Hepatitis A is called. Hepatitis A - What is this disease? Symptoms, treatment and prevention of hepatitis A

Hepatitis - inflammatory disease Liver. By the nature of the flow distinguishes sharp and chronic hepatitis. The sharp flows with pronounced symptoms and have two outcome options: complete cure, or a transition to a chronic form.

Different types of hepatitis differ from each other in different ways of infection, the speed of progression, the severity of clinical manifestations, methods of treatment and the projection for the patient. For hepatitis, a specific complex of symptoms, which, depending on the type of disease, can manifest themselves stronger than others.

What is hepatitis?

Hepatitis is an acute or chronic inflammatory liver disease, which arises due to infection with specific viruses or influence on the parenchyma of the toxic organs (for example, alcohol, drugs, drugs, poisons).

Viral hepatitis is a group of common and dangerous infectious diseases for a person who are quite significantly different from each other. different virusesBut still have a common line - this is a disease that is striking the liver of a person and causing it inflammation.

The main signs of hepatitis is - abdominal pain, loss of appetite with frequent nausea and vomiting, headache, general weakness and an increase in body temperature up to 38.8 ° C, and in severe cases - yellowing of the skin and eyes.

Types of viral hepatitis

Hepatitis classify:

• due to development - viral, alcoholic, medicinal, autoimmune hepatitis, specific (tuberculosis, echinococcal, etc.), hepatitis secondary (as complications of other pathologies), cryptogenic (unclear etiology);
• for course (acute, chronic);
• on clinical features (jaundice, rude, subclinical forms).

By the mechanism and paths of infection are divided into two groups:

• Having an oral-fecal transmission mechanism (A and E);
• Hepatitis for which blood compact (hemoperkanta), and speaking easier - laid through blood path, is the main (B, C, D, G is a group of parenteral hepatitis).

Depending on the form of hepatitis, the disease can disturb the patient for a long time, while in 45 - 55% of cases there is a complete recovery. Chronic (constant) form of viral hepatitis can disturb the patient throughout life.

Hepatitis A or Botkin's disease is the most common form of viral hepatitis. His incubation period (from the moment of infection before the emergence of the first signs of the disease) ranges from 7 to 50 days.

During this period, a person can infect others. Most of the symptoms of viral hepatitis usually disappear in a few days or weeks, but the feeling of fatigue can delay the months as the liver comes back to normal. For a complete recovery takes several months.

Viral Hepatitis B.

Jaundice arises as a result of the violation of the exchange of bilirubin, toxic to the body. With violation of the functions of the liver, it accumulates in the blood, is distributed throughout the body, laying off in the skin and mucous membranes and giving them a yellowish color.

Most often, as a result of the disorder of the outflow from the bile liver, the part of which enters the blood and is distributed throughout the body, itching appears: bile acids, laying off in the skin, are very annoying it.

In some cases, patients develop The so-called lightning spicy hepatitis. This is an extremely severe form of a disease in which there is a massive fission of tissues and the extremely rapid development of symptoms. In the absence of treatment, such a sharp hepatitis ends with the death of man.

Forms of development

For viral hepatitis, 4 forms are distinguished:

1. Little, more often characteristic of hepatitis C: Jaundice is often absent, the temperature is subfebrile or normal, the severity in the right hypochondrium, a decrease in appetite;
2. Middle severity: The above symptoms are more pronounced, pain in joints, nausea and vomiting appetite, the appetite is practically absent;
3. Heavy. There are all the symptoms in a pronounced form;
4. Lightning (fulminant)not occurring at hepatitis C, but very characteristic of hepatitis B, especially in the case of coinfection (AGD / HBV), that is, the combinations of two viruses in and D, which cause superinfection.

Complications and consequences for the body

And acute, and chronic hepatitis can lead to very serious consequences. Among them should be especially noted:

• inflammatory diseases of the biliary tract;
• the liver to whom (ends with death in 90% of cases);
• cirrhosis liver - occurs in 20% of patients with viral hepatitis. Most often to cirrhosis leads hepatitis B and its derivatives;
• liver cancer;
• expansion blood vessels and subsequent internal bleeding;
• casting fluid B. abdominal cavity - Ascite.

Treatment of hepatitis

Hepatitis treatment depends on the etiological factor, which caused the inflammatory process in the liver. Of course, hepatitis of alcohol or autoimmune origin usually requires only symptomatic, disinfect and hepatoprotective treatment.

The standard tactics of hepatitis treatment assumes:

• elimination of the causes of the disease by destroying the virus and detoxification of the body;
• treatment of concomitant diseases;
• restoration of the health of the liver;
• maintaining normal organic life;
• compliance with special diet and certain sanitary and hygienic protection measures.

Treatment of acute hepatitis

The treatment is necessarily carried out in the hospital. Moreover:

• a diet number 5a is prescribed, a semi-noarier mode (with a serious flow - bed);
• with all the forms of hepatitis, alcohol and hepatotoxic drugs are contraindicated;
• intensive disinfectant infusion therapy is performed to compensate for this
• liver function;
• hepatoprotective preparations are prescribed (essential phospholipids, silimarine, frost's extract bottles);
• prescribe a daily high enema;
• correction of exchange - preparations of potassium, calcium and manganese, vitamin complexes.

