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Lecture notes, cheat sheets
Childhood diseases. Acute and chronic viral hepatitis in children (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 10. Acute and chronic viral hepatitis in children 1. Acute hepatitis Acute hepatitis is an inflammatory disease of the liver. Etiology. The most common cause of acute liver damage in humans is viral hepatitis. Acute hepatitis can also be caused by enteroviruses, pathogens of intestinal infections, infectious mononucleosis viruses, and septic bacterial infections. There are also acute toxic hepatitis caused by drugs (MAO inhibitors - hydrazine derivatives, PAS, isonicotinic acid derivatives, male fern extract, etc.), industrial poisons (phosphorus, organophosphorus insecticides, trinitrotoluene, etc.), mushroom poisons of pale grebe, morels (muscarine, afalotoxin, etc.). Acute hepatitis can occur as a result of radiation (radiation) damage, with extensive burns of the body, severe infectious diseases, and toxicosis of pregnant women. Pathogenesis consists in the direct effect of a damaging factor on the hepatic parenchyma or in immunological disorders that occur in response to a primary liver lesion, followed by cytolysis of affected and intact hepatocytes. In some cases, disturbance of microcirculation in the liver and intrahepatic cholestasis are of additional importance. Clinic. In mild cases, acute hepatitis is practically asymptomatic, being detected only during a random examination. In more severe cases (with toxic hepatitis), the clinical symptoms of the disease develop rapidly, combined with signs of general intoxication and toxic damage to other organs and systems. At the height of the disease, icteric staining of the skin and mucous membranes, whitish-clay-colored stools, rich dark (beer-colored) urine, and hemorrhagic phenomena are characteristic. The skin is orange or saffron. In mild cases, jaundice is visible only in daylight, icteric staining of the sclera and mucous membrane of the soft palate appears most early. Sometimes there are nosebleeds, petechiae; patients are concerned about pruritus, bradycardia, depressed mental state, irritability, insomnia and other signs of damage to the central nervous system. Enlargement of the liver and spleen on palpation is slightly painful. Diagnostics. Based on clinical and laboratory data, hyperbilirubinemia (100-300 µmol/l or more), increased activity of a number of serum enzymes: aldolase, aspartate aminotransferase and especially alanine aminotransferase (significantly above 40 units), lactate dehydrogenase, hypoalbuminemia, hyperglobulinemia are detected. The indicators of protein-sedimentary samples (thymol, sublimate, etc.) are far from normal. The liver's production of fibrinogen, prothrombin, VII, V coagulation factors is impaired, resulting in hemorrhagic phenomena. Differential diagnosis. Of great importance is a carefully collected anamnesis, establishing the possibility of professional or household intoxication, taking into account the epidemiological situation in identifying the nature and cause of the disease. In unclear cases, the first consideration should be viral hepatitis. The detection of the so-called Australian antigen is characteristic of serum hepatitis B (it is also detected in virus carriers, rarely in other diseases). Mechanical (subhepatic) jaundice occurs acutely, usually only when the common bile duct is blocked by a stone in cholelithiasis. But in this case, the appearance of jaundice is preceded by an attack of biliary colic; direct bilirubin in the blood is noted, the stool is discolored. With hemolytic adrenal jaundice, free (indirect) bilirubin is determined in the blood, the stool is intensely colored, the osmotic resistance of erythrocytes is usually reduced. With false jaundice (due to staining of the skin with carotene with prolonged and abundant consumption of oranges, pumpkins, carrots), the sclera are usually not stained, hyperbilirubinemia is absent. Treatment. Hospitalization in special departments of infectious diseases hospitals is mandatory, and sanitary and epidemiological measures are carried out at the source of infection. Prescribe bed rest, a gentle diet with limited fat and increased carbohydrate content, and a large amount of fruit juices. In severe cases, detoxification therapy is carried out. Forecast depends on the etiology of the disease, the severity of liver damage, the timeliness of therapeutic measures. Prevention acute hepatitis consists in observing the rules of personal hygiene, carrying out sanitary and epidemic measures, ensuring appropriate sanitary and technical supervision at enterprises, which prevents the possibility of industrial poisoning with hepatotropic poisons. You should not eat obviously inedible or unknown mushrooms, as well as edible, but old ones (which can also cause severe poisoning). 2. Chronic hepatitis Chronic hepatitis - polyetiological chronic liver lesions of an inflammatory-dystrophic nature with moderately severe fibrosis and predominantly preserved lobular structure of the liver, occurring without improvement for at least 6 months, clinically characterized by asthenic-vegetative, dyspeptic syndromes, hepatomegaly, impaired liver function, morphological persistence of necrosis, inflammation, fibrosis while maintaining the overall architectonics of the liver. Etiology. The greatest importance is caused by viral, toxic and toxic-allergic liver damage due to viral hepatitis, chronic drug intoxication, and less commonly - viruses of infectious mononucleosis, herpes, and cytomegaly. Pathogenesis. The direct effect of an etiological factor (virus, hepatotoxic substance) on the liver parenchyma, causing degeneration and necrobiosis of hepatocytes and reactive proliferation of mesenchyme. One of the pathogenetic mechanisms of the transition of acute viral and toxic hepatitis to chronic and further progression of the latter are specific immunological disorders. Clinic. Pain in the liver area is dull, constant. Characterized by enlarged liver, pain or a feeling of heaviness, fullness in the right hypochondrium, dyspeptic symptoms; Jaundice, skin itching, and low-grade fever are less common. There is no enlargement of the spleen, or it is slightly enlarged. Lethargy, fatigue, loss of appetite, belching, nausea, poor fat tolerance, flatulence, unstable stool, general weakness. The skin is pale, dry, and sometimes some patients exhibit mild (subicteric sclera and palate) or moderate jaundice. Diagnostics. Based on clinical and laboratory data, moderate hyperbilirubinemia is detected. Positive results of protein-sedimentary tests - thymol, sublimate, etc. In the blood serum of patients, the content of aminotransferases is increased: ALT, AST and LDH, with difficulty in the outflow of bile - alkaline phosphatase. Ultrasound of the liver and liver scan allows you to determine its size; with hepatitis, sometimes there is a reduced or uneven accumulation of the radioisotope drug in the liver tissue, in some cases there is an increased accumulation in the spleen. Liver puncture biopsy and laparoscopy make it possible to more accurately distinguish between these two forms of hepatitis, as well as to carry out differential diagnosis with other liver diseases. Treatment. A diet is prescribed with the exception of hot, spicy foods, refractory animal fats, and fried foods. Cottage cheese (up to 100-150 g daily), mild cheeses, low-fat boiled fish (cod, etc.) are recommended. In case of toxic and toxic-allergic hepatitis, it is extremely important to completely stop contact with the corresponding toxic substance. The use of hepatoprotectors (Karsila, Essentiale, etc.), cytostatics, antiviral drugs, and immunocorrectors is indicated. Author: Gavrilova N.V. << Back: Diseases of the biliary system in children (Classification of pathological conditions of the biliary tract in childhood. Biliary dyskinesia. Chronic cholecystitis) >> Forward: Kidney diseases in children. Classification (Classification of kidney diseases in children. Pyelonephritis. Chronic pyelonephritis. Glomerulonephritis. Acute glomerulonephritis. Subacute diffuse glomerulonephritis. Chronic diffuse glomerulonephritis)
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