies to HEV in the blood.
  • Prevention: Ensuring safe water supply, compliance with hygiene rules. In some countries, the HEV vaccine is available.
  • Treatment: Supporting, aimed at alleviating symptoms. Ribavirin can be used to treat chronic hepatitis E in people with weakened immunity.
  • Geographical distribution: Widely distributed in developing countries, especially in Asia and Africa.

B. Nevirus hepatitis: Other causes

Viral infections are not the only cause of hepatitis. Other factors that can cause inflammation of the liver include:

• Alcoholic hepatitis: It is caused by excessive alcohol consumption. Prolonged alcohol abuse can lead to damage to the liver, inflammation and, ultimately, to cirrhosis of the liver.
• Non -alcoholic steatogepatitis (nasG): The type of non -alcoholic fatty liver disease (NAZBP), characterized by inflammation of the liver and damage to the liver cells in people who do not consume an excessive amount of alcohol. NASG is often associated with obesity, type 2 diabetes and high cholesterol.
• Autoimmune hepatitis: The condition in which the body’s immune system attacks the liver cells, causing inflammation and damage.
• Medicinal hepatitis: It is caused by certain drugs that can be toxic to the liver.
• Toxic hepatitis: It is caused by the effects of toxins, such as industrial chemicals or toxic mushrooms.
• Genetic diseases: Some genetic diseases, such as hemochromatosis and Wilson’s disease, can lead to damage to the liver and hepatitis.

C. General characteristics of hepatitis:

Despite various reasons, hepatitis has some general characteristics:

• Inflammation of the liver: The main feature of hepatitis. Inflammation can lead to damage to liver cells (hepatocytes) and impaired liver function.
• Damage to liver cells: Damage to hepatocytes can lead to the release of liver enzymes (for example, ALT and AST) in the blood. An increased level of liver enzymes is a sign of liver damage.
• Disorders of the liver function: Inflammation and damage to the liver can disrupt various liver functions, including metabolism, detoxification, protein synthesis and bile production.
• Symptoms: Symptoms of hepatitis can vary from lungs to severe and can include fatigue, loss of appetite, nausea, vomiting, abdominal pain, jaundice (yellowing of the skin and eye proteins), darkening of urine and light stool.
• Potential complications: Chronic hepatitis can lead to serious complications such as liver cirrhosis, liver cancer and liver failure.

II. Hepatitis symptoms: acute and chronic

Symptoms of hepatitis can vary depending on the type of hepatitis, the stage of the disease and the individual characteristics of the body. Some people with hepatitis can be asymptomatic, especially in the early stages of the disease.

A. Symptoms of acute hepatitis:

Acute hepatitis refers to sudden inflammation of the liver, which usually lasts less than six months. Symptoms of acute hepatitis may include:

• Fatigue: A sense of constant fatigue and weakness.
• Loss of appetite: There is a lack of desire or a decrease in appetite.
• Nausea and vomiting: Feeling of nausea and vomiting.
• Abdominal pain: Discomfort or pain in the upper right side of the abdomen (where the liver is located).
• Jaundice: Yellowing of the skin and white proteins. The jaundice is caused by the accumulation of bilirubin, bile pigment, in the blood.
• Darkening of urine: Urine becomes darker than usual due to an increased level of bilirubin.
• Light chair: The chair becomes pale or clay in color due to a decrease in the content of bile.
• Quickly: Skin itching caused by the accumulation of bile acids in the skin.
• Fever: Improving body temperature (rarely).
• Pain in muscles and joints: Pain in the muscles and joints (rarely).

B. Symptoms of chronic hepatitis:

Chronic hepatitis refers to prolonged inflammation of the liver, which lasts more than six months. Many people with chronic hepatitis can be asymptomatic for many years. Symptoms of chronic hepatitis may include:

• Fatigue: A sense of constant fatigue and weakness.
• Abdominal pain: Discomfort or pain in the upper right side of the abdomen.
• Loss of appetite: There is a lack of desire or a decrease in appetite.
• Nausea: Feeling of nausea.
• Jaundice: Yellowing of the skin and white proteins (can be periodic or constant).
• Quickly: Skin itching.
• Abdomen (ascites): The accumulation of fluid in the abdominal cavity.
• Leg swelling (swelling): The accumulation of liquid in the legs and ankles.
• Easy formation of bruises or bleeding: Violation of blood coagulation due to a decrease in the production of coagulation factors by the liver.
• Confused consciousness, drowsiness or coma (liver encephalopathy): Violation of the function of the brain due to the accumulation of toxins in the blood.
• Bloody vomiting or black tar -shaped stool (varicose bleeding): Bleeding from advanced veins in the esophagus or stomach.
• Splenomegaly: An increase in the spleen.
• Palmaric erythema: Redness of the palms.
• Vascular stars: Small blood vessels visible under the skin.

