In the human body, the liver is a kind of chemical laboratory where blood is cleansed of many toxic and harmful substances. If this body works normally, then it copes with its tasks qualitatively, but this does not always happen. There are pathologies that can affect the liver, for example, hepatitis A. Symptoms in children and adults are important to recognize as soon as possible in order to start effective therapy. Let us consider in more detail what this disease represents and whether complications can be avoided.
What is hepatitis A
There can be several forms of this disease, all of them have their own characteristics and manifestations. If we consider hepatitis A, then this is an infectious disease that affects liver cells. The disease is characterized by a cyclic course and is manifested by symptoms of intoxication and various deviations in the work of this organ.
If you look at the international classification, then hepatitis A is divided into several types:
- Hepatitis with hepatic coma.
- Acute hepatitis A.
- No liver coma.
Clinical manifestations of hepatitis
Each disease proceeds in its own way, hepatitis A periods have the following:
- Incubation. It begins after the virus enters the intestine through the oral cavity, then it penetrates the liver, where it begins to intensively multiply. The incubation period of hepatitis A lasts from three to five weeks.
- The pre-icteric period begins with the appearance of the first manifestations of the disease - the appetite decreases, fatigue appears, there may be pain in the abdomen. Often there is an increase in temperature.
- A vivid manifestation of the disease, which is characterized by yellow skin, dark urine and light feces. Hepatitis A virus causes liver enlargement, sometimes the spleen also enlarges.
- At the next stage, the appearance of the disease decreases, the patient's condition improves, the liver returns to its original size.
- The recovery period, which usually takes about 3 months. At this time, the child still feels some malaise, there may be complaints.
How does hepatitis infection occur?
Hepatitis A virus most often affects the children's body. Pathology can be observed in individual cases or in the form of small epidemics when a whole group falls ill in a kindergarten or a class in a school.
Hepatitis is a disease that only people are susceptible to, and therefore only a person can be the spread of infection. Most often, this role is played by a patient with an atypical form of hepatitis A, in which the disease is not diagnosed. A person is a carrier of the virus, infecting around the rest.
Infection with hepatitis A occurs in various ways, most often with food, water, you can get infected through feces. The transmission of hepatitis by airborne droplets is not possible, you can get infected during a blood transfusion, but due to the instability of the virus in the blood, this risk is quite small.
The human body is quite susceptible to this infection, usually epidemics erupt in child care facilities, when a large number of babies are immediately affected by hepatitis A (we will consider the symptoms in children a little lower). It is worth noting that if a person at least once in his life, for example in childhood, has suffered this disease, then immunity is developed for life.
Classification
This issue is approached in terms of the type, severity and course of the disease. The following types of hepatitis A are distinguished:
- Typical, which is manifested by all the characteristic symptoms of the disease.
- Atypical, it has erased signs and is mild.
Signs of the disease depend on the severity of the pathology, doctors distinguish:
- The mild form that is most often found in children. Intoxication is weak, the liver increases slightly. The disease is cyclical in nature, and recovery occurs in about a month.
- Hepatitis A moderate. A smooth course of the disease is noted, yellowness is moderate, not only the liver, but also the spleen can increase. Signs of intoxication may persist for up to 2 weeks. An organ is only able to recover within two months.
- Severe form is diagnosed relatively rarely. Signs of intoxication are strongly manifested, the child becomes lethargic, inhibited. Dizziness, cardiac arrhythmias, nosebleeds, and skin rashes are noted. The liver greatly increases in size, and palpation causes severe pain.
- Anicteric form is found in 20% of patients. No yellowing of the sclera and skin is observed. There is weakness, loss of appetite, may be vomiting and nausea. The disease can be recognized by an enlarged liver.
- There is also a subclinical form of the disease, in which there are no manifestations at all. The diagnosis can only be made after clinical studies. Such children support the epidemic process in the children's team.
- Can manifest a cholestatic form of hepatitis A. Symptoms in children are observed in the form of obstructive jaundice. The skin can have not only yellow, but also a greenish tint. Itchy skin appears, the liver increases slightly. This form takes a long time, can stretch for several months, but does not go into a chronic one.
The course of the disease in children
How hepatitis A manifests itself in children will depend on the course of the pathology. Doctors say:
- Acute course. It occurs most often, and, as a rule, all symptoms disappear in 2-3 weeks. Acute hepatitis A in babies can last up to 3 months, but there may be some complaints for some time after recovery.
- A prolonged course is noted if the disease does not recede for more than 3 months. The liver for a long time cannot come back to normal, but recovery sooner or later will come if all the doctor's recommendations are followed.
- Pathology with exacerbations. With this course, the clinical signs of the disease intensify, liver tests deteriorate, the pathological process in the cells of this organ persists for a long time.
