viral hepatitis



OVERVIEW

Definition

Viral hepatitis is an infectious disease caused by hepatitis virus infection.

Viral hepatitis mainly damages the liver.

Viral hepatitis may be cured in the acute stage, while hepatitis B, C, and D may become chronic and develop into cirrhosis, liver failure, and even liver cancer. Hepatitis D can recur or aggravate the condition of hepatitis B.

Types

According to the type of virus infected, it can be divided into the following categories:

Viral Hepatitis A: Also known as Hepatitis A and Hepatitis A. The pathogen is Hepatitis A virus, which is an RNA virus.

Viral Hepatitis B: also known as Hepatitis B, Hepatitis B. The pathogen is the Hepatitis B virus, a DNA virus.

Viral Hepatitis C: also known as Hepatitis C, Hepatitis C. The causative agent is the Hepatitis C virus, which is an RNA virus.

Viral Hepatitis D: also known as Hepatitis D, Hepatitis D. The causative agent is the Hepatitis D virus, which is an RNA virus and is dependent on the Hepatitis B virus for replication.

Viral hepatitis E: also known as hepatitis E, hepatitis E. The causative agent is hepatitis E virus, an RNA virus.

Morbidity

Viral hepatitis occurs worldwide, and China is a high incidence area of viral hepatitis.

With the gradual spread of vaccination, the growth of viral hepatitis in China has been effectively controlled, but there is still a risk of transmission due to the large population base of the disease.

Causes

Causes

Viral hepatitis is caused by infection with hepatophilic viruses, but the source of infection, the route of transmission, and the susceptible population are different for different types of viruses.

Sources of infection

People with viral hepatitis and hepatitis virus carriers (including chronically infected and asymptomatic carriers, etc.) can be sources of infection.

Hepatitis E also has the following sources of infection.

Routes of transmission

Hepatitis A and Hepatitis E are mainly spread through the digestive tract, such as contaminating water and food after fecal discharge, and then entering the body through the mouth.

Hepatitis B and C can be transmitted through blood, sexual contact, and mother-to-child transmission.

Susceptible People

All people are susceptible to hepatophilic viruses if they are not immunized.

Pathogenesis

Different types of hepatitis viruses enter the liver through different routes.

After infecting the liver cells, the virus can cause liver damage through direct damage to the liver cells and the involvement of the immune system in the damage to the liver cells. Different types of hepatitis viruses may be involved in one or both of these mechanisms.

Symptoms

Acute hepatitis

Different types of viral hepatitis have different incubation periods. After the incubation period, the onset of the disease is acute and the following symptoms may occur:

The above symptoms may occur simultaneously or may start with weakness, lack of appetite, anorexia, nausea and vomiting, followed by the gradual onset of jaundice.

As the condition improves, the symptoms may gradually disappear.

Chronic Hepatitis

If chronicity occurs, the following symptoms may occur:

Weakness.

Loss of appetite.

Abdominal bloating.

Nausea and vomiting.

Darkening of the skin.

Yellowing of the skin, white eyes, and deepening of the color of the urine.

Prone to bleeding, such as bleeding from the mouth when brushing teeth.

Spider nevus: vascular nevus on the skin with the appearance of a spider; when pressure is applied to its center, the surrounding radial network of blood vessels disappears immediately and reappears after the pressure is removed.

Liver palms: reddening of the skin of the lower part of the palm of the hand at the level of the greater and lesser fissures, with fading of the color when pressure is applied.

Severe hepatitis

The initial onset of severe hepatitis is similar to the acute phase and progresses rapidly over a short period of time, often with the following symptoms:

Profound jaundice.

Severe gastrointestinal reaction with frequent vomiting.

Extreme malaise, which may be accompanied by persistent high fever, abnormal behavior, lethargy, or even coma.

Significant bleeding tendency, prone to bleeding gums and bleeding spots under the skin.

Complications

Liver cirrhosis: it may present with similar manifestations as viral hepatitis, such as malaise, lack of appetite, anorexia, nausea, vomiting, diarrhea, jaundice, etc. It may also present with abdominal distension and increased abdominal circumference.

Liver failure: in addition to the above manifestations of hepatitis and cirrhosis, there are also different degrees of hemorrhage, increased intracranial pressure and other manifestations (e.g., nosebleed, bleeding gums, vomiting blood or blood in stool, vomiting, blurred vision, etc.).