Compliance with diet

In addition to medication therapy, the patient should be necessary to comply with the diet. Food should be based on the following rules:

• the complete exception of alcohol (including beer);
• ban on marinades, smoked, acute and fat;
• recommended low-fat meat and fish;
• you can use low-fat dairy products.

Antiviral therapy in a tandem with a diet and bedding can lead to complete recovery. However, it should be noted that compliance with diet nutrition and therapy is required after recovery. Otherwise, the recurrence and the transition of the disease in chronic viral hepatitis is practically not excluded.

What you can eat:

• various teas based on herbs and berries, juices and compotes with a small content of sugar;
• freshly, good favorable porridges;
• various soups and vegetable purees;
• dairy products with low fat content;
• meat and fish must be low-fat varieties cooked for a pair;
• steam oslet;
• bread cut, rye, hanging cookies.

From sweets you can use dried fruits, not too sweet jam, honey. Baked apples are useful, in small quantities of bananas and berries.

What is impossible:

• very strong tea, chocolate, coffee;
• bean products, mushrooms;
• sour, salted, too sweet;
• sdob, puff pastry, pancakes, pies;
• sausage products and canned meat;
• pork;
• eggs in steep and fried.

Prevention

Prevention is needed that viral hepatitis will not return, and in the case of chronic manifestation - did not exacerbate, did not complicate. Prevention is to comply with the following rules:

• exception from the diet of alcohol (fully);
• compliance with all the recommendations of the doctor (do not miss receptions, correctly by recipe to use drugs);
• compliance with diet (eliminate fried and fatty, salty and sharp, conservation and canned);
• be careful when contacting infected biomaterials (concerns health workers), namely, to use PPE (protection means).

How to protect yourself from hepatitis?

Viral hepatitis often lead to serious I. hazardous complications And their treatment is not only long, but also expensive.

Prevention is as follows:

• Wash your hands before eating
• Boil water before use
• Always wash fruits and vegetables, thermally handling food
• Avoid contact with biological fluids of other people, including blood
• Protect with sexual contacts (including and oral)
• Do piercing and tattoos only with sterile devices in proven centers
• Make a vaccination from hepatitis.

This is all about hepatitis (alcoholic, viral and others): what is the disease, how are infected, what are the first signs and the main symptoms, which drugs are effective in exacerbation.

Hepatitis A (Botkin's disease) is an acute viral liver disease, usually transmitted through dirty hands.

Botkin's illness more often sick, which is associated with the virus transmission mechanism. However, the person of any age can get sick. The greatest risk to infect occurs when visiting countries with a hot climate, for example, India and African states. After the disease, a persistent lifelong immunity remains, so it is impossible to get hepatitis and is impossible.

Botkin's disease is considered the most benign hepatitis, as it proceeds only in acute form and, unlike hepatitis B and C, never takes a chronic course.

Liver

The liver is the "factory" of the body, which performs hundreds of vital tasks, including the following:

• storage of glycogen - carbohydrate, which quickly provides energy cells;
• protein synthesis;
• production of bile that helps absorb fats;
• production of substances rolling blood;
• processing and removal from the body of alcohol, toxins and drugs.

The liver of a person is only one, but it is very life-in. It continues to work even with extensive lesions due to their self-healing ability.

Hepatitis symptoms usually pass within two months, but sometimes can last until six months. As a rule, adults are sick hard. Prediction with Botkin's disease is favorable. With timely treatment, as a rule, complete recovery comes.

If you have found hepatitis A, you need to examine anyone who you could infect. Recommended a survey:

• living with you people;
• people who have recently prepared meals;
• to whom you had an intimate connection.

It is also necessary to observe personal hygiene: wash your hands after visiting the toilet and before cooking food. It should also be used with own towels, cutlery and toothbrush.

Hepatitis A Symptoms (Botkin Diseases)

Hepatitis A symptoms appear, on average, a month after the infection with the virus. The period between infection and the appearance of the first signs of hepatitis is called the incubation period. When hepatitis A is from 7 to 50 days, more often about a month. At this time, the virus actively multiplies in the body, but the person does not bother anything yet.

At the end of the incubation period, the first symptoms appear, which are similar to the usual cold. This period is called Promotional. For the extended period of hepatitis A characteristic:

• a slight increase in temperature - usually 37-38 ºC, not higher than 39.5 ° C;
• nausea or vomiting;
• sore throat;
• loss of appetite;
• chronic fatigue (constant feeling of fatigue);
• pain in the joints or muscles;
• pain in the abdomen.

At this stage, symptoms such as headache, cough, constipation, diarrhea or skin rash may appear. Smokers celebrate tobacco taste dullness.

About ten days after the appearance of the initial symptoms, the active stage of the disease begins, when there are signs characteristic of liver damage:

• jaundice - coloring of the skin and eye proteins in yellow color;
• dark urine, white feces (discolored chair);
• itching skin;
• increase and soreness of the liver.

At this stage, the initial symptoms, such as fatigue, the absence of appetite and nausea can also be reduced significantly.

Jaundice

Jaundice is the yellowing of the skin and the proteins of the eyes.

This condition speaks of the lesion of the liver, its inability to remove bilirubin from the body - a yellow-color substance contained in the blood, which is a by-product of the decay of red blood tauros.

The nature and severity of the symptoms vary greatly from different people. Some do not have jaundice at all, others are sick in severe form with all the "classic" manifestations of viral hepatitis.

