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Abstract: 49-year-old Ms. Wu, who was usually healthy and often dined out, was infected with hepatitis E. She was admitted to the hospital with severe disease that developed into cholestasis, and was given a variety of liver-protective drugs, plasma, and hormone combination therapy for nearly 2 months before the patient’s liver function returned to normal, her gallbladder returned to normal size, and her cholestasis was relieved, and her condition gradually recovered.
Basic information】Female, 49 years old
Disease Type】Hepatitis E, cholestasis
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】November 2021
Treatment plan】Medication (compound glycopyrrolate injection + injectable glutathione + injectable methylprednisolone sodium succinate) + blood transfusion treatment
Treatment period】2 months of hospitalization
Results】Liver function returned to normal, gallbladder returned to normal size, and cholestasis was relieved
I. Initial consultation
Ms. Wu, 49 years old, was transferred to our hospital today from a local hospital with severe yellow skin staining, slight facial swelling, and severe fatigue. This morning, the bilirubin rose to 400.9 μmol/L, and the doctor talked with the family to prepare for a critical illness, and then the family referred the patient to our hospital. Combining the patient’s bilirubin rise to 400.9 μmol/L, prothrombin activity of 36% (<40%), along with direct bilirubin/total bilirubin of 70% and elevated alkaline phosphatase and glutamyl transpeptidase, the patient was diagnosed with cholestasis (obstructive jaundice also needs to be excluded).
II. Treatment history
The patient’s condition was serious, and he was immediately given first-level care with a personal escort, blood was drawn to observe our test indexes, serology and upper abdominal MRI + bile duct MRCP were checked, and while waiting for the results, hepatoprotective drugs were rapidly administered, and compound glycopyrrolate injection and glutathione for injection were selected for intravenous injection.
The next day MRI suggested liver injury, large gallbladder volume, cholestasis, bile duct MRCP without bile duct dilatation, excluding obstructive jaundice caused by tumor, stones and other factors, and considered cholestatic liver injury. Cholestasis was established.
The patient’s diagnosis was clear, but the bilirubin continued to rise and his condition worsened. After discussion in the department, the treatment plan was adjusted to give fresh plasma input to play a certain degree of plasma replacement, and also to supplement coagulation factors and increase colloid osmotic pressure. After 1 week, the bilirubin decreased to 301 μmol/L and the prothrombin activity increased to 46%, and the condition improved significantly. After nearly 2 months of hospitalization, liver function was basically normalized and clinical symptoms were relieved.
III. Treatment effect
The patient’s diet, sleep and mental status basically returned to normal, skin itching was relieved, the color of urine returned to normal, and the review of liver function indicated bilirubin 28μmol/L, prothrombin activity 71%, hepatitis E antibody IgM turned negative, but IgG was still positive. The ultrasound showed that the liver was mildly damaged, the gallbladder wall was slightly gross, the volume was normal, and no bile duct dilatation was seen. With the recovery of liver function, the volume of gallbladder returned to normal, and the cholestasis was relieved, the patient was discharged.
IV. Notes
Although hepatitis E is an acute hepatitis, it is not chronic, but the liver suffered such a major blow, combined with heavy cholestasis, although the serology is normalized, but the recovery of hepatobiliary pathology still needs some time, do not carelessly cause liver function and cholestasis repeatedly, the patient also need to pay attention to the following points after discharge.
1, pay attention to rest, avoid heavy physical work within six months, appropriate walking can be, not recommended strenuous exercise, weight bearing.
2, pay attention to dietary hygiene, avoid frequent dining out, especially street stalls with poor hygiene conditions.
3, after discharge from the hospital temporarily do not eat more greasy food, and can not drink alcohol to avoid inducing cholecystitis, gallstones.
4. Pay attention to regular review and adjust the treatment drugs according to the patient’s specific conditions.
V. Personal insight
Cholestasis can be seen in many diseases, liver, biliary and pancreatic diseases can involve the gallbladder, resulting in poor bile excretion or complete obstruction, inducing skin and mucous membrane yellowing, this patient had severe cholestasis related to liver injury, and it took 2 months of treatment to turn to safety. In addition to hepatitis E, hepatitis A virus and Helicobacter pylori are also transmitted through diet, so try to eat at home in daily life to ensure both hygiene and food safety, which is beneficial to health.