C. Symptoms of liver cirrhosis:

The liver cirrhosis is a late stage of chronic hepatitis, characterized by irreversible damage to the liver and the formation of cicatricial tissue. Symptoms of liver cirrhosis may include:

• All symptoms of chronic hepatitis.
• Ascites: The accumulation of fluid in the abdominal cavity.
• Swelling: The accumulation of liquid in the legs and ankles.
• Varicose bleeding: Bleeding from advanced veins in the esophagus or stomach.
• Hepatic encephalopathy: Violation of the function of the brain due to the accumulation of toxins in the blood.
• Jaundice: Yellowing of the skin and white proteins.
• Splenomegaly: An increase in the spleen.
• Liver failure: The inability of the liver perform its functions.
• Liver cancer (hepatocellular carcinoma): Cancer development in roasted.

III. Hepatitis Diagnostics: Methods and procedures

The diagnosis of hepatitis includes a combination of an anamnesis, physical examination and laboratory tests. The purpose of the diagnosis is to determine the cause of inflammation of the liver, assess the degree of damage to the liver and the exclusion of other liver diseases.

A. Anamnesis and physical examination:

The doctor will ask the patient about his medical history, hepatitis risk factors (for example, drinking alcohol, the use of injection drugs, sexual behavior), the drugs that he takes, and the symptoms that he experiences. A physical examination can reveal signs of hepatitis, such as jaundice, an increase in the liver or spleen, ascites and swelling.

B. Laboratory research:

• Liver tests: Blood tests that measure the level of hepatic enzymes (for example, ALT, AST, alkaline phosphatase, gamma-vlutamiltranspetidase) and bilirubin. An increased level of liver enzymes indicates damage to the liver.
• Viral hepatitis tests: Blood tests that determine the presence of antibodies to hepatitis A, B, C, D, and E. These tests help determine the type of viral hepatitis.
• Coagulogram: A blood test that evaluates blood coagulation. Violation of blood coagulation may be a sign of liver damage.
• General blood test: A blood test that estimates the number of blood cells (red blood cells, white blood cells and platelets). Changes in the number of blood cells can be associated with hepatitis or other diseases.
• Alfa-Fetoprotein (AFP): A blood test that is used to screening liver cancer (hepatocellular carcinoma).
• Analyzes for autoimmune hepatitis: Blood tests that determine the presence of autoantiber (for example, antinuclear antibodies, antibodies to smooth muscles, antibodies to liver and kidneys).
• Analyzes for genetic diseases: Blood tests that determine the presence of genetic mutations associated with liver diseases (for example, hemochromatosis, Wilson’s disease).

C. Instrumental research methods:

• Ultrasound study (ultrasound) of the liver: The non -invasive visualization method, which allows you to assess the size, shape and structure of the liver. Ultrasound can identify signs of hepatitis, such as an increase in the liver, fatty liver infiltration or cirrhosis of the liver.
• Computer tomography (CT) of the liver: The visualization method that uses x -rays to obtain detailed images of the liver. CT can identify signs of hepatitis, liver cancer and other anomalies.
• Magnetic resonance tomography (MRI) of the liver: The visualization method that uses magnetic fields and radio waves to obtain detailed images of the liver. MRI can identify signs of hepatitis, liver cancer and other anomalies. MRI is often more sensitive than CT to identify small foci in the liver.
• Biopsy baked: Invasive procedure in which a small sample of the liver tissue is taken for a microscopic examination. The liver biopsy can be used to confirm the diagnosis of hepatitis, determine the cause of inflammation of the liver, assess the degree of damage to the liver and exclude other liver diseases.

D. Elastography of the liver:

• Transive elastography (fibroscan): A non -invasive method that measures the stiffness of the liver. The stiffness of the liver increases with cirrhosis.
• Elastography of the shift wave: A method that uses ultrasound or MRI to measure the stiffness of the liver.

IV. Hepatitis treatment: General principles and specific approaches

The treatment of hepatitis depends on the type of hepatitis, the stage of the disease and the individual characteristics of the body. The general principles of treating hepatitis include:

• Elimination of the cause of inflammation of the liver: For example, the cessation of alcohol treatment with alcohol hepatitis, avoiding drugs that cause drug hepatitis, or treatment of viral infection.
• Supporting therapy: Aims to relieve symptoms and maintain the function of the liver.
• Specific treatment: Aimed at eliminating the cause of hepatitis or slowing down the progression of the disease.
• Prevention of complications: Aimed at preventing the development of liver cirrhosis, liver cancer and liver failure.