It should be referred to your doctor if you think that you have hepatitis A, especially in the following cases:

• you recently visited the region of the world where hepatitis A is common, for example, in Africa, India or Pakistan - the incubation period lasts up to 6-7 weeks, so the trip could be a few months ago;
• you have jaundice.

As a rule, hepatitis A does not pose a threat to life, but you need to diagnose in time to eliminate the possibility of others, more dangerous diseases, such as cirrhosis. You may also need to examine your friends, family members and sexual partners to eliminate the possibility of their infection.

How is hepatitis A transmitted?

The causative agent is the hepatitis A. virus. Most often, the virus is transmitted by the fecal-oral way, i.e., through dirty hands, poorly washed food and objects contaminated by feces with hepatitis and human.

You can get infected when eating mollusks living in water, in which uncleanness merged. Often the source of infection becomes dirty water, as well as ice cubes from it, fruits and vegetables, washed in it.

Less often hepatitis A is transmitted as follows:

• through a common needle with an infected person when using intravenous drugs;
• during oral sex.

It can be infected with hepatitis with close personal contact in places of accumulation of a large number of people, for example, in hostels and barracks.

The sick person most actively distinguishes the virus in a barn period (when the skin has not yet been painted in a yellowish color), as well as with erased forms that are not always diagnosed, and the sick continue to attend public spaces. After the appearance of the jaundice, the contagious of a person decreases significantly.

Who is subject to the disease?

The infection is widespread in the poor regions of the world, where people live very boringly, in unsanitary conditions and do not have free access to clean water.

The greatest incidence of hepatitis A is observed in the following regions:

• region south of Sahara and North Africa;
• indian Peninsula (especially in Bangladesh, India, Nepal and Pakistan);
• some regions of the Far East (with the exception of Japan);
• Near East;
• South and Central America.

Hepatitis A is less common in high-income countries. In Russia, the incidence of Botkin's disease has greatly decreased after 1995 and now will be much varied depending on the region. Every 5.6.10 years there is an increase in the number of patients - hepatitis flashes.

The children of the first year of life are rarely sick, since protective antibodies are obtained with mothers milk. The main group of patients with hepatitis are schoolchildren. Among the more adult population, students, military personnel and patients of psychiatric hospitals are more likely.

It is believed that one ill with the detected hepatitis accounts for 5 people who have Botkin's disease flows hidden and is not diagnosed.

Other risk groups:

• homosexuals;
• drug addicts;
• saenizers and Vodokanal employees;
• people visiting less developed countries.

Hepatitis A Diagnosis (Botkin Diseases)

If you have in contact with a person with hepatitis A (Botkin's disease), or you have started to appear characteristic symptoms, such as jaundice (yellowing of skin and eye proteins), consult a doctor to pass tests. The main diagnostic test is the analysis of hepatitis. The presence of antibodies of a certain type against hepatitis A testifies to the disease.

In addition, if hepatitis is necessarily required, a biochemical analysis of blood is carried out from a vein, with the help of which hepatic samples are determined: bilirubin, common protein, alosa, asate, thymol sample, etc. According to these indicators of the courts of the liver.

The diagnostic standard also includes:

• general analysis of blood from the finger, which shows the presence of inflammation, as well as the possible development of anemia;
• urine analysis, which allows you to determine the content in the urine of bilirubin and products of its decay.

To determine the size and study of the structure of the liver, ultrasound of the liver (liver ultrasound) is often prescribed. In rare cases, with an unclear diagnosis, liver biopsy is prescribed to eliminate other diseases - fence small pieces of hepatic tissue for subsequent analysis in the laboratory.

Hepatitis analyzes can be passed free of charge on the CHI policy. To do this, contact the precinct therapist or infectious background into the territorial clinic. The doctor will give a direction for tests that can be passed in a clinic or diagnostic center.

Without direction (for money), the diagnosis for hepatitis can be passed in many clinics in the separation of paid services, as well as in specialized laboratories that can be found

Hepatitis A Treatment (Botkin Diseases)

Treatment of hepatitis A is carried out in the hospital (infectious hospital). With light and medigative forms, the main part of the treatment is a diet and a semi-noar mode. Treatment in the hospital lasts before improving the well-being, the disappearance of jaundice, improving blood indicators. After discharge from the hospital, it is usually required 1.5-2 weeks before proceeding to work. If recovery is delayed, the sick leave is extended.

Mode and diet

It is extremely important to rest as much as possible, especially during initial stageSince, most likely, you will feel strong fatigue. For a time of illness, it is recommended to observe the semi-respecting mode. This means that most of the time you need to spend in bed. You can only get up for visiting the toilet, hygienic manipulations and meals.

At the time of hospitalization and approximately 2 weeks after the discharge, you must issue a sick leave. If the recovery period is delayed, the hospital sheet is extended.

With all types of hepatitis for the time of illness and the recovery period, a gentle diet is recommended. From the diet strictly exclude all products that increase the burden on the liver:

• fatty products, including fatty varieties of meat (pork, lamb, goose, duck, etc.);
• roasted, canned, pickled, cooked with plenty of spices and spices;
• alcohol (including beer);
• radish, garlic, onions;
• legumes;
• chocolate, cocoa, coffee;
• yolk eggs.

