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Abstract: In the past, chronic viral hepatitis was a scary topic, but in recent years, with the continuous progress of medicine, various iterations of antiviral drugs have been updated, bringing benefits to patients with viral hepatitis. The patient in this case is a middle-aged male who came to the hospital with the complaints of “weakness, acid reflux, epigastric discomfort for one month, and yellow urine for one week”, and was confirmed to have chronic viral hepatitis, chronic gastritis, and fatty liver through liver function tests, and was treated with medication.
Basic information】Male, 31 years old
Disease Type】Chronic viral hepatitis, chronic gastritis, fatty liver
Hospital】Liaoning Provincial People’s Hospital
Time of consultation】August 2018
Treatment plan】Liver protection and enzyme reduction (polyenyl phosphatidylcholine, magnesium isoglycyrrhetinate, compound dichloroacetate diisopropylamine) + cholestasis and anti-yellowing (gardenia yellow granules) + suppression of gastric acid (conversion sugar, pantoprazole sodium) + antiviral (entecavir)
[Treatment period] 15 days of inpatient treatment, regular outpatient follow-up
Treatment effect】The treatment effect is remarkable, the patient’s symptoms improved, liver function improved significantly
I. Initial consultation
A young male, 31 years old, came to the hospital with the complaints of “weakness, acid reflux, epigastric discomfort for 1 month and yellow urine for 1 week”. One month ago, the patient developed weakness, burning discomfort in the upper abdomen and acid reflux without any obvious cause, and thought he had stomach problems. Gastroscopy indicated chronic non-atrophic gastritis, liver CT indicated fatty liver, and liver elasticity value was F4 stage. The liver function was significantly abnormal and the results were ALT: 1040.4 U/L, TBIL: 240.4umol/L, AST: 545.1 U/L, GGT: 309 U/L, positive for hepatitis B surface antigen and negative for hepatitis C antibody, considering viral hepatitis? The patient was referred to our outpatient clinic and diagnosed with “acute attack of chronic hepatitis B”.
II. Treatment process
After admission, we took a detailed medical history and denied any previous history of hepatitis. Laboratory tests revealed hepatitis B major triplet, viral quantification: 1.37E+08IU/ml, positive hepatitis B core antibody IgM, abnormal liver function ALT, decreased albumin, high liver elasticity, elevated fetoprotein, high viral replication, high titer of hepatitis B virus surface antigen, and combined with the patient’s symptoms and signs, acute hepatitis B was excluded. The diagnosis was chronic viral hepatitis B (acute exacerbation), chronic gastritis, and fatty liver. The patient was given polyenyl phosphatidylcholine, magnesium isoglycyrrhizate, and compound dichloroacetate diisopropylamine for sedative dosing for liver preservation and enzyme lowering treatment; Injury Yellow granules were given orally to clear heat and detoxify the toxin, and to promote bile and reduce yellowing. Conversion sugar and pantoprazole sodium were administered as rehydration solution to inhibit gastric acid, protect gastric mucosa, improve acid reflux symptoms, and treat chronic gastritis. Because of the high viral load of hepatitis B, antiviral therapy was indicated, and antiviral therapy was recommended. The patient and his family were informed of the precautions for antiviral therapy, and I agreed to antiviral therapy, signed the informed consent for antiviral therapy, and was given entecavir oral antiviral therapy.
III. Treatment effect
After 15 days of symptomatic treatment with liver protection, enzyme lowering, antiviral and acid suppression, the patient’s symptoms improved significantly, with increased appetite and no acid reflux and heartburn. The patient’s liver function improved significantly on the recheck, ALT: 117.2U/L, TBIL: 25.8umol/L, AST: 61.0U/L, GGT: 280U/L, AFP decreased, and the quantification of hepatitis B virus: 5.46E+06IU/ml. Although the liver function was not completely normal, the hepatitis B viral load decreased and entecavir was effective. The patient requested to be discharged from the hospital and was allowed to be discharged under the premise of antiviral treatment, and was instructed to take the medication as prescribed by the doctor and to follow up with the outpatient clinic for review.
IV. Notes
However, the hepatitis B virus was still replicating at the time of discharge and the liver function was still abnormal, so it was still contagious. Therefore, after going home, pay attention to isolation and rest to avoid further increase in liver function ALT, follow the doctor’s prescription for entecavir to be taken orally on an empty stomach, and ensure that no food can be eaten 2 hours before and after the medication, because food will affect the absorption of the drug and reduce the efficacy.
After returning home, the oral nucleoside antiviral drugs during the consolidation treatment should not be stopped without permission, and do not miss the drugs, otherwise it will easily lead to virus mutation, drug resistance, and even liver failure in serious cases. Regular follow up and review, patients should have outpatient review 1 month and 3 months after discharge, and at least once every 6 months thereafter. In life, pay attention to balanced nutrition, eat less and more meals, avoid spicy and stimulating food; adjust your mind and keep a good mood.
V. Personal insight
Chronic viral hepatitis is the most common chronic hepatitis in clinical practice. Acute attack is the appearance of acute hepatitis symptoms on the basis of the original viral infection, sometimes patients are not aware that they have hepatitis, so there is a certain difficulty in clinical diagnosis, which needs to be combined with the patient’s symptoms, signs, laboratory tests and ultrasound results to comprehensive analysis, early detection, early diagnosis and early treatment. In addition to symptomatic support, anti-fibrosis, immunomodulation and other treatments, antiviral treatment is mainly needed. Only antiviral treatment is the fundamental treatment for chronic viral hepatitis, which can slow down the disease progression and reduce the incidence of liver cancer.