A. Treatment of viral hepatitis:

• Hepatitis a:

  • There is no specific antiviral treatment.
  • Continuating treatment aimed at relieved symptoms, such as nausea, vomiting and fatigue.
  • Recreation is recommended, the use of a sufficient amount of liquid and the avoidance of alcohol and other substances toxic for the liver.

• Hepatitis B:

  • Acute hepatitis B: Usually does not require specific treatment. Supporting treatment aimed at relieved symptoms.
  • Chronic hepatitis B: Treatment with antiviral drugs (for example, leenofovir) to suppress viral replication and slow down the progression of the disease. The purpose of treatment is to reduce the risk of developing cirrhosis, liver cancer and liver failure. The treatment is usually long -term, and patients need to regularly undergo monitoring to assess the effectiveness of treatment and detect side effects. In some cases, liver transplantation may be considered.

• Hepatitis C:

  • Treatment of direct action antiviral drugs (DAA) with high efficiency (more than 95% of the cure).
  • Treatment is usually carried out for several weeks or months and is well tolerated.
  • After curing hepatitis C, patients need to regularly undergo monitoring for screening liver cancer.

• Hepatitis D:

  • Treatment is more complicated than with hepatitis B.
  • Interferon alpha can be effective, but often causes side effects.
  • Hepatitis B vaccination is the best prevention of hepatitis D.

• Hepatitis E:

  • Specific antiviral treatment is usually not required for acute hepatitis E.
  • Supporting treatment aimed at relieved symptoms.
  • Ribavirin can be used to treat chronic hepatitis E in people with weakened immunity.

B. Treatment of non -viral hepatitis:

• Alcoholic hepatitis:

  • Continuation of alcohol consumption is a cornerstone of treatment.
  • Supporting therapy, including a high -protein and calorie diet, vitamin additives and complications (for example, ascite, liver encephalopathy).
  • In severe cases, corticosteroids or pentoxyphillin can be used.
  • In some cases, liver transplantation may be considered.

• Non -alcoholic steatogepatitis (nasG):

  • Changing lifestyle, including weight loss, low -fat and sugar diet, and regular physical exercises.
  • Treatment of concomitant diseases, such as obesity, type 2 diabetes and high cholesterol.
  • In some cases, drugs, such as vitamin E, pioglitazone or enjoyed acid, can be used.

• Autoimmune hepatitis:

  • Treatment with immunosuppressive drugs, such as corticosteroids and azathioprine, to suppress the immune system and reduce liver inflammation.
  • The treatment is usually long -term, and patients need to regularly undergo monitoring to assess the effectiveness of treatment and detect side effects.

• Medicinal hepatitis:

  • The cessation of taking the medicine that caused hepatitis.
  • Supporting therapy to relieve symptoms and maintain liver function.
  • In some cases, corticosteroids can be used.

• Toxic hepatitis:

  • Avoiding the effects of toxin that caused hepatitis.
  • Supporting therapy to relieve symptoms and maintain liver function.
  • In some cases, antidotes can be used.

• Genetic diseases:

  • Treatment is aimed at managing the underlying genetic disease. For example, with hemochromatosis, phlebotomy (bloodletting) is performed to reduce iron level in the body. For Wilson’s disease, medicines are used that bind copper and remove it from the body.

V. Prevention of hepatitis: strategies and recommendations

Hepatitis prevention plays an important role in reducing the incidence and mortality associated with this disease.

A. Prevention of viral hepatitis:

• Hepatitis a:

  • Vaccination: a hepatitis A vaccine is highly effective and recommended for people at risk of infection, such as travelers in endemic regions, people with chronic liver diseases, people who use injection drugs, and health workers.
  • Compliance with hygiene rules: thoroughly washing hands with soap and water after visiting the toilet and before eating.
  • Safe preparation and storage of food: Avoid the use of raw or undercooked seafood and food prepared in unsanitary conditions.
  • Safe water supply: drink only clean and safe water.

• Hepatitis B:

  • Vaccination: Hepatitis B vaccine is highly effective and recommended for all babies, children and adults at risk of infection, such as people who use injection drugs, sexual partners of infected people, health workers and people with chronic kidney diseases.
  • Safe sex: using condoms in sexual contact.
  • Avoid joint use of needles: do not use the needles for injections, tattoos or piercings together.
  • Screening of pregnant women: screening of pregnant women on hepatitis B allows you to identify infected mothers and take measures to prevent the transfer of the virus for the child during childbirth.
  • Safe medical procedures: Make sure that all medical procedures are carried out using sterile equipment.