Hypersplenism: splenomegaly, decreased blood cells, decreased red blood cells, manifested by anemia symptoms such as pallor, dizziness, palpitations, etc. Decreased white blood cells are prone to infection.

Gastrointestinal bleeding: vomiting blood, blood in stool or black stool, etc. In severe cases, shock occurs, even life-threatening.

Secondary infection: weakness, fever and other manifestations.

Hepatic encephalopathy: cognitive decline, personality change, behavioral abnormality and so on.

Portal hypertension: manifestations such as splenomegaly, ascites and esophageal varices.

Hepatorenal syndrome: manifestations such as sudden onset of oliguria or anuria, ascites and jaundice of varying degrees, decreased blood pressure, nausea, vomiting and drowsiness.

Electrolyte disorders such as hyponatremia, hypokalemia and hyperkalemia: manifestations such as weakness, abdominal distension, nausea, vomiting, headache, drowsiness, painful muscle spasm, etc. In severe cases, respiratory failure or even death may occur.

Hepatogenic diabetes mellitus: symptoms of diabetes mellitus such as polyuria and polyphagia.

Consultation

Department of Medicine

Gastroenterology

When symptoms such as nausea, vomiting, loss of appetite, abdominal distension, right upper abdominal pain occur, it is recommended to consult the Department of Gastroenterology promptly. After confirming the diagnosis, refer to the Department of Infectious Diseases for further treatment.

Department of Infectious Diseases

Those who have not received the relevant vaccinations and are in close contact with the diagnosed patient may also consult the Department of Infectious Diseases if they experience the above symptoms.

Emergency Department

In case of emergencies such as deep jaundice, frequent vomiting, persistent high fever, drowsiness, coma, etc., it is recommended to go to the Emergency Department immediately.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of documents, common problems

Tips for medical treatment

You may need to undergo abdominal ultrasound, abdominal CT, abdominal MRI, etc. Therefore, you should wear loose-fitting clothes that are easy to put on and take off, avoid metal materials as much as possible, and inform your doctor in advance if you are pregnant or planning to become pregnant.

Preparation checklist for medical consultation

In particular, you need to pay attention to the time of onset of symptoms, special manifestations, etc.

Is there fever? What is the highest degree?

Is there nausea or vomiting? Is there anorexia of greasy food?

Is there fatigue? How long has it been present?

Is there jaundice? Such as yellowing of skin, sclera, yellowing of urine, etc.

Are there bleeding gums when brushing teeth? Or are there small bleeding spots on the skin?

Is there any discomfort felt in the right upper abdomen? Is it accompanied by pain?

How long have these symptoms been present?

Have you received any blood transfusions or blood products?

Have you received an organ transplant, hemodialysis, or eyebrow tattoo?

Have you been in close contact with anyone with viral hepatitis?

Have you been vaccinated against hepatitis?

Test results in the last six months, which can be carried to the doctor’s office

Laboratory tests: blood and liver function, hepatitis virus nucleic acid test and antigen and antibody test

Imaging examination: abdominal ultrasound, abdominal CT examination

Medication for the past 3 months, if available, bring along the box or package with you to the doctor

Antipyretic and analgesic drugs: ibuprofen, acetaminophen

Antiviral drugs: Lavomidine, Sofosbuvir

Hepatoprotective drugs: glutathione, ursodeoxycholic acid, magnesium isoglycyrrhizate, silymarin

Diagnosis

Diagnosis is based on

Medical history

May have had close contact with a person with viral hepatitis.

May have eaten or been in contact with food, fluids, etc. of unknown origin.

May have received blood transfusions, blood products, organ transplants, etc.

May have had tattoos, pedicures, etc.

May have had acute viral hepatitis.

Clinical manifestations

There are gastrointestinal symptoms such as fever, lack of appetite, anorexia, nausea and vomiting.

Urine, skin and sclera are yellow and the color may gradually deepen.

Abdominal palpation can be used to find out whether the liver and spleen appear enlarged and to determine roughly whether they have been damaged.

Most of the patients will have enlarged liver, which may be painful when touching, and some of them may have enlarged spleen. During the recovery period, the liver and spleen may gradually shrink back to normal.

