(Disclaimer: This article is only for popular science purposes, in order to protect the privacy of patients, the relevant information in the following content has been processed) Abstract: Acute hepatitis B, that is, acute viral hepatitis B, is caused by hepatitis B virus infection. Today, this elderly male patient came to the clinic with intermittent abdominal pain with nausea for 10 days. After comprehensive examination, he was diagnosed with acute hepatitis B viral hepatitis (jaundice), and after treatment of hepatoprotection and enzyme-lowering, the patient’s symptoms such as abdominal distension, abdominal pain, fatigue, and yellowing of the urine were significantly improved, and hepatitis B virus was cleared up, and the patient was discharged from the hospital without any problems. 【Basic information】 Male, 64 years old 【Disease type】 Acute viral hepatitis B (jaundice) 【Hospitalization】 Liaoning Provincial People’s Hospital 【Date of consultation】 January 2019 【Treatment plan】 Liver-protecting treatment (compound diisopropylamine dichloroacetate injection) + enzyme-lowering treatment (magnesium isoglycyrrhizinate injection) + yellowing treatment (adenosylmethionine butyldisulfonic acid for injection) + regulation of immunity (thin chi glycopeptide injection) ) 【Treatment cycle】 3 weeks of hospitalization, 1 month later outpatient follow-up 【Treatment effect】 Abdominal distension, abdominal pain, fatigue, yellow urine and other symptoms significantly improved, hepatitis B virus clearance I. Initial interview The patient is an elderly male, complaining of intermittent abdominal pain with nausea for 10 days to come to the clinic. The patient came to the clinic 10 days ago with no obvious triggers of sudden onset of abdominal pain, mainly persistent vague pain in the epigastrium, obvious after eating, not severe in nature but with a sense of blockage, no improvement after defecation and bowel movement, occasional nausea, warmth, no vomiting, nausea, anorexia of greasy food, self-consciously dark urine color, such as black tea color, no skin itching, no fever, and was admitted to local hospitals, where he underwent liver, gallbladder, and spleen ultrasound, which showed a fatty liver with a slightly echogenic area in the right lobe of the liver, and a grossly irregular lumenal wall of the gallbladder. Pancreatic echogenicity was enhanced, and the intestinal tract was pneumatized. Liver function tests showed a marked increase in ALT, AST, total bilirubin and other indicators, and he came to the emergency room for further diagnosis and treatment. Emergency temperature measured the highest 37.6 ℃, with liver insufficiency admitted to the hospital, complete the examination returns hepatitis B surface antigen positive, hepatitis B e antibody, hepatitis B core antibody positive, then came to the Department of Infection Consultation. After consultation, the preliminary diagnosis was chronic viral hepatitis B. After explaining the condition, the patient and his family agreed to be transferred to the ward. After transferring to the ward, the patient was taken care of according to the routine care of hepatitis B. As the patient’s liver function was abnormal and ALT was obviously elevated, suggesting serious liver necrosis, he was instructed to take absolute bed rest and try not to get out of bed. Laboratory returns were positive for hepatitis E IgG, and viral hepatitis E was considered as a previous infection. Quantitative examination of hepatitis B virus showed hepatitis B minor triple positive, autoimmune hepatitis spectrum negative, blood ammonia 35.2 μmol/L, which could be excluded from acute hepatitis A and E, autoimmune liver disease. After analyzing the characteristics of the case, the acute attack of chronic hepatitis B was basically excluded, and the diagnosis of acute viral hepatitis B (jaundice type) was determined. Therefore, Diisopropylamine Dichloroacetate Injection was given to be injected intravenously for hepatoprotective treatment, Magnesium Isoglycyrrhizinate Injection was given to be injected intravenously for enzyme lowering treatment, Adenosylmethionine Butanedisulfonate Injection was given intravenously to reduce jaundice, and Ganoderma Lucidum Peptide Injection was given intravenously to regulate immunity in order to seek for the rapid clearance of Hepatitis B Surface Antigen. After 1 week of hepatoprotective, enzyme-lowering and immunomodulatory treatment, the patient showed obvious improvement in symptoms such as abdominal distension, abdominal pain, fatigue, yellow urine, etc., increased appetite, no nausea and vomiting, liver function improved, jaundice did not rise, and blood ammonia returned to normal. After 12 days of hospitalization, hepatitis B virus DNA was negative, indicating that hepatitis B virus was clearing itself and the patient entered the recovery period. After 3 weeks of hospitalization, urine yellowing improved, liver function further improved, and hepatitis B surface antigen turned negative, suggesting hepatitis B virus clearance, indicating that acute viral hepatitis B was cured. The patient was instructed to follow up in 1 month. Precautions: We are glad that the patient has been cleared of hepatitis B virus after treatment, but the patient has not yet produced hepatitis B surface antibody, which may be produced with the passage of time, and has a protective effect against hepatitis B virus infection. Generally speaking, the higher the antibody titer, the stronger the protective effect, so it is necessary to review the hepatitis B penta-analysis on a regular basis. When the patient is discharged from the hospital, the liver function improves, but ALP, GGT, total bilirubin and so on have not returned to normal, need to continue to take oral hepatoprotective and anti-yellowing drugs, such as silymarin capsule, gardenia granules. Some patients may remain hyperbilirubinemia, so half a month after the outpatient follow-up, review liver function, hepatitis B virus quantitative examination. Acute viral hepatitis B (jaundice type) like other jaundice type hepatitis, the recovery period can be up to 1-3 months. Patients should pay attention to rest during the recovery period to avoid further aggravation of liver function abnormalities. At the same time, it is necessary to eat a light diet, avoiding too greasy, otherwise, post hepatitis fatty liver may occur. V. Personal perception For acute onset of hepatitis B, sometimes it is necessary to identify whether it is really acute hepatitis B or acute attack of slow hepatitis B. Sometimes there are certain difficulties in diagnosis, and it is necessary to observe the effect in treatment and detect the quantitative hepatitis B virus and changes in the titer of hepatitis B surface antigen. In general, in acute hepatitis B, liver damage is more severe, ALT > 1000 U/L, jaundice is more severe, hepatitis B surface antigen titer is lower, hepatitis B viral load is lower, and 90% of patients can clear the virus within six months, such as in this case, the patient cleared the virus at the time of the hospital visit, but has not yet produced antibodies. In contrast, acute exacerbations of chronic hepatitis B generally result in a decrease in the hepatitis B viral load, but rarely result in complete clearance of the virus.