- The course of the disease, in which the bile ducts are affected. This often happens with a moderate form. The disease can occur without severe symptoms and is only recognized by laboratory tests.
- The course of pathology with the addition of intercurrent infections. Diseases that are added, as a rule, do not increase the severity of hepatitis symptoms, but can provoke an increase in the liver.
Diagnosis of hepatitis A
Making the correct diagnosis for any disease begins with clinical research. Recognition of hepatitis A in children is also based on epidemiological, laboratory, clinical data.
If this pathology is suspected, a hepatitis A test is taken. Laboratory indicators can be divided into specific ones; they help detect HAV RNA in the patient’s blood using PCR and anti-HGA JgM antibodies using ELISA.
Using non-specific indicators, you can determine the degree of liver damage, evaluate the course of the pathology, its severity and make a prognosis. When blood is taken for hepatitis A, then a test is required to determine the activity of liver-cell enzymes and indicators of pigment metabolism.
Only after clarification of the diagnosis can we start the treatment of the disease.
But already at the initial stage of the development of the disease, parents can pay attention to the symptoms that appear and consult a doctor in a timely manner. Let's look at the signs of hepatitis A that parents should know.
Symptoms of the preicteric period
The duration of this period is from 3 to 7 days. It consists of an infectious stage and secondary toxicosis. The first is characterized by manifestations of intoxication of the child's body, which are caused by damage to the nervous system. The onset of the disease is quite acute, with the following symptoms:
- A sharp increase in temperature.
- General weakness.
- Headache.
- Tachycardia.
- Rarely, but may be vomiting.
- Abdominal pain.
The infectious period lasts a couple of days, and then the temperature decreases, the condition of the child improves. The stage of secondary toxicosis and its symptoms signal the development of liver failure, signs of hepatitis A in this case develop gradually, most often noted:
- Lethargy.
- Apathy.
- Drowsiness.
- May be dizziness.
- Appetite decreases, aversion to fatty foods appears.
- Nausea and vomiting.
At this stage, the liver becomes denser, noticeably increases in size, the child may feel pain in the right hypochondrium. If during this period we take blood for analysis, then an increase in the activity of liver enzymes is detected.
The pre-icteric period ends with darkening of urine and discoloration of feces.
Symptoms in children in the icteric period
If hepatitis A is diagnosed, symptoms in children in the icteric period depend on the stage of the disease. They are distinguished by three: an increase in symptoms, the height of pathology and recession.
The blood level of bilirubin rises, usually this process takes 6-8 days, and then a decline begins if the course of the disease is favorable. Changes in protein, fat, carbohydrate metabolism, water-salt balance is disturbed, liver function suffers.
As a rule, the symptoms of hepatitis A in children of 6 years in this period are as follows:
- Suddenly, the temperature can change. It all depends on concomitant pathologies and the presence of complications in the form of inflammatory processes.
- The work of the cardiovascular system is disrupted.
- Pathological changes in the digestive system.
It must be borne in mind that the seriousness of this disease is that hepatitis A makes changes in the functioning of the heart, which are explained by a violation of metabolic processes in the heart muscle.
Manifestations in the post-abdominal period
The end of the icteric period is judged by the amount of bilirubin in the blood. If the indicators have fallen to normal values, then it can be argued that the peak of the disease is behind.
The icteric period usually lasts up to two weeks, but can last even longer. Postpartum can last from three weeks, but in some children - even several months. There are no clear indicators of the end of this period, as a rule, the main criterion is the normalization of liver size, a decrease in the activity of liver enzymes.
How does hepatitis A manifest in infants
The course of the disease in infants has its own characteristics. There is a tendency to occur in a mixed form (viral-bacterial), which is recognized upon examination.
Another feature is that during hospitalization, doctors do not reveal the onset of the disease, but an exacerbation of the latent process - congenital or intrauterine.
The disease in children is more severe than in adults or older children. The preicteric period takes only a few days and does not have pronounced clinical manifestations, so the pathology is often recognized when jaundice begins.
The acute onset may have the following manifestations in infants:
- Decreased appetite.
- Frequent spitting up.
- Joining an intestinal infection.
- Heat.
- There may be catarrhal phenomena from the respiratory system.
- Feces and urine change their color just a day before the icteric period begins.
Hepatitis treatment should only be carried out under the supervision of a physician. Depending on the severity of the disease, the doctor may hospitalize a small patient or prescribe home therapy.
Hepatitis A Treatment
Since the incubation period of hepatitis A is often not manifested by any symptoms, then, as a rule, the disease is diagnosed already in the icteric stage. At the first manifestations in the form of fatigue, loss of appetite, some parents may not pay serious attention. Only a competent specialist can give all recommendations on how to treat hepatitis A, usually therapy comes down to the following measures:
- With a mild form, the patient is not hospitalized, bed rest is prescribed, with a severe form, it must be observed for at least 5 days.
