Chronic hepatitis: causes, symptoms, diagnosis and treatment

Currently, the problem of chronic hepatitis is extremely urgent. According to statistics, 5% of the world's population suffers from an ailment. This diagnosis unites a group of liver pathologies, each of which has different causes and symptoms. The diagnosis of chronic hepatitis is made if the disease cannot be eliminated for at least 6 months.

The concept

The mechanism of the development of pathology is the death of liver cells, which occurs under the influence of various adverse factors. Moreover, the process is irreversible. A logical result is a significant increase in the load on the remaining parenchymal cells that form the main structure of the organ.

The disease, as a rule, is preceded by acute hepatitis, the treatment of which was not carried out properly, or against the background of therapy, there was no positive dynamics due to a pronounced weakening of the body's defenses or excessive activity of the factor that causes the disease (for example, a virus).

In addition, in some cases, the transition to a chronic form occurs due to the absence of symptoms. A person may not suspect that he has been developing a dangerous disease for several months or years, until the regenerative function of a vital organ has exhausted itself.

In the International Classification of Diseases (ICD), chronic hepatitis has the code B18.0 and means an inflammatory process that develops in the liver, the duration of which is at least six months.

Causes

A disease never arises on its own. The launch of its development occurs only under the influence of certain provoking factors.

By etiology, chronic hepatitis is classified into the following types:

1. Infectious. The causative agents are viruses, the vital activity of which leads to hepatitis B, C and D. Infection can occur with the parenteral route of administration of drugs (when they pass the gastrointestinal tract and enter the bloodstream immediately), during the gestation of the child (from mother to fetus) , during lactation, with unprotected sexual intercourse. In most cases, the infection enters the human body during the implementation of medical procedures, accompanied by a violation of the integrity of the skin. This situation occurs in the absence of thorough sterilization of instruments and with the reuse of disposable needles. In addition, other people's manicure tools, razors and other personal accessories are also dangerous. According to statistics, with transfusion of blood and its components, hepatitis B infection most often occurs. The chronic form may not manifest itself for a long time. If untreated, liver failure or cirrhosis develops.
2. Toxic. It develops due to the negative effects on the liver cells of all kinds of toxic substances. Most often occurs with excessive use of alcohol-containing drinks, uncontrolled medication and prolonged exposure to adverse conditions (for example, when human activity is associated with harmful production). The risk of developing chronic hepatitis increases with self-medication by the following types of pharmacological drugs: antipyretic, antibiotics, cytostatics, anti-tuberculosis, antiarrhythmic.
3. Autoimmune. It occurs as a result of damage to the parenchyma cells by the body's own protective forces. In other words, the immune system mistakenly considers them alien. A feature of the disease is that, as a rule, young people suffer from it. Often, pathology develops simultaneously with other ailments of an autoimmune nature.
4. Ischemic. Disruption of blood circulation leads to hypoxia, due to which the liver does not receive enough oxygen and nutrients. As a result, harmful compounds that are products of metabolic processes begin to accumulate in the body. The most common occurrence of fatty degeneration of an organ is a reversible condition that precedes cirrhosis.
5. Cryptogenic. The causes of its occurrence are unknown to medicine, but they differ from the above. An accurate diagnosis requires a thorough differential diagnosis. In the ICD, this type of hepatitis has a separate code - B19.0.

Thus, at risk are people suffering from severe pathologies of an infectious nature, intestinal and cardiovascular diseases, ignoring the principles of a healthy diet, taking medicines uncontrollably, as well as people whose daily activities are associated with harmful production.

Symptoms

Chronic hepatitis is an ailment whose clinical picture is quite extensive. However, many patients may not experience any warning signs for a long time.

