Chronic Hepatitis Flashcards
What is Chronic Hepatitis?
it is diffuse inflammatory process in the liver lasting more than 6 month’s or an inflammatory destructive process in the liver flowing without improvement for at least 6 months, with relapses clinically charactered by asthenic-vegetative dyspeptic syndromes ,hepatomegaly, impaired indicators of liver function, necrosis ,inflammation, fibrosis with preservation of the general achitectonics of the liver
Etiology of Chronic Hepatitis
Viral-Hepatitis B virus
-Hepatitis C virus
-HDV
-HGV
Toxic due to alcohol, medicines,household and industrial poisons.
Nonalcoholic steatohepatitis(NASH)
Idiopathic probably autoimmune
Obesity
Dyslipidemia
Glucose intolerance
Due to metabolic disorders -the action of exogenous and endogenous xenobiotics,nutritional disorders and other factors-non alcoholic hepatic steatosis and steatohepatitisClassification of chronic hepatitis
By etiology
Chronic viral hp caused by hepatitis B, hepatitis B and D, hepatitis C
Autoimmune hepatitis, including several subcategories 1 and 2 based on serological distinctions
Drug associated
Idiopathic or crypto genie
By severity-mild
-moderate
-severe
By biochemical activity
Minimal activity-ALT doesn’t exceed 3 norms
Moderate activity-ALT from 3 to 10 norms
Expressed activity- ALT level exceeds 10norms
By stage-reflects the level of progression of the disease, the level of hepatic fibrosis
Morphological-aggressive
- persistent
- lobular
- cholestatic
According to activity-active (activity degree mild, moderate,severe,very severe)
-nonactive
According to liver functional condition-compensated
-decompansated
Clinical picture of chronic hepatitis
Depends on the form of chronic hepatitis,process activity,liver functional condition, is formed by degree of the main clinical syndromes expression
Cytolytic syndrome
Mesenchymal inflammatory syndrome
Cholestatic syndrome lastenovegetative syndrome
Dyspeptic syndrome
Hemorrhagic syndrome
Syndrome of hypersplinism
1.cytolytic syndrome
Clinical signs-losing weight,liver smell,gynecomastia in men and men dies disturbance in women, spider nerves,liver smell,fever,jaundice
Lab data-
Pathogenesis of chronic hepatitis
Action of the etiological factor increases the functional load on hepatocytes
This leads to accumulation of toxic substances in them, leading to increased lipid peroxidation, violation of cell membranes; violation of blood supply to the parenchyma and hepatocyte necrosis
Liver syndromes in chronic hepatitis
Cytolysis Cholestasis Mesenchymal-inflammatory Liver cell deficiency (hyperazotemia) Hypersplinism Pathological regeneration syndrome and tumour growth Hemorrhagic Asthenic Dispeptic
Cytolytic syndrome
Signs-fever; heaviness in the hypochondrion agravated after physical activity,asthenia,nausea, vomiting which doesn’t bring relief,jaundice ,weight loss
On labs-increase in AST,ALT,LDG-5, gamma-GTR,iron,free and bound bilirubin,increase glutamate dehydrogenase
Cholestasis syndrome
Caused by malformations and transport of bile in Hz or damage to intrahepatic bile ducts
Patient complains of itching of the skin,xanthomas,xanthelesma,dark urine,malasorbption syndrome, hepatomegaly
On labs we see increase in substances that should be excreted by bile-alkaline phosphatase,cholesterol,bilirubin, gamma-GTP, high cholesterol
Mesenchymalno inflammatory syndrome
Syndrome of autoimmune liver damage, always matches with cytolysis due to autoimmune reactions associated with the production of autoAG to Hz
Patient complains of fever,artralgia,vasculitis
On labs-increase in gamma globulins,frequently with hyperproteinemia,,appearance of l.e cells,smooth muscle fibres.
Increase IgM,G,A
Asthenovegetative syndrome-
Weakness ,expressed dizziness,hypochondrion,rapid weight loss
Dyspeptic syndrome
Bleeding of different origin,skin hemorrhages
Labs show-decrease in quantity and function of thrombocytes,decrease in synthesis of 2,5,7 factors of blood coagulation
Hypersplinism syndrome
Anemia
Due to strengthening of the spleen and increase function to remove destroyed blood cells
Decrease platelets,leukocytes,erythrocytes
We see pancytopenia
Portal hypertension
Results from impaired passage of blood from portal and splenic vein
Pressure in abdominal veins rises
Blood starts to shunt to the systemic veins through collaterals
Chronic active hepatitis
Main complains-weakness,fatigue,absent mindedness,frequently bad mood
Dyspeptic syndrome-nausea,bad appetite,constipation,diarrhea
Transient jaundice-itchy skin, joint pain.pain in muscles,
Gynecomastia in men,weight loss,palmar erythema,spider nerves, yellow discolouration of mucus membranes
In CBC-ESR increased,pancytopenia(combination of anemia,leukopenia,thrombocytopenia)
Biochemical blood analysis in the period of exacerbation shows expressed protein metabolism disturbance,hypoalbunemia,hyperglobunemia
Cytolytic syndrome shows increase in level of specific liver enzymes e.g aldolase etc
Cholestatic syndrome shows increase in alkaline phosphatase,hyperbililubinemia
Immunologic data- increase in IgY rarely IgM,antibodies to smooth muscle
Chronic autoimmune hepatitis
Occurs mainly in women of 10-30years
Signs-fever, artralgia,vasculitis,pleuritis,amenorrhea in women,
Many nonliver findings present-lymphadenopathy,splenomegaly,
Immunologic changes-revealing l.e cells in blood,antibodies to cell nucleus and non striated muscle tissue, increase concentration of immunoglobulins,increase reaction of complement binding
Lab data- massive cell infiltration of liver tissue big quantity of plasma tic cells in infiltrate
Border lamina destruction
Lab and instrumental diagnosis
CBC Liver function test-alkaline phosphatase,aminotransferases,ALT,AST Biopsy- Thyroid tests Viral serological tests Serum albumin,platelet count,prothrombin time, Abdominal US CT ECG Urine Liver elastometry
Treatment of Chronic hepatitis
Antiviral therapy
Gamma interferon or in combination with (synthetic nucleozides,antioxidants)
In hepatitis caused by HBV- human leukocytes alpha inteferon or gene-engineered (recombinated preparations of alpha inteferon-reaferon,intronA subcutaneously or i.m 5-6IU , 3times a week during 6 months
In HCV and in superinfection by HDV-duration of therapy is 12 months
In chronic hepatitis with minimal activity-immunosuppressive therapy known as hepatoprotectors e.g silibinin 6-8 capsules daily during 2-3months
In cholestatic hepatitis-cholestyramine 10-16g daily for 1-2 months , Vitamin A,D,E,K
Glucocorticoids(prednisalone 25-30mg daily) for 4months to a year till decreasing level of bilirubin and cholesterol. If not effective cytostatics(azothyoprine50-100mg daily)
For ascites-diuretics
Prophylaxis Diet Exercise Stop alcohol , smoking, Vaccination