Allowed:

• cereal cereal;
• dairy products with a small fraction of fat;
• lean meat (beef, turkey, rabbit) and fish;
• soups and burst on the vegetable broth;
• non-fat sweets (honey, grazing, marmalade, jam, marshmallow, etc.).

All products are prepared for a couple, boil or extinguished. Food takes 4-6 times a day, small portions.

It is advisable to drink more liquid, bringing the daily volume to 2-3 liters. It helps to remove toxins from the body and speed up recovery. For drinking, you can use alkaline mineral waters, compotes and juices from fruits and berries, fruit, broth of rosehip, faint tea with honey or milk.

Treatment of itching with hepatitis A

Some hepatitis patients are strongly bothering itching. This symptom is closely related to the level of bilirubin in the blood. As soon as the bilirubin decreases, itching goes away. If the body itches, the following tips can help:

• check the room and maintain the coolness in the room;
• wear loose clothing;
• do not take a hot bath or shower.

In severe cases, antihistamines can be assigned to you, but they are not always suitable.

Means from nausea and vomiting

If you have nausea or vomiting, try the following:

• eat gradually six times a day, instead of three large meals;
• do not eat oily food, as you may be worse from this.

It is produced in the form of tablets, capsules, powder for the preparation of the solution, as well as a solution for injection - injections, is usually used in severe cases.

The side effects of metoclopramid rarely occur. These include:

• diarrhea;
• drowsiness - Do not get drunk and do not use the power tool if you feel drowsiness.

Strong vomiting can cause dehydration.

Unloading the liver

It is necessary to unload the liver to complete recovery. You should not drink alcohol, since the liver is responsible for filtering alcohol from the blood. Refrain from self-medication and reception of any drugs, even vitamins, without the recommendation of the doctor. Take only those drugs that the doctor recommends and strictly follow the dosage.

To remove the toxins from the organisms formed during damage to the liver and inflammation, sorbents are prescribed - preparations absorbing harmful substances and contributing to their removal from the body. In severe cases, intravenous drip administration of medicinal solutions are prescribed for disinfection.

Also, with hepatitis A, hepatoprotectors are prescribed - drugs protecting hepatic cells from damage and improving the liver and gallbladder.

Of great importance for the restoration of the liver and the fight against infection is the reception of vitamins A and E to the appointment of a doctor.

In severe cases of a patient with hepatitis A translated into intensive care, where drugs are administered intravenously drip, and also constantly control the vital indicators of health and liver work. Sometimes they resort to intravenous plasma introduction. With severe intoxication, plasmapheresis is used. This is a blood fence, its cleaning from toxins on special filters and return back. Sometimes they are returned to the body of the patient only blood cells, and its liquid part is plasma - change to the donor.

Emergency prevention of hepatitis A

If the analysis showed that you have become infected with the hepatitis A virus, but there are no symptoms, it is possible to prevent the development of the disease with the help of vaccination and a medicinal product called immunoglobulin.

Immunoglobulins are proteins - antibodies that are removed from a man's donor blood having immunity to hepatitis A. This treatment, as a rule, effectively only in the first 14 days after infection.

Hepatitis A Complications (Botkin Diseases)

Hepatitis and rarely gives complications, usually the disease ends with complete recovery. Most heavy complication Botkin's disease - liver failure. After recovery from hepatitis, a persistent immunity is usually preserved and a re-illness is not possible. However, if the treatment is not completed, and complete recovery has not come, the appearance of a repeated wave of the disease is possible. This happens in 15% of the diseases of Botkin and can repeat repeatedly.

Liver failure - This is a rare and potentially life-threatening complication of hepatitis, in which the liver can stop normally function. The following groups of people are simply subject to her:

• people with already existing liver disease, such as cirrhosis or hepatitis C (heavier type of hepatitis);
• people with weakened immune system (As a result of a chronic disease, such as diabetes, or by the side effect of some methods of treatment, such as chemotherapy).

Some symptoms of hepatic insufficiency are similar to Hepatitis A symptoms and include jaundice, nausea and vomiting.

Other symptoms:

• rapid formation of bruises and bleeding (for example, if blood is often comes from the nose or bleeding gums);
• heat and attacks of chills, since the body becomes more susceptible to infectious diseases;
• eugene - cluster of fluid on the legs, ankles and feet;
• ascites - accumulation of fluid in the abdominal cavity, which leads to a rapid increase in the abdomen;
• sleepiness and disorientation in space and time.

Often, you can compensate for the defective liver operation using medicinal preparationsBut complete cure is possible only when transplanting liver.

Hepatitis A Vaccinations (Botkin Diseases)

In our country, several vaccines of domestic and imported production from hepatitis A. It is believed that the vaccination from hepatitis creates sufficient protection against infection by 6-10 years.

Vaccination against hepatitis A is included in the national calendar of preventive vaccinations over epidemic testimony, that is, it is carried out in children from 3 years and adults from the following categories:

• resisting in the regions of Russia with a high incidence of hepatitis A;
• medical workers,
• educators and staff of children's institutions;
• employees of the public catering;
• vodokanal workers and sewer services;
• traveling abroad to the foci, unfavorable hepatitis A;
• those who were in close contact with sick hepatitis;
• sick chronic diseases liver;
• military teams located in the field.

In addition, you can make this vaccination at your own desire - paid.