• Hepatitis C:

  • Avoid joint use of needles: do not use the needles for injections, tattoos or piercings together.
  • Safe medical procedures: Make sure that all medical procedures are carried out using sterile equipment.
  • Screening of blood and organs: thorough screening of blood and organs before transfusion or transplantation.
  • Safe sex: the use of condoms in sexual contact (although the risk of hepatitis C is low).

• Hepatitis D:

  • Hepatitis B vaccination: hepatitis B vaccination prevents HBV infection and, therefore, HDV.
  • Avoid joint use of needles: do not use the needles for injections, tattoos or piercings together.
  • Safe sex: using condoms in sexual contact.

• Hepatitis E:

  • Safe water supply: drink only clean and safe water.
  • Compliance with hygiene rules: thoroughly washing hands with soap and water after visiting the toilet and before eating.
  • Safe preparation and storage of food: Avoid the use of raw or undercooked meat of pigs and wild animals.
  • Vaccination: In some countries, a vaccine against HEV is available.

B. Prevention of non -viral hepatitis:

• Alcoholic hepatitis:

  • Refusal to drink alcohol: the most effective way to prevent alcohol hepatitis.
  • Moderate drinking: if you drink alcohol, do it in moderation (no more than one drink per day for women and no more than two drinks per day for men).

• Non -alcoholic steatogepatitis (nasG):

  • A healthy lifestyle: maintaining a healthy weight, a low -fat diet, and regular physical exercises.
  • Control of concomitant diseases: treatment of obesity, type 2 diabetes and high cholesterol.

• Medicinal hepatitis:

  • Caution when taking drugs: Take medications only as prescribed by a doctor and observe the recommended dose.
  • Information of the doctor: tell your doctor about all the drugs that you take, including overcomplex drugs, vitamins and additives.
  • Regular monitoring: If you take medications that can be toxic to the liver, regularly monitor liver samples.

• Toxic hepatitis:

  • Avoid the effects of toxins: avoid contact with industrial chemicals, pesticides and other toxic substances.
  • Caution when consuming mushrooms: do not use mushrooms if you are not sure of their safety.

VI. Hepatitis and pregnancy: risks and management

Hepatitis during pregnancy can pose a serious threat to both the mother and the child. Risks and management depend on the type of hepatitis.

• Hepatitis a:

  • Risk for the mother: acute hepatitis A can lead to premature birth, premature rupture of the fetal membranes and liver failure.
  • Risk for the child: hepatitis A is rarely transmitted from mother to child.
  • Management: supportive therapy for the mother. Hepatitis A vaccination is recommended for pregnant women at risk of infection.

• Hepatitis B:

  • Risk to the mother: chronic hepatitis B can lead to exacerbation of the disease during pregnancy.
  • Risk for the child: High risk of hepatitis B transfer from mother to child during childbirth.
  • Management: Pregnant women with hepatitis B are recommended to receive antiviral treatment in the third trimester of pregnancy to reduce the risk of the child’s transfer to the child. The newborn from infected mothers introduce immunoglobulin against hepatitis B and a hepatitis B vaccine within 12 hours after birth.

• Hepatitis C:

  • Risk to the mother: chronic hepatitis C can lead to exacerbation of the disease during pregnancy.
  • Risk for the child: the risk of hepatitis C transfer from mother to child is about 5%.
  • Management: Treatment of hepatitis C of direct action antiviral drugs (DAA) is not recommended during pregnancy. Treatment can be postponed until after giving birth.

• Hepatitis E:

  • Risk for mother: Hepatitis E in pregnant women is associated with a high risk of liver failure and death.
  • Risk for the child: a high risk of premature birth, miscarriage and death of the child.
  • Management: supportive therapy for the mother. HEV vaccination can be considered before pregnancy in endemic regions.

VII. Hepatitis in children: features and approaches to treatment

Hepatitis in children has some features compared to hepatitis in adults.

• Hepatitis a:

  • It often proceeds asymptomatic or with mild symptoms in children.
  • Hepatitis A vaccination is recommended for all children aged 1 year and older.

• Hepatitis B:

  • Children infected with hepatitis B at birth have a high risk of chronic infection.
  • Hepatitis B vaccination is recommended for all newborns.
  • Children born of infected mothers are introduced by immunoglobulin against hepatitis B and a hepatitis B vaccine within 12 hours after birth.

• Hepatitis C:

  • The transmission of hepatitis C from mother to child rarely occurs.
  • Treatment of hepatitis C of direct action antiviral drugs (DAA) is available for children aged 3 years and older.

• Autoimmune hepatitis:

  • It may be difficult to diagnose in children.
  • Treatment with immunosuppressive drugs, such as corticosteroids and azathioprine.

** VIII. Complications