Laboratory tests

Blood biochemical parameters include alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum bilirubin, serum albumin and globulin, prothrombin time, gamma-glutamyl transpeptidase (gamma-GTP or GGTP), serum alkaline phosphatase (ALP), total bile acids, and cholinesterase.

Alanine aminotransferase, aspartate aminotransferase: the most commonly used indicators to determine the degree of hepatocellular injury, the more severe the injury, the greater the elevation.

Serum bilirubin: Hepatocellular damage can lead to elevated serum bilirubin. Liver failure will show an increase in serum bilirubin and a decrease in alanine aminotransferase and aspartate aminotransferase.

Serum albumin and globulin: The liver synthesizes albumin, and if albumin levels fall, liver synthesis is impaired. As the disease worsens, the albumin to globulin ratio may gradually decrease.

Gamma-glutamyl transpeptidase: Acute hepatitis, chronic active hepatitis, and decompensated cirrhosis will show mild or moderate elevation, and if cholestasis occurs, it can be significantly elevated.

Serum alkaline phosphatase: mainly excreted through the hepatobiliary system, excessive production or obstruction of excretion can be elevated, which can be used to observe the development of the disease and treatment.

Total bile acids: can be elevated in case of hepatocellular damage or obstruction of intrahepatic or extrahepatic biliary system.

Cholinesterase: reflects the reserve function of the liver.

Blood biochemistry tests require fasting, and a temporary dietary ban is required after dinner the night before the test until the blood draw is completed.

The blood is tested for antibodies to the hepatitis virus, mainly immunoglobulin M (IgM) and immunoglobulin G (IgG), and for hepatitis B, including surface antigen.

A venous blood test is required and the results are not affected by diet.

The blood is tested for the presence of hepatitis virus nucleic acid, and if found, it can be used as a basis for confirming the diagnosis.

It can also test for viral genotypes, etc., to inform treatment.

The blood sample comes from a vein and the results are not affected by diet.

It mainly checks levels such as alpha-fetoprotein (AFP), which can help determine the presence of liver cancer and other serious conditions.

Imaging

The most common imaging test used for liver screening is an abdominal ultrasound.

Abdominal ultrasound can determine the size and shape of the liver and spleen, important blood vessels in the liver, and the presence of space-occupying lesions.

The ultrasound is non-invasive and the position of the body is adjusted according to the doctor’s instructions.

CT is a radiologic examination that can observe the shape of the liver and determine whether there is cirrhosis or space-occupying lesions.

If space-occupying lesions are found, it is possible to roughly determine whether they are benign or malignant.

For CT scanning of the abdomen, fasting for at least 4 hours before the examination (drinking water is available).

Magnetic Resonance Imaging (MRI) is non-radioactive and provides a clearer picture of the structural changes in the liver tissue.

With the help of contrast, dynamic enhancement scanning, etc., it is possible to distinguish the benign and malignant nature of the occupation more effectively.

Fasting for at least 4 hours before the examination (drinking water is allowed). Remove metal objects such as necklaces, earrings, cell phones, watches, etc. before the examination.

Transient elastography

Transient elastography is based on ultrasonography and is a non-invasive, convenient and quick test that can be repeated many times.

The test results are relatively reliable and can distinguish mild liver fibrosis, progressive liver fibrosis or early cirrhosis more accurately.

The accuracy of liver fibrosis diagnosis can be improved if combined with the relevant indexes of blood test.

Differential Diagnosis

Viral hepatitis needs to be differentiated from other causes of hepatitis, such as drug-induced hepatitis, alcoholic liver disease and autoimmune liver disease. Those who present with jaundice also need to be differentiated from other causes of jaundice.

Other causes of hepatitis

Similarities: Both may present with symptoms such as lack of appetite, nausea, vomiting, and jaundice, and laboratory tests may reveal abnormal liver function.

Differences: The serologic findings of viral hepatitis can be used as a basis for differential diagnosis, but simultaneous occurrence with other hepatitis cannot be excluded. Drug hepatitis and alcoholic liver disease can be found related to the history of drug use and long-term excessive alcohol consumption. Autoimmune liver disease can find autoantibodies and other indicators abnormal.

Other causes of jaundice

Similarities: Jaundice may occur in all cases, and abnormal bilirubin levels may be detected in laboratory tests.

