A Hepatitis (infectious disease)

GENERAL

Hepatitis A has been known since ancient times, even then described the typical symptoms of the disease, due to which the disease called jaundice. Later, the term "catarrhal jaundice" was introduced, but it does not reflect the true etiology of the pathological process.

Interesting facts about hepatitis A:

• The disease was named after the Russian doctor S. P. Botkin, who in the second half of the XIX century for the first time explained its essence and identified infectious hepatitis as a single infectious disease.
• Botkin's disease in peacetime It observed as isolated cases or individual flashes
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  . Epidemic spread occurred during the wars and difficult post-war period. The disease is often found in tropical African and Asian countries, in popular tourist regions: Turkey, Tunisia, Egypt, and India. In our times of epidemic outbreaks of hepatitis are sometimes found in children's and labor groups.
  
• Hepatitis A is a typical disease of dirty hands. Pathogen enters the body through unwashed hands, on which there are traces of the patient's secretions, as well as in the use of contaminated water and food. Besides, contribute to the spread of infection flies.
• In epidemiological terms infectious disease It refers to intestinal infections. Cases of infection are fixed throughout the year, but marked seasonal outbreaks of the disease in the early months of autumn.
• Botkin's disease sick people of any ageBut in patients with such a diagnosis about 40% of cases occur in children of preschool age and 20% for children aged 7 to 14 years.
• The liver is one of the vital organs in charge of the complicated processes of metabolism. There are synthesized cholesterol, proteins, enzymes, glycogen and amenable to cleavage toxic metabolites. Highlighting the bile, the body promotes normal digestion. Thus, viral liver lesion is extremely negative effect on metabolic processes and leads to the accumulation of toxic substances, bile stagnation and disorder of digestive function.

Despite the fact that this type of hepatitis is considered one of the most favorable in regard to the consequences, treatment and recovery period after a previous infection takes a long time, therefore, hepatitis A brings both social and economic losses. For this reason, the prevention of hepatitis A has an important place in the developed countries' health policies.

See also: What is Hepatitis - Causes, Symptoms and Treatment

CAUSES

Pathogen Disease Botkina - a virus that exhibits resistance to extreme environmental conditions and to aggressive substances (acid, chlorine, ether). Under the influence of formalin or brief boiling it perishes.

The source of the viral infection are people in the incubation period and in the first days after the onset of symptoms of jaundice, as well as people who have the infection is in the erased anicteric form.

The incubation period for the disease ranges from 7 to 50 days, but more often it lasts from two weeks to three months.

How do you get infected and develop the disease:

• From an organism carrying the virus is released along with the faeces.
• In a healthy human body it falls through the mucous membranes of the digestive fecal-oral route.
• Then, from the intestine to the bloodstream pathogen migrates to the liver, where it settles.
• In very rare cases infection occurs through blood during medical procedures with blood or during the use of non-sterile injection materials.
• Viral particles actively proliferate within liver cells - hepatocytes. After that they penetrate into the bile ducts and with the bile enter the intestine.
• As a result, anatomical and functional changes in the parenchyma of the liver, a large amount into the blood bile acids and pigments, and so there is the characteristic yellow coloration of the sclera, skin and mucous membranes shells.
• The affected liver cells are attacked by immune cells, then they develop an inflammatory response.
• Infected hepatocytes are killed, whereby the liver is broken.

Factors contributing to the development of the disease Botkin:

• weakening the body's defenses;
• prolonged physical exhaustion;
• influence liver poisons;
• excessive consumption of animal fats;
• food poisoning;
• exhaustion;
• diabetes.

CLASSIFICATION

The forms of the disease:

• easy - in most patients;
• average - 30%;
• heavy - at 1-3%.

Classification of an infectious disease of the embodiment of the pathological process:

• an exemplary embodiment of the appearance of symptoms of jaundice;
• atypical variant without external signs of disease in children can occur in the form of a chair disorder.

SYMPTOMS

Hepatitis A, as well as many other infectious diseases, characterized by cyclical.

Stage of the disease Botkin:

• Preicteric stage - lasts for 5-7, sometimes 10-12 days.
• Icteric phase - lasts about 1-2 weeks.
• Recession jaundice - recovery.

Symptoms prodromal period (step preicteric):

• fever;
• weakness, dizziness;
• bile and intestinal disorders;
• headache;
• loss of appetite;
• nausea, vomiting;
• heaviness, or pain under the right rib;
• bad taste in the mouth;
• bloating;
• belching;
• pharyngitis;
• insomnia, irritability.