With our service, you can choose a clinic where you can make vaccination. We recommend that you first call the contact phone to the selected medical insurance and to clarify the presence of a vaccine, vaccination schedule and other features of vaccination against hepatitis A.

The vaccine is introduced twice with an interval of 6-12 months. But it is believed that already 14 days after the first vaccination in the blood, the protective level of antibodies is created. Re-vaccination is carried out to increase the strength and duration of immunity.

Types of vaccines from hepatitis A

In Russia, several vaccines from hepatitis A are registered:

• Havrix (Belgium production);
• Avaksim (production France);
• Hepro-In-Vak (production Russia);
• Vakta (production of the Netherlands).

If you need a vaccination before traveling to another country, you need to make one injection two weeks before the trip, although if necessary, you can even be vaccinated on the day of departure.

Such an adhesive gives protection for about one year. If after 6-12 months to make a re-vaccination, it will give protection at least 6-10 years.

Side Effects Vaccination

After vaccination, some people appear painful sensitivity, redness and flaws of the skin at the injection site. A small painful nodule can be formed there. Usually it goes quickly, and you should not worry about this.

More rare side effects:

• fatigue;
• headache;
• loss of appetite;
• nausea;
• a slight increase in temperature.

To which doctor to contact with hepatitis A

When the symptoms of hepatitis appear, refer to (family doctor) or (for a child), since the described features may be associated with many reasons, and the primary diagnosis is required, which is conducted by a wide profile specialist.

If you consider with a lot of probability, you are sick with viral hepatitis, you can immediately visit. With the help of our service you can find these specialists by clicking on the links.

With the help of a removal, you can choose an infectious hospital for hospitalization if the doctor recommends to go to the hospital.

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All materials of the site were checked by doctors. However, even the most reliable article does not allow to take into account all the features of the disease in a particular person. Therefore, information posted on our website cannot replace the visit to the doctor, but only complements it. Articles prepared for a study destination and are a recommendatory.

The content of the article

Hepatitis A (synonyms of the disease: Botkin's disease, infectious, or epidemic, hepatitis) - acute infectious disease caused by the hepatitis A virus, mainly with the fecal-oral contamination mechanism; It is characterized by the presence of an initial period with an increase in body temperature, dyspepsic, flu-like features, prevailing the lesion of the liver, the symptoms of hepatitis, metabolic disorders, often jaundice.

Historical data of hepatitis A

For a long time The disease mistakenly considered a catarrhal jaundice, due to the blockage of the total bile duct with mucus and swelling of its mucous membrane (R. Virhov, 1849). For the first time, the situation is scientifically substantiated that the so-called catarrhal jaundice is an infectious disease, expressed S. P. Botkin (1883). The causative agent of the disease - the hepatitis A virus (HAV) was opened in 1973 p. S. feinstone.

Etiology hepatitis A.

Hepatitis A causative agent refers to the Picornaviridae family (Italian. Picollo is small, small; English RNA - ribonucleic acid), kind of enteroviruses (type 72). Unlike other enteroviruses, HAV replication in the guts is finally proven. HAV is a particle size of 27 - 32 nm, which does not contain lipids and carbohydrates. The virus can be reproduced in some primary and translated human cell cultures and monkeys. The virus is resistant to the external environment factors, at room temperature, several months can be maintained, sensitive to formalin, concentrated solutions of chlorine and chlorine lime, resistant to freezing, at a temperature of -20 ° C retains vitality for two years.
The sterilization of the flowable ferry at a temperature of 120 ° C for 20 minutes completely inactivates the contagious material.

Epidemiology of Hepatitis A.

The only source of infection is a sick person. The selection of the pathogen into the external environment with feces begins in the incubation period, 1-3 weeks before the appearance of clinical symptoms of the disease. The greatest contagiousness is observed in the first 1-2 days of the disease and stops after the 10-14th day of the disease. The pathogen is contained in the urine, menstrual blood, sperm having less epidemiological value.
There is no pathogen in breast milk. Often the source of infection is patients of riotless and inapparantine forms of viral hepatitis A, the number of which can significantly exceed the number of patients with a manifest form. Viro is not observed.
The main mechanism for infection is fecal-oral, realized by water, food and contact-household paths. A large number of cases of food and water outbreaks of infection are known. Often group outbreaks of viral hepatitis A occur in children's preschool institutions and schools. There is the possibility of parenteral infection with hepatitis A during medical manipulations, however, a small duration of the Virushemia period makes this way of spreading infection in secondary. Possible sexual path of infection.
The susceptibility of people to infection with hepatitis A is 100%. Due to the intensive distribution of the disease, most people manage to pass the yellow or rude infection to 14 years. In the age structure of the incidence of hepatitis A is approaching child infectious diseases (measles, scarlet). Adults account for about 10-20% of all cases of hepatitis A.
Seasonality autumn-winter, is observed only among children. It is characterized by the frequency of incidence of incidence at the C-5 interval.
Hepatitis A is a very common infection, the incidence rate depends on the state of sanitary culture and communal improvement. Immunity persistent, lifelong.