Differences: Other jaundice may be caused by certain medications, infections not caused by hepatitis viruses, cholecystitis, cholelithiasis, pancreatic head cancer, hepatocellular carcinoma, etc. Symptoms of the original disease may be present. Hepatitis virus serology can clarify the presence or absence of infection.

Treatment

Different types of viral hepatitis can be treated with medications, but the medications used and the treatment regimens may vary greatly, especially in chronic hepatitis B and chronic hepatitis C.

All viral hepatitis can be treated with medication along with general therapy to reduce discomfort and other symptoms.

If severe hepatitis, liver failure, and other serious conditions develop, artificial liver support therapy, liver transplantation, and other options are also needed depending on the situation.

If complications occur, treatment for the complications is also required.

General treatment

When symptoms such as fever, fatigue and jaundice are severe, bed rest is recommended to avoid activities.

As the disease gradually improves, you can gradually resume activities according to your physical strength.

Pay attention to changes in symptoms such as jaundice and fatigue, especially for pregnant women, and monitor liver function and coagulation function regularly.

Medication

Hepatitis A

At present, there is no specific drug, the medication is mainly symptomatic, and liver-protecting and anti-yellowing drugs, such as glycyrrhizic acid preparations and silymarin, can be used.

Hepatitis B

Acute hepatitis B in adults is mostly a self-limiting disease if the condition is mild, and the symptoms can be improved through sufficient rest and nutritional support. Chronic hepatitis B can be treated with antiviral drugs, immunomodulators, hepatoprotective drugs, and antifibrotic drugs.

Antiviral drugs: including interferon such as common interferon alpha, polyethylene glycol interferon alpha, nucleoside (acid) analogs such as entecavir, tebivudine, tenofovir ester and propofol tenofovir.

Immunomodulators: such as thymopentapeptide and thymosin.

Hepatoprotective drugs: glycyrrhizic acid preparations (e.g., magnesium isoglycyrrhizinate, diammonium glycyrrhizinate), silymarin, bisabolol, glutathione, thiopronin, polyenylphosphatidylcholine, S-adenosylmethionine, ursodeoxycholic acid, and so on.

Anti-hepatic fibrosis drugs: such as Fuzheng Huayu capsule, Compound turtle shell soft liver tablets, Anluo Huayu pill and other proprietary Chinese medicines.

Hepatitis C

Antiviral treatment is needed, and the drugs used include pegylated interferon, ribavirin, sofosbuvir, dalatasvir, radipavir, and asurevir.

Hepatitis D

Alpha-interferon is the only drug currently approved for the treatment of chronic hepatitis D. It inhibits the replication of the hepatitis B virus and controls the disease. Polyethylene glycol interferon alpha-2a or alpha-2b may also be used.

Newer drugs have entered clinical trials, such as Lonafarnib.

Hepatitis E

The same principles of treatment as for hepatitis A. Symptomatic treatment with medication is the mainstay.

It is important to note that pregnant women infected with hepatitis E have the possibility of developing severe hepatitis and should be closely observed for changes in condition and timely management of complications.

Reminder of medication

All the above drugs should be used under the guidance of professional doctors, and should not adjust the dose or stop the drug by themselves.

Monitor the liver and kidney functions during use.

Liver transplantation

Viral hepatitis does not usually require surgery, but in the case of end-stage liver failure, surgical treatment such as liver transplantation may be required.

Healthy livers have a strong regenerative ability and can grow gradually after transplantation, allowing liver function to return to normal gradually.

Sometimes antiviral medication may also be needed at the same time to prevent reinfection.

Artificial Liver Support System

An artificial liver support system simulates some of the functions of the liver outside the body with the help of devices, etc., and temporarily replaces the liver to perform detoxification and other functions.

Artificial liver support systems vary in complexity and in the number of liver functions they can perform, and some systems can replace more liver systems.

If liver failure occurs, artificial liver support systems can be an important treatment.

Prognosis

Cure

Viral hepatitis can be cured in all acute stages, but the probability of cure varies.

Viral hepatitis carries a risk of progression to severe hepatitis, and once it has progressed to severe disease hepatitis, there is a greater risk of death from the disease.

Hazards

Viral hepatitis is an infectious disease and the hepatitis virus can infect others and is contagious.