Symptoms of jaundice period:

• normal body temperature or slightly elevated;
• yellowing of the skin and sclera;
• sometimes sharp pruritus;
• darkening of the urine to a dark colored beer;
• light feces (acholic chair);
• liver enlargement;
• mucous reddish hue;
• indigestion replaced by constipation;
• sometimes splenomegaly;
• reduced blood pressure, bradycardia.

Icteric period is about 7-10 days, followed by recovery of the body begins, which is accompanied by a decrease in liver size and improvement in patient well-being. The turning point hepatitis A begins with a sharp drop of bilirubin in the blood.

Usually Hepatitis A lasts about 40 daysBut 15% of patients become chronic phase and takes a protracted period of about nine months. After suffering hepatitis A formed lifelong immunity.

Elderly people and children under one year of hard to carry hepatitis A. At preschool children the disease is mild, whereas in adults pronounced symptoms of intoxication. In pregnant women, hepatitis A can induce premature labor and severe complications of pregnancy, therefore, still in the planning period is necessary to think about the advisability of vaccination.

DIAGNOSTICS

As a general rule, identification of icteric forms of the disease is not complicated. However, strong and sharp pain in the right upper quadrant may indicate biliary colic, which occurred after the blockage of the bile duct stone. In such cases, liver function studies are conducted. In hepatitis A, they point to the deviation, while for colic remain normal.

Similarly can identify traces virus by polymerase chain reaction (PCR). Virus from the feces reveal only at the end of the incubation period, and specific immunoglobulins anti-HAV IgM from the blood - after only 1-2 weeks after infection. In the acute phase of hepatitis A in the blood revealed an increased amount of serum enzymes, which indicate the disintegration of hepatocytes.

Diagnostic feature of hepatitis A may be an increase in bilirubin levels, decreased erythrocyte sedimentation rate, monocytosis, lymphocytosis, and leukopenia.

See also: How is Hepatitis C?

TREATMENT

Treatment of patients with the disease Botkin spend only in a hospital infectious disease ward. Standard therapy scheme does not provide for the use of antiviral drugs. It focuses on symptomatic treatment, since the patient's body unable to cope with the infection. Assigned drugs are used to accelerate the excretion of toxins associated with impaired liver function.

General measures in the treatment of Botkin's disease:

• Hospitalization, rest and bed rest. According to the observations of doctors, the disease often becomes malignant for failure hospitalization or home care. Recommendation on the limitation of physical activity based on the fact that any physical activity promotes glycogen consumption, and negative effects on the liver increases.
• Diet (table №5) with restriction of animal fats in the diet, reducing the amount of protein and increasing the carbohydrate content. The fluid should flow in a large amount to accelerate excretion of toxins.
• Vitamin therapy involves administration of high doses of ascorbic acid, and vitamins B6 and B12.
• Glucose in the form of fruit juice, sweet tea or intravenous drip.
• Hepatoprotectors for protecting liver cells from harmful influences.
• Steroidal anti-inflammatory agents in low dosages in the case of protracted course of hepatitis. The treatment is usually at least 2-3 weeks when canceling hormonal agents gradually reduce their dosage.

COMPLICATIONS

Delays in seeking care and failure to comply with doctor's recommendations for treatment, recreation and work can lead to complications.

Possible complications of hepatitis A:

• transition into a chronic disease;
• encephalopathy;
• enzymatic malfunction of the liver;
• cirrhosis of the liver;
• liver failure;
• ascites.

PREVENTION

Measures of prevention of hepatitis A:

• Vaccination. Effective specific measure of protection is vaccination against hepatitis A. Unfortunately, it is not included in the list of mandatory vaccinations, but is recommended for people traveling to countries with hot climate, children attending pre-school institutions and individuals who are on duty may come into contact with patients. Vaccination is carried out in three stages, with an interval of 6 months. Vaccination against hepatitis A is able to protect against infection during the next 6-10 years.
• Adherence to the simple rules of hygiene. Children from the very young age must understand the need to wash hands with soap and water after returning from a walk, going to the toilet and before eating.
• Isolation of people suspected of having an infectious disease. The hospital carried out disinfection of feces and boiling the used dishes.
• Quarantine and disinfection of premises in a facility where cases of hepatitis A have been identified
• Immunization of children and pregnant women, exposed to the ill person.
• Fight with flies during the epidemic.
• Providing the population with clean drinking water.

FORECAST FOR RECOVERY

The vast majority of patients who have had hepatitis A, even in severe forms, remain fully healthy. Extend the duration of treatment may be complications of the biliary tract. Relapses and transition into a chronic stage is observed in 15% of patients due to delayed or incorrect treatment, in this case, the prognosis worse.

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