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Abstract: Acute jaundiced viral hepatitis A is an infectious disease characterized by inflammatory lesions of the liver and is a type of acute viral hepatitis. In this case, the patient came to the hospital with the complaints of “fever, nausea, yellow eyes and yellow urine” and was diagnosed as “acute jaundice type A viral hepatitis”, and after treatment with liver protection and enzyme reduction, the patient’s condition gradually recovered and his liver function improved.
Basic information】Male, 37 years old
Disease Type】Acute jaundice type A viral hepatitis
Hospital】Liaoning Provincial People’s Hospital
Consultation time】May 2019
Treatment plan】hepatoprotective, enzyme-lowering, and yellowing treatment with drugs (acetylcysteine injection, compound dichloroacetate diisopropylamine injection, magnesium isoglycyrrhizate injection, gardenia jasminoides granules)
Treatment period】Inpatient treatment for 8 days, outpatient follow-up after 1 week
Treatment effect】The patient’s condition gradually recovered and liver function improved.
I. Initial consultation
The patient came to the clinic with the main complaint of “fever, nausea, loss of appetite for half a month, yellow eyes and yellow urine for 4 days”. The patient had fever with no obvious cause half a month ago, with body temperature of 37.8℃, nausea, loss of appetite, abdominal distension and weakness. The patient’s symptoms, signs and biochemical examinations were combined to make the diagnosis of “acute jaundice type A viral hepatitis” clear. It was recommended that the patient be hospitalized for further isolation and liver preservation treatment.
II. Treatment
The patient was diagnosed with acute jaundice type A viral hepatitis based on the following criteria: 1. young male, often eating out, acute onset. 2. fever with gastrointestinal symptoms, followed by jaundice. 3. significant abnormal liver function, slightly elevated fetoprotein. 4. pathogenesis: positive IgM antibody to hepatitis A. At present, he is still in the jaundice stage, so he was given treatment of liver protection, enzyme lowering and yellowing, etc. He was given acetylcysteine injection and compound dichloroacetate diisopropylamine injection for liver protection, magnesium isoglycyrrhizate injection for enzyme lowering, and gardenia yellow granules for oral treatment to lower yellowing.
III. Treatment effect
After 1 week of treatment with liver protection, enzyme lowering and immunomodulation, the patient showed improvement in fatigue, abdominal distension and yellow urine, no abdominal pain, no nausea and vomiting, increased appetite, no yellow staining of skin and sclera on physical examination, no knocking pain in liver and kidney area, and high indexes of glutathione transaminase, alkaline phosphatase and direct bilirubin on re-examination of liver function test. After 8 days of hospitalization, the patient’s condition improved and liver function improved, and the patient requested to be discharged.
IV. Precautions
After treatment the patient’s condition improved, as a doctor is very pleased, but after discharge the patient should pay attention to the following points.
1. The patient was discharged from the hospital with a total of 23 days of illness, exceeding the isolation period of acute hepatitis A by 3 weeks, and could be discharged from medical isolation. However, the patient’s liver function has not yet fully recovered, and he still has slight weakness, yellow urine and other symptoms, so he needs to continue to rest, and hepatoprotective and enzyme-lowering drugs should continue to be taken orally, and liver function and methemoglobin should be rechecked in 1 week at the outpatient clinic.
2, acute jaundice type A viral hepatitis is lifelong immunity and will not be re-infected later, but there is no cross-immunity with other viral hepatitis. At present, the patient is in the recovery period, it takes 1-3 months to fully recover, after discharge from the hospital still need to pay attention to rest, light diet, avoid strain occurrence of liver function rebound and post-hepatitis fatty liver.
V. Personal insight
Acute jaundice type A viral hepatitis is a relatively common viral hepatitis in the clinic, mostly occurs in children and adolescents, can be a hidden infection, can be divided into jaundice type and non-jaundice type, the patient in this case is jaundice type, the onset of the disease is more acute, the disease is more serious, the course of the disease is longer, the disease can be left after hyperbilirubinemia. The disease can be prevented by paying attention to personal hygiene and dietary hygiene, changing bad dietary habits such as eating raw seafood, and receiving live attenuated or inactivated hepatitis A vaccine.