Some types of viral hepatitis can become chronic, and the different types of viral hepatitis that can become chronic are listed below:

Long-term protection is not always available when viral hepatitis is cured, and hepatitis E, for example, carries a risk of re-infection and morbidity.

Daily

Daily management

Daily management

Take medication according to the doctor’s requirement. As the liver function is impaired, the metabolism of medication mostly needs to pass through the liver, so do not take other medication or change the dosage of medication on your own.

Do not share razors, nail clippers, etc. with patients with viral hepatitis and avoid contact with their blood.

Clothes contaminated by blood and vomit should be washed and sterilized separately.

When itching occurs, do not scratch the skin to prevent bleeding and infection.

You can wash the skin with water, do not rub the skin hard or use irritating cleansers.

When you have fatigue or fever, it is better to rest in bed and wait for your body to recover gradually before getting out of bed.

Keep a regular routine and avoid staying up late and being tired. You can choose to walk, tai chi and other low-intensity exercise, the time is not too long, do not feel fatigue can be.

Avoid sexual intercourse until the infectiousness disappears, or insist on using condoms.

Follow your doctor’s request for review, especially for chronic hepatitis, which requires regular blood biochemistry, alpha-fetoprotein, abdominal ultrasound and other tests.

Dietary management

Eat three regular, small and frequent meals, strictly prohibit overeating, eight minutes of fullness is enough to maintain a suitable body weight.

Due to impaired liver function, diet should avoid greasy, high salt and high fat food, such as fatty meat, deep-fried, barbecued and pickled food.

Priority should be given to low-fat foods, such as low-fat milk or yogurt (1 to 2 cups a day), beans, egg whites (no more than 3 whole eggs a week), skinless chicken or fish and shrimp (the size of a poker box a day).

Substitute vegetable oils for animal oils, such as peanut oil, olive oil, corn oil and soybean oil.

Don’t limit your staple food to refined white rice and noodles, alternate variations of all types of coarse grains, mixed beans and potatoes.

Eat less high-sugar foods, such as white granulated sugar, candies, sweet drinks, pastries, concentrated fruit juices, jams and honey.

Eat more vegetables (about one pound per day), especially green leafy vegetables; eat about one fist-sized piece of fruit per day.

Stop drinking alcohol to prevent further damage to the liver.

Take vitamin supplements as prescribed by your doctor.

Strictly prohibit the intake of moldy food, substandard drinking water, etc.

Mindset Adjustment

Chronic hepatitis has a long treatment cycle, which requires objective understanding, optimism and adherence to treatment.

Prevention

Vaccination

Hepatitis A virus, Hepatitis B virus and Hepatitis E virus already have vaccines to prevent infection.

There is no vaccine for hepatitis C virus and hepatitis D virus.

Since hepatitis D virus depends on hepatitis B virus for replication, vaccination against hepatitis B virus can prevent hepatitis D virus infection.

Enhanced Protection

If you are going to undergo operations that may damage the skin and mucous membranes, such as piercing, tattooing and injections, you should go to a regular place where standardized sterilization can reduce the risk of infection.

If there are wounds on the body, they need to be bandaged to prevent contamination with other people’s blood or other body fluids.

Do not share personal items such as nail clippers, cups, razors, toothbrushes, etc. with others.

Insist on the use of condoms when having contact with sexual partners of unknown health status.

Wear gloves when cleaning up personal items, blood, vomit, etc. of unknown health status.

Medical workers, cleaning staff in hotels and hospitals should observe the code of practice, wear gloves and protect skin and wounds when working.

Stay away from drugs. Sharing needles may lead to infections such as Hepatitis B virus and Human Immunodeficiency Syndrome Virus (HIV).

During the onset of Hepatitis A and Hepatitis E, isolate as required and do not engage in food processing, food service, childcare, etc. to prevent transmission to others.

Wash hands before and after meals.

Avoid drinking water of unknown hygiene.

Do not eat food of unknown hygiene or not fully cooked. Foods that are susceptible to pathogens, such as pork, pig offal, venison, shellfish, etc., should be cooked and steamed thoroughly when consumed, and bad eating habits such as eating raw, semi-raw, and directly after pickling should be eliminated.

Public utensils should be sterilized, and it is better to implement the meal sharing system.

After the diagnosis of viral hepatitis, you need to pay attention to the following aspects to prevent transmission to others.