Pathogenesis and Pathomorphology of hepatitis A

Pathogenesis is not studied enough. It is largely due to the lack of an adequate model of the disease and a lack of data on the replication of the causative agent. According to the scheme developed by A. F. Blueman and I. Guy. Novitsky (1988), the seven main phases of pathogenesis are distinguished.
I. Epidemiological phase, or penetration of the pathogen in the human body.
II. Enteral phase. The virus enters the intestines, but it is not possible to detect it in the cells of the mucous membrane. The hypothesis according to which the virus breeds in the intestines is confirmed experimentally on Tamarian monkeys. According to electron morphological studies, in the early illness in the enterocytes, signs of cytolysis of varying degrees are found similar to those observed in various viral infections.
III. Regional lymphadenitis.
IV. Primary generalization of infection is the penetration of the causative agent through blood into parenchymal organs.
V. The hepatogenic phase, which begins with the penetration of the virus into the liver. There are two forms of damage to the liver. With one, changes are covered with mesenchym, hepatocytes are not damaged, the process is broken in the phase of parenchymalous dissemination. In second form, there is a moderate lesion of hepatocytes. It was believed that cell damage was due only to the cytopathic effect of the virus (CPD). However, the development of pathological changes in the liver coincides with the advent of antibodies against the virus, and the most significant changes are developing after stopping the replication of the virus. It is proved that the virus is able to cause a strong and fast immune response, antibodies appear even before clinical symptoms occur, the immunocyte sensitization occurs early. All this gives reason to believe that the destruction of hepatocytes is significant due to immunological processes.
Vi. Phase of secondary virusemia, associated with the output of the virus from damaged liver cells.
VII. Phase of reconvalues.
Secondary virusemia is completed with the enhancement of immunity, the liberation of the body from the virus, the predominance of reparative processes.
Morphological changes in the case of hepatitis A somewhat different from those that are observed in patients with viral hepatitis B. A characteristic morphological type of liver damage during hepatitis A is portal or periportal hepatitis. Inflammatory and alternative changes in the central zone hepatic Dolki. Around the hepatic vein, as a rule, is not observed. With an electron microscopic examination of the hepatitis A virus in the liver tissues is not detected.

Hepatitis A Clinic

The following clinical forms of hepatitis A are isolated: jaundice (with cytolysis syndrome; with cholestasis syndrome), rude-like, subclinical.
The disease occurs more often in acute cyclic form, although exacerbations, recurrences, a protracted flow and a transition to a chronic form (0.3-0.5% of patients) are possible.
Distinguish the following periods of the disease: incubation; initial, or birth; icteric; Recognitiveness. The incubation period lasts 10-50 days, on average 15 days.

Yellowed form

Initial period. In most cases, the disease begins sharply. An increase in temperature (no more than 38.5 ° C) is observed within 2-3 days. Patients complain of general weakness, deterioration of appetite, nausea, sometimes vomiting, pain or sense of gravity in the right hypochondrium and post mill. During the examination, the liver, sometimes the spleen is moderately enlarged. Such a beginnings is observed during dyspeptic version. The influential version of the initial period is characterized by a short fever (2-3 days), short-term fragmentation in the body, pyrrhetium in the throat.
At the end of the initial period, urine acquires dark color (strong tea or beer), which is due to the presence of bile pigments and is preceded by jaundice for 2-3 days.
The patient can complain about the skin of the skin. In the initial period of the disease, an important laboratory sign of viral hepatitis is to increase the activity of serum enzymes, primarily Alaninotransferase (Alat). The duration of the initial period is on average 3-7 days.

Justice period

Subicotheric Scler testifies to the end of the initial period and the transition to the jaundice. Jaundice for 2-3 days reaches maximum development, after which it contains an average of 5-7 days. First, it appears on the scler, the mucous membrane of the soft sky, the bridles of the tongue, then on the skin of the face, the body. With the development of a jaundice, a significant part of the clinical manifestations of the disease characteristic of the initial period disappears, the overall state of patients is improved, most of them normalize appetite, nausea disappear, signs of intoxication.
In most cases, the disease has a lighter flow, only 3-5% of patients - medium-heavy. The heavy form of hepatitis A is rarely observed (1-2%). When examining the patient (palpation), attention is drawn to a further increase in the liver, which can be compacted, sensitive, even painful. More often than in the initial period, an increase in the spleen is revealed.
In the increase in jaundice, the main laboratory indicator is the level of bilirubin in serum. The concentration of bilirubin in the blood of patients with hepatitis A can fluctuate in large limits, reaching with severe diseases of the disease 300-500 μmol / l, although such high rates are rarely detected. Hyperbilirubinemia is characterized by preferential accumulation in the blood-related (direct, soluble) pigment fraction, which is 70-80% of its total. The relatively minor level of the free fraction of bilirubin (20-zh%) indicates that the function of hepatocytes relative to binding bilirubin with glucuronic acid is the least vulnerable, the excretory function is more violated. Violations of the excretion of bilirubin in the intestine leads to discoloration of feces. Thus, the clinically pigment exchange disorders the jaundice, the darkening of urine and the discoloration of the feces. Urobilinuria is terminated at this time, since due to Aholia, Urobilinogen is not produced and does not come to the blood. Jaundice gradually decreases. The first sign of updating the excretory function of hepatocytes is kala coloring. From this time, the level of bilirubin in the blood serum and the intensity of jaundice decrease.
During the rank of illness, an increased activity of Alat is maintained. Among other laboratory indicators should be noted an increase (sometimes significant) indicator of the thymol sample, an increase in the specific gravity of gamma globulins in serum. Hemorrhagic manifestations may appear in patients with severe hepatitis on the skin. In these cases, disruptions are detected by the blood coagulation system (reduction of the prothrombin index, as well as concentrations in the blood plasma V, II, VI, X of coagulation factors).
When studying blood - leukopenia with relative lymphocytosis or normal amount of lymphocytes, ESO, as a rule, does not change.
Syndrome cholestaza It is not typical for hepatitis A. It is characterized by the presence of cholestasis without pronounced signs of hepatocellular insufficiency. The duration of the cholestatic form can be since-4 months. In addition to the jaundice, a sharp fell, in clinical signs of cholestasis belongs to the skin of the skin. When studying blood, moderate leukocytosis is detected, an increase in ESP, an increase in alkaline phosphatase activity, cholesterol indicators, beta-lipoproteins.
To the angry form of hepatitis A, there are cases of disease without jaundice syndrome, when the blood bilirubin level does not exceed 25-zmol / l. Other major clinical manifestations of the yellow and rude forms of hepatitis A coincide, however, under the last, they are weaker, the duration of the disease is less. Changes in the blood are insignificant, in addition to the level of activity of an amala, which increases with all clinical forms of hepatitis A.
Claimed diseases of the disease (0.5-1% of cases) are possible.