- A sick child needs proper and proper nutrition, in which the ratio of proteins, fats and carbohydrates will be 1: 1: 4.
- Parents should include more raw vegetables, fruits, herbs, and juices in their diet.
- It is necessary to exclude refractory fats, which are usually found in margarine, fat. It is necessary to exclude canned food, sausages, fatty varieties of fish and meat. The use of hot seasonings, sauces, sweets and cakes will not be useful.
- Usually, doctors do not prescribe special drugs to combat hepatitis, choleretic drugs can be prescribed. In the acute period of the disease, cholelitic drugs are recommended, for example, “Magnesium sulfate”, “Berberine”, and during the convalescence of cholester-secreting action: “Allochol”, “Cholenzym”.
- Doctors often prescribe a course of B vitamins (Combilipen) to patients.
- If cholestasis is observed with a cholestatic form, then Ursosan is indicated in an amount of 10-15 mg / kg per day. In severe form, the duration of such therapy can be from 3 to 6 months.
- If hepatitis is severe, then infusion therapy is prescribed, which involves the introduction of drip and intravenous 1.5% Reamberin solution at a dosage of 10 ml / kg of the child’s body weight.
- Throughout the treatment, regardless of the form of the disease and its severity, enterosorbents are prescribed, for example, Enterosgel, Enterodes.
- One and a half to two months after the onset of the disease, the first examination of the patient is carried out, after 3 months a second examination is necessary. If the doctor does not diagnose clinical manifestations, then the child is deregistered.
It is necessary to consider: if therapy is carried out at home, then for a small patient a separate room and all personal accessories (utensils, hygiene products) should be allocated.
The consequences of hepatitis A
Since the virus of this disease is able to disrupt the functioning of the liver and the enzyme system, it can be assumed that this negatively affects the work of the entire child’s body. Each parent must understand the severity of this pathology and its consequences, therefore, at the first manifestations, it is imperative to consult a specialist.
If therapy is started in a timely manner, all the doctor's recommendations, bed rest are followed, food adjustments are made, then you can not be afraid of possible complications. If Botkin’s disease (also called hepatitis A) is not treated, then this will certainly negatively affect the health of the child in the future. Among the complications that are most often encountered are the following:
- Disorders in the liver.
- Digestion problems.
- The liver is reduced in size.
- Encephalopathy develops.
- Ascites.
- It may end in liver failure.
- Transition of the disease into a chronic form.
If treatment is started in a timely manner, then hepatitis A gradually recedes, all laboratory indicators return to normal, the liver restores its work.
How to prevent the development of the disease
Prevention of viral hepatitis A plays an important role. Various measures to prevent the spread of the virus include exposure to the source of infection, modes of transmission and the susceptibility of the body to infection.
It is important to carry out early diagnosis, then it will be possible to isolate the patient from others in order to prevent the spread of the virus. If the child was in contact with the patient, then it is necessary to examine the skin daily, sclera of the eyes for the appearance of icteric color, palpate the liver.
If there is already a focus of hepatitis A, then in order to identify an atypical form, it is necessary to conduct laboratory examinations every 2 weeks until the outbreak fades.
You can prevent the spread of infection in the following ways:
- Supervise catering.
- Monitor the quality of drinking water.
- Observe public and personal hygiene standards.
- If a sick child is found, then disinfection must be carried out in this outbreak.
- For prophylaxis, normal immunoglobulin with a high content of antibodies to hepatitis A virus is administered.
Usually, immunization is carried out in the season of hepatitis virus activity, this occurs most often in late summer and early fall.
But as much as possible to protect themselves and their children from the disease is possible only with the help of vaccination. In Russia, doctors use various types of vaccines, most often the following:
- Hepatitis A vaccine with polyoxidonium "GEP-A-in-VAK-PO L" is produced in Russia.
- French vaccine Avaxim.
- Havriks is an English-made vaccine.
- Another hepatitis A vaccine produced in Russia is the purified concentrated adsorbed inactivated liquid GEP-A-in-VAK.
These types of vaccines are introduced into the body of the child before he reaches the age of one. Often they practice coadministration against hepatitis A and B, but in different parts of the body. Almost 95% of vaccinated children form a strong immunity against this virus.
Adverse events after vaccination are usually absent. Slight redness, swelling at the injection site, and a slight increase in temperature may be observed. Such side effects are far from in all small patients, most often the kids are well tolerated.
Without the normal functioning of the liver, the effective functioning of all other organ systems is impossible, therefore, any of its pathologies should be diagnosed in a timely manner and undergo effective therapy. This is especially true for small patients. Responsibility for their health lies entirely with the parents, so it is important to pay attention to any deviations from the norm in the behavior of the baby, in laboratory indicators. This is the only way to prevent the development of more serious complications.