Chronic active hepatitis

Description:

The Chronic Active Hepatitis (CAH) is the chronic disease of a liver caused by influence of three types of hepatotropic viruses and causing chronic hepatitis of V type, chronic l hepatitis (delta) and chronic hepatitis of S type.

Symptoms of Chronic active hepatitis:

At a number of sick HAG of a virus etiology the direct connection with an acute viral hepatitis is traced, but in most cases the acute phase of hepatitis and emergence of clinical symptoms of chronic hepatitis are divided by 3 — 5 years and more. The disease begins gradually, is shown by repeated episodes of unsharp jaundice, increase in a liver and a number of nonspecific symptoms.

The astenovegetativny syndrome is extremely characteristic: weakness,

the expressed fatigue, sometimes so strong that patients are forced to carry out to beds from 5 to 7 h in the afternoon. Often there are complaints to bad working capacity, nervousness, depression of spirit (morbid depression). Sharp weight loss is characteristic (on 5 — 10 kg).

Pains in a liver — quite frequent symptom of a disease, they can be the constants aching sometimes — very intensive. Sharply amplify after an exercise stress. Pains, apparently, are connected with the expressed inflammatory infiltration in connecting fabric (rich with nerves), in portal, periportal zones, especially in the liver capsule. Some patients have no pain syndrome, but the feeling of weight, overflow in the field of the right hypochondrium which is not depending on meal is noted; many patients complain of unpleasant taste of foodstuff.

The Dispepsichesky syndrome seldom reaches considerable expressiveness, the constant, painful nausea amplifying at meal and drugs accompanies an exacerbation of a disease at most of patients. The Dispepsichesky syndrome at sick HAG can be connected with disturbance of disintoxication function of a liver and the combined injury of a pancreas.

The syndrome of a small liver failure which is shown the drowsiness expressed by bleeding, jaundice and ascites is observed at patients with the severe HAG necrotizing forms.

The syndrome of a cholestasia can be observed along with astenovegeta-tivny frustration or a dispepsichesky syndrome. It is expressed by a passing skin itch, increase in content of bilirubin, cholesterol, activity of ShchF, GGTP in blood serum.

In the period of an aggravation there are such extrahepatic displays of a disease as a joint pain and muscles with temperature increase of dosubfebrilny figures, at the same time there are no swelling and deformations of joints. Patients note an amenorrhea, decrease in a libido, a gynecomastia.

Extrahepatic signs (vascular asterisks, a hyperemia of palms — hepatic palms) often come to light at this form of hepatitis. Their emergence matches biochemical and morphological features of activity of process and is not as often consider, the instruction on cirrhosis. If clinical improvement is followed by noticeable reduction or disappearance of vascular asterisks, then the hyperemia of palms remains long, often before biochemical remission.

The hepatomegalia comes to light at the majority of sick HAG. In the period of the expressed aggravation the liver acts on 3 — 7 cm from under a costal arch, moderately dense, the edge is pointed, the palpation is painful. Remission is followed by noticeable reduction of a liver: at many patients she acts on 2 — 3 cm or is palpated at edge of a costal arch. Moderate increase in a spleen meets often, considerable — is rare. Approach of remission is followed by reduction of a spleen. Activity of reticuloendothelial tissue of spleen at sick HAG can be increased therefore at a research with "шТс accumulation of a colloid in a spleen is more often increased, but to a lesser extent, than at cirrhosis.

Asymptomatic HAG at 25% of patients proceeds latentno with complaints to intolerance of greasy and fried food, alcohol. At inspection the hepatomegalia, the normal or unsharply increased bilirubin level, increase in activity of aminotransferases by 3 — 5 times comes to light. At a histologic research the picture characteristic of HAG of a moderate or insignificant degree of activity is found. Cirrhosis forms latentno though develops less than at other options of a current.

Functional condition of a liver. The aggravation of HAG of a virus etiology is characterized by a hypergammaglobulinemia, a hypoalbuminemia, increase in indicators of a thymol turbidity test and activity of aminotransferases. Activity of ALAT of blood serum usually is more, than ASAT. In most cases the content of crude protein and bilirubin of blood serum increases. In remission of chronic active hepatitis indicators of gamma-globulins, functional trials and activity of enzymes are seldom normalized completely, at most of patients they only improve.

Serological indicators. Diagnostic value has identification of markers of hepatitis B in blood serum.

Hepatitis B virus markers in blood serum of patients with chronic active hepatitis of a virus etiology: HBsAg is positive in most cases; anti-HBs are negative; anti-NVS are positive usually in high credits, at a part anti-HBcIgM is positive; HBcAg is positive or negative; The DNA polymerase is positive or negative; to ANTI-NVA are negative or positive.

Existence in HBeAg blood serum and/or anti-NVS of the class IgM, and also DNA polymerase demonstrates replication of a virus of hepatitis B, identification to ANTI-NVA can indicate the favorable forecast of a disease.

Existence of HBsAg in various combinations to anti-NVS of the class IgM and ANTI-NVA characterizes a phase of integration of a virus of hepatitis B into a hepatocyte genome.

Features of a current. HAG of a virus etiology can have continuously recurrent current or proceed with alternation of aggravations and clear clinical, and sometimes and biochemical remissions.

Continuously recurrent current of virus HAG can be observed within several years with very short light intervals duration about one month.

At HAG with alternation of aggravations and remissions of an aggravation are usually frequent and long. Clinical remission occurs in 3 — 6 months, and improvement of biochemical indicators — later 6 — 12 ms. In some cases functional trials are completely normalized during remission, however, for short term — usually up to 2 — 3 months. Some patients within one year have several aggravations.

The forecast of HAG depends on a disease stage by the time of establishment of the diagnosis and histologic signs of activity of process, first of all like necroses. Ch. Hazzi (1986) determines the favorable forecast of HAG first of all by lack of symptoms of cirrhosis by the time of observation, at atom 5-lstny survival is noted at 80% of patients. In the presence of symptoms of cirrhosis 5-year survival is defined only in 50%.

Reasons of Chronic active hepatitis:

HAG can develop after hepatitises as virus (hepatitises B, C and D), and not virus (toxic, autoimmune) etiologies.

Treatment of Chronic active hepatitis:

Etiological antiviral treatment is made in a phase of replication of a virus. Antiviral therapy reduces terms of a replikativny phase, leads to a virus eradikation, promotes transition to an integrative phase, prevents development of cirrhosis, perhaps, hepatocellular cancer (A. R. Zlatkina, 1994)