Complications of hepatitis A.

The exacerbation and recurrences are observed in 2-5% of patients. Often they are associated with disorders of the diet and regime, the irrational use of glycocorticosteroiding, the addition of intercurrent diseases, and the like. In some patients, exacerbations are manifested by a deterioration in laboratory indicators (biochemical exacerbations). In the event of remote relapses, it is necessary to take into account the possibility of infection with viral hepatitis V. In such cases, a study is required for the hepatitis B virus markers (HBsag, anti-NVS).
Forecast in patients with hepatitis A favorable.

Diagnosis of hepatitis A.

Support symptoms clinical diagnostic Hepatitis A with all the options for the initial (waived) period is the pain or sense of gravity in the right hypochondrium, sometimes itching the skin, the increase and sensitivity of the liver, the darkening of urine. These signs indicate the defeat of the liver. It is important to increase the activity of Alat in serum. In the jaggptic period, the reduced symptoms join jaundice, aholia (white feces), the content of bilirubin increases in the serum with a predominance of the associated (direct) fraction, the activity of the amalate is significantly increased. Epidemiological data is taken into account, communication with patients and a certain duration of the incubation period. In the account that hepatitis A is predominantly children.

Specific diagnosis of hepatitis A

Specific diagnosis is based mainly on the detection of antibodies to the hepatitis A virus, which belong to the class M immunoglobulin - the so-called early antibodies (anti-HAV IGM). Detection of the virus in Kale in the presence of clinical signs of the disease almost ceases, so a coprological study is informative when examining persons who have contact with patients in the foci, especially during outbreaks in children's institutions.

Differential diagnosis of hepatitis A

In the initial (waiting) period of the disease hepatitis, and most often need to be differentiated with flu and other respiratory diseases, sharp gastritis, food toxicoinfection. Hepatomegaly, pain or sense of gravity in the right hypochondrium, liver sensitivity during palpation, feeling of bitterness in the mouth, sometimes itching of the skin, darkening of urine, splenomegaly under these diseases are not observed. Sometimes a rapid increase in liver with stretching its fibrous capsule, increase lymph nodes In the gate of the liver determine pain syndromewhich reminds an acute appendicitis clinic. Carefully assembled disease occasionally in most cases allows you to establish that the patient has a few days before the occurrence of signs acute belly There were a decrease in appetite, nausea, darkening of urine. Attentive examination of the patient allows you to reveal the increase in the liver, sometimes spleen.
Instead of the expected leukocytosis, a normal number of leukocytes or leukopenia with relative lymphocytosis is observed. Epidemiological history data is of great importance.
To determine the diagnosis of hepatitis A in the initial period of the disease or in the case of a rude form, the determination of the level of activity of serum alanine substransferase is helped.
During the jaundice period of viral hepatitis, it is necessary to find out the origin of the jaundice.
Adhesive jaundice is due to an increase in the hemolysis of erythrocytes (hemolytic jaundice) and accumulating in the blood of an unbound (indirect, insoluble) bilirubin fraction, which indicates against viral hepatitis. In such persons, unlike patients with viral hepatitis, the level of the amala is not raised, the urine color does not change, the aholia does not arise - the feces are intensively painted.
Differentiation of the littering (common) jaundice with a cholestatic form of viral hepatitis can cause significant difficulties. In such cases, it is possible to find out the diagnosis of a thorough analysis of the peculiar features of the birthday period, when hepatitis has rather pronounced signs, and in the case of a littered (common) jaundice they are not. Clinically, the possibility of a litter jaundice indicates the earth-gray tint of the skin, intense itching, sharp abdominal pain.
Often, the development of jaundice is preceded by bouts of bile colic or acute pancreatitis. Of great importance is the inspection of the patient - the presence of a symptom of the Couvia and the local muscle tension, the symptom of the orthnera is similar. If the jaundice is due to a bile disease, often observed fever, chills, leukocytosis, an increase in ESR.
The differential diagnosis of viral hepatitis with a large duodenal duodenal cancer is quite complex. In these cases, jaundice is often preceded by a long itchy of the skin, while the mouth of the total bile duct and pancreatic duct is blocked only partially. Such patients have a manifestation of pancreatitis and cholangitis, jaundice has an alternate character (an important sign of this pathology).
With all the forms of obtaceous jaundice, the bilirubin study does not have a differential diagnostic value. More attention deserves the determination of the activity of Alt in the serum, which, with this form of jaundice, normal or slightly increased, while when viral hepatitis It increases significantly. Auxiliary value is the coefficient of transamamine - asat / alto the ratio. In patients with viral hepatitis, Alat's activity is preferably increasingly increasing, so this coefficient is less than one, with a mechanical jaundice - more units. The activity of alkaline phosphatase in viral hepatitis is normal or moderately increased, with a common jaundice - significantly rises. However, with the cholestatic form of viral hepatitis, the activity of the serum enzyme is significantly increasing, and therefore its differential diagnostic value decreases. In difficult cases, special instrumental (including endoscopic), ultrasound examination, duodenography, and if necessary - laparoscopy is similar.
With chronic hepatitis and cirrhosis of the liver, viral hepatitis is differentiated on the basis of the clinical features of the disease and laboratory indicators - the duration of the flow, signs of portal hypertension, deep disorders of protein metabolism, reduce the synthesis of albumin, increasing the number of gamma globulins more than the existence of hepatic signs. In difficult cases, the diagnostic value has a liver scan.
Jaundice can develop with such infectious diseasesAs infectious mononucleosis, leptospirosis, cytomegalovirus disease, toxoplasmosis, pseudotuberculosis is similar. For leptospirosis, for example, a sharp beginning, fever, pain in the calf muscles, kidney damage, hemorrhagic syndrome, sclerites, leukocytosis and a significant increase in ESP, for infectious mononucleosis - angina, polyadenitis, leukocytosis, and the presence of atypical mononuclear plaes. Pseudo-tuberculosis is characterized by acute start, pain in the field of a draft-like process, a clinical picture of mesadenit, symptoms of socks, gloves, weapons, various rashes, including the Scarlatin-like.
The differential diagnosis of hepatitis A with other varieties of viral hepatitis (B, C, E) are carried out using specific research methods. Given epidemiological data.