Symptoms of chronic hepatitis and their severity depend on the form of the disease:

1. Inactive (another name - persistent). In most cases, the course of the pathology is not accompanied by any signs. They are present in some people, but their severity is so weak that they do not pay any attention to the symptoms. At the same time, the organ increases in size slightly, the indicators of the general blood test are normal, and the level of liver enzymes is slightly increased in the biochemical analysis. Under the influence of negative factors (alcohol, food poisoning, etc.), an exacerbation occurs in which the patient complains of severe pain in the right hypochondrium. During palpation, the doctor notes a moderate increase in organ size. As a rule, after eliminating the triggering factor and following the diet, the patient’s well-being normalizes.
2. Active (other names - aggressive, progressive). The course of this form of chronic hepatitis is always accompanied by pronounced symptoms. In this case, visible changes occur both in general and in the biochemical analysis of blood. The clinical picture is quite multifaceted, but doctors distinguish the following main signs of chronic hepatitis in an active form: nausea, belching, flatulence, diarrhea, bloating, loss of appetite, constant feeling of weakness, decreased working capacity, fatigue, weight loss, fever, bleeding gums , the skin becomes yellowish, dark urine, pain in the right hypochondrium, itching throughout the body, spider veins.

The severity of symptoms directly depends on how severely the liver is affected. In addition, due to the accumulation of harmful compounds in the body, patients may complain of sleep disturbances and instability of the psychoemotional state. Also, signs of other autoimmune diseases may be added to the above symptoms if the cause of liver damage is an attack by antibodies that are produced by the body's own defense system.

Manifestations of chronic hepatitis in children are the same as in adults. But since their immune system is not fully developed, they most often show an active form of the disease.

Diagnostics

If disturbing symptoms appear, consult a physician. If he suspects a liver disease, he will be referred either to a gastroenterologist or to a hepatologist.

In the process of admission, the specialist conducts primary diagnostics, including:

• History taking. The doctor needs to provide information on what medicines the patient has been taking recently, whether he received any injections, whether he visited beauty salons, whether he had ever had unprotected sexual intercourse, and how long, whether he or she was being transfused . In addition, it is important for a specialist to know what diseases a person and his closest relatives suffer from.
• Inspection To determine the size of the liver, the doctor palpates. In addition, he carries out percussion (tapping the necessary zones) to evaluate the resulting sound phenomena, which also makes it possible to understand whether the organ is enlarged or not.

For an accurate diagnosis it is necessary to undergo a thorough examination.

Laboratory diagnosis of chronic hepatitis involves the following tests:

1. Biochemical. The patient takes a blood sampling, which determines the level of protein, bilirubin, aminotransferase, alkaline phosphatase. A thymol test is also performed.
2. Immunological. Blood also serves as biomaterial. The study is necessary to identify and determine the concentration in the liquid connective tissue of immunoglobulins G and M to viral hepatitis. According to the results of the analysis, one can judge at what stage of development the disease is.

It is important to know that in the presence of chronic hepatitis, laboratory results may be within normal limits. For an accurate diagnosis, the doctor prescribes an ultrasound of the abdominal organs. In addition, according to the indications, additionally can be performed: computed tomography, MRI or liver biopsy.

Drug therapy

The tactics for treating chronic hepatitis depend on its shape and type. If the disease is in the acute stage, the patient is placed in a hospital in the gastroenterological department.

With the viral nature of the pathology, the doctor prescribes glucocorticosteroids, antiviral and interferon alfa. To eliminate intoxication, administration of enterosorbents is indicated. A course of treatment for chronic hepatitis is carried out until the blood counts are normalized.

If the disease is autoimmune, the doctor prescribes glucocorticosteroids and cytostatics. If chronic hepatitis is extremely severe, organ transplantation may be necessary.

In case of toxic damage, it is necessary to eliminate the provoking factor. After that, the doctor prescribes hepaprotectors.

The treatment regimen is compiled individually, taking into account the characteristics of the patient’s state of health and according to the results of all analyzes. Chronic hepatitis is a disease in which it is unacceptable to prescribe medications for yourself. In most cases, such situations lead to cirrhosis.

Diet

To maintain the liver and improve well-being, it is necessary to adjust the diet.

