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Abstract: Patients come to the clinic with fever accompanied by jaundice. The treatment is mainly based on symptomatic treatment and supportive treatment such as liver protection, enzyme lowering and yellowing, which can generally achieve good treatment results.
Basic information】Female, 62 years old
Type of disease】Acute hepatitis E (jaundice type)
Hospital】Liaoning Provincial People’s Hospital
Consultation time】April 2019
Treatment plan】Medication (compound dichloroacetate diisopropylamine + isoglycyrrhetinic acid magnesium injection + silymarin capsule + S-adenosylmethionine + Injinxiang Huang granules + thin glucose peptide injection + dexamethasone + ornithine monophosphate + human albumin)
[Treatment Period] Hospitalization for 21 days, outpatient follow-up after 1 month
Treatment effect】Symptoms improved significantly, and the disease was stabilized and cured
I. Initial consultation
An elderly woman came to the hospital with complaints of fever, fatigue, loss of appetite and yellow urine for 7 days. The patient had fever with no obvious cause 7 days ago, but her temperature was not measured, accompanied by loss of appetite, nausea, vomiting, abdominal distension after meals, generalized weakness, and a decrease in body temperature.
Physical examination showed a body temperature of 36.2℃, moderate yellow staining of skin and sclera, liver and spleen were not detected under the ribs, and percussion pain in the liver area was positive. Ancillary tests showed liver function: ALT 291.1 U/L, GGT 82 U/L, AST 120.4 U/L, TBIL 141.4 umol/L.
After seeing the patient, the initial diagnosis was viral hepatitis E acute jaundice type, which required isolation and treatment, and was admitted to the ward after full communication with the family.
II. Treatment history
After admission, the infection department routinely provided level 2 care, digestive isolation, and bed rest. Further improvement of liver and kidney function, coagulation function, tumor series and other tests. The patient’s history was characterized as an elderly female, with acute onset, characterized by fever with gastrointestinal symptoms and jaundice, and obvious abnormal liver function, which was consistent with the characteristics of acute viral, and the possibility of acute hepatitis E was considered. Glycopeptide injection to enhance immunity. The diagnosis of acute hepatitis E (jaundice type) was clear because the IgG and IgM antibodies to hepatitis E were positive.
The patient developed tinnitus and sore throat after the application of S-adenosylmethionine. Considering S-adenosylmethionine allergy, dexamethasone was given intravenously, and S-adenosylmethionine was immediately discontinued and replaced by menadione ornithine to eliminate yellowing. The patient developed hypoproteinemia and was given human albumin.
III. Treatment effect
After the symptomatic treatment of liver protection, enzyme lowering and yellowing elimination, the patient’s treatment effect was obvious, the condition improved, the digestive symptoms gradually improved, the appetite increased, no nausea and vomiting, the color of urine gradually became lighter, the liver function gradually improved after several re-examinations, the jaundice progressively decreased, and entered the recovery period, after reducing the amount of isoglycyrrhetinic acid magnesium injection, the patient’s condition was stable, and he was discharged after 21 days in hospital. The patient was discharged after 21 days of hospitalization. The patient was instructed to follow up with the outpatient clinic in 1 month.
IV. Precautions
The patient’s condition was improved after treatment, but the whole course of acute hepatitis E includes 3 periods: pre-jaundice, jaundice and recovery period, and the duration of the disease does not exceed 6 months. Otherwise, it is easy to cause the liver function to rebound, and the patient is advised to follow the doctor’s advice to apply silymarin capsules orally to protect the liver regularly.
The prognosis of acute hepatitis E is generally good, but some patients can remain hyperbilirubinemia, so the patient is advised to follow up regularly after discharge, and according to the patient’s condition at the time of discharge, outpatient follow-up is recommended in 1 month.
The patient’s diet after discharge should be light, nutritionally balanced, ensure vitamin intake, no alcohol consumption, and avoid unnecessary drug applications that may aggravate the burden on the liver. It is not advisable to over-supplement, otherwise it will easily lead to fatty liver, and to gradually increase the amount of exercise appropriately.
V. Personal insights
1, acute hepatitis E is a relatively common viral hepatitis, mainly through the fecal-oral route of transmission, can be implicitly infected, clinical symptoms with fever, gastrointestinal symptoms and jaundice as the main features, generally self-limiting, more than can be completely recovered, as change the case patients, through liver protection, lowering enzymes, remove yellow and other symptomatic and supportive treatment, the condition can be effectively alleviated.
2, albumin is synthesized in the liver, when the liver function is impaired, the ability of albumin synthesis decreases, coupled with the obvious digestive tract symptoms of the patient, albumin intake is reduced, resulting in albumin can be significantly decreased. When plasma albumin is lower than 30g/L, thoraco-abdominal fluid can easily appear, so timely intravenous supplementation of human albumin is needed when necessary.
3. Patients are advised to pay attention to dietary hygiene in daily life, eat regularly and not to overeat to prevent this disease, and to seek medical consultation and symptomatic treatment in a timely manner if discomfort symptoms such as loss of appetite, nausea and vomiting occur again.