Treatment of hepatitis A.

Treatment of patients with light and medium-eyed forms of hepatitis A does not require the use of drugs. The basis of treatment is sufficient basis therapy, gentle regime in acute period - Bed and diet number 5, which provides for the exclusion of patient fatty, smoked, marinated products, fried dishes, canned food, meat broths, sour cream, etc .. It is prohibited to use products containing refractory fats (for example, fat), strong tea , coffee, cocoa and all types of alcohol. Recommended low-fat cheese, vegetarian and dairy soups, oatmeal, manna, buckwheat, rice porridge, kefir, prostrochy, pasta, meat and fish of low-fat varieties. It is allowed to use vegetable fats, butter within the physiological needs. To enrich the diet, vitamins recommend berries, fruits, vegetables (beets, carrots, cabbage) in a cooler form, as well as compotes, kisins, mousses and jelly from juice. Singing need to be prepared without salt (attached limited during meals), in a steady form, Meat (in the form of minced) is preparing for a couple. The amount of fluid should exceed the physiological need for 30-40%. From choleretic agents in the acute period, it is advisable to apply only sorbitol and magnesium sulfate, which, not enhanced bile products, contribute to its outflow due to osmotic action and the release of hormone - cholecystokinin. It is necessary to ensure that the defecation is daily.
If there is a need to apply disintellation and infusion therapy. In the case of significant intoxication, a 5-10% glucose solution is introduced with the addition of ascorbic acid.
Patients are discharged from hospital under clinical indications, after complete normalization of pigment exchange.

Dispensarization

A month after the discharge of the patient examines in the infectious hospital, where he was treated. If biochemical indicators are normal, the patient further requires observation by the doctor KIZ or a gastroenterologist, or a district doctor at the place of residence with a repeated inspection after 3 and 6 months.
With residual phenomena of viral hepatitis, the patient is subject to a monthly outpatient supervision by a doctor of an infectious hospital, and when indicated - hospitalization.

Hepatitis A. Prevention

Patients are hospitalized, sometimes isolated at home under the supervision of the epidemiologist. Main sanitary and epidemiological measures to prevent fecal-oral dissemination of infection.
Supervision of persons who were in contact with patients in the foci is carried out within 35 days. In children's institutions, set quarantine for 35 days; For two months after the last case of hepatitis and do not conduct planned vaccinations. Prevention of viral hepatitis A provides for the introduction of immunoglobulin in epidemiological indications (intensity of morbidity) in the most susceptible age groups Population: Children from 1 to 6 years - 0.75 ml, 7-10 years and 1.5 ml, over 10 years old and adults - 3 ml.

Viral hepatitis A (or Botkin's disease)- a special kind of viral hepatitis; he does not have chronic shapes and has a fecal-oral transmission mechanism. The following properties have a less common type of viral hepatitis - hepatitis E..

Hepatitis A and E viruses Do not provide direct damaging action on the liver. Hepatitis - inflammation of the liver - it occurs because the viruses penetrate into the liver cells, thereby causing the reaction of blood protective cells against the changed hepatic tissue.