The following products must be included in it:

• bread (wheat or rye);
• tea;
• whole milk;
• kefir;
• skim cheese;
• cheese (hard, not spicy);
• butter and vegetable oils;
• chicken egg protein;
• soups without frying;
• cereals;
• steamed lean meat, boiled or baked (except chicken and veal);
• vegetables (only green peas are allowed from legumes);
• low-fat fish;
• compote;
• sweet fruits and berries;
• honey;
• jam.

The following foods should be completely excluded from the diet:

• mushrooms;
• legumes;
• vinegar;
• garlic;
• sorrel;
• spinach;
• cocoa;
• marinades;
• canned food;
• pepper;
• radish;
• radish.

All dishes must be baked, boiled or steamed. Fatty and fried foods should be completely ruled out. Before use, the products are crushed. It is forbidden to eat hot and cold food, it should be warm.

Thus, a diet involves eating medium-calorie foods with a high protein content. Do not forget about the water balance. Every day you need to drink up to 2 liters of clean non-carbonated liquid.

Lifestyle

In order to increase the effectiveness of treatment measures and minimize the likelihood of frequent exacerbations, the following rules must be observed:

• Avoid intense physical exertion. When disturbing symptoms appear, bed rest is indicated. The work schedule should be gentle, it is also forbidden to work at night.
• If possible, spend holidays in sanatoriums or cities and countries with familiar climatic conditions.
• Sleep at least 7 hours a day. Proper rest positively affects the state of the body's immune system.
• Maintain normal bowel function. Constipation should be eliminated. If necessary, it is recommended to consult your doctor who will prescribe mild safe laxatives.
• Do not smoke, do not use drugs and alcohol-containing drinks.
• Regularly undergo examinations by a specialist. Compliance with medical recommendations for chronic hepatitis is the only way to improve the course of the disease.

It is important to understand that the treatment of pathology in most cases is carried out for the rest of your life. The above rules should always be followed, and not only during exacerbations.

Forecast

Chronic hepatitis is a disease that threatens not only the health but also the life of the patient. If any warning signs occur, you should consult a doctor who will conduct a thorough diagnosis. Unfortunately, many patients ignore the first symptoms, seeking medical help at the stage of liver cirrhosis and other dangerous complications (for example, with gastrointestinal bleeding).

Currently, modern drugs are used to treat chronic hepatitis, which not only improve the course of the disease, but also prevent further destruction of liver cells. In this regard, with a timely visit to the doctor, the prognosis in most cases is favorable, but it also depends on the form of pathology, patient compliance with the diet and the principles of a healthy lifestyle.

Prevention

In order to prevent the development of the disease, it is necessary:

• timely treat hepatitis in acute form, preventing their transition to chronic;
• use only your cosmetic tools and personal hygiene items;
• when visiting tattoo parlors and before any injections, carefully make sure that the needles are disposable;
• limit the use of alcoholic beverages;
• observe all precautions in contact with toxic substances;
• take medicines according to the scheme developed by the attending physician, do not increase their dosage on their own;
• parents are responsible for vaccinating their children against hepatitis and other dangerous diseases;
• wash hands after using the toilet and before each meal;
• Avoid accidental sexual intercourse;
• drink only boiled or bottled water.

Compliance with these recommendations significantly reduces the risk of infection with hepatitis of any kind, as well as in the presence of a transition to a chronic form.

Finally

Currently, liver diseases are diagnosed as often as pathologies of the cardiovascular system. In most cases, the destruction of parenchymal cells of the organ is asymptomatic, and therefore patients seek medical help at the stage of development of complications. To prevent this, it is necessary to visit a doctor with regular, even mild ailments. He will conduct an initial diagnosis, and if hepatitis is suspected, he will also prescribe a number of studies. Upon confirmation of the diagnosis on an individual basis, he will draw up a treatment regimen including medication, lifestyle changes and diet. In most cases, the prognosis is favorable, since modern drugs not only improve the course of the pathology, but also can stop the process of death of liver cells. Ignoring medical recommendations, on the contrary, leads to cirrhosis and other complications that can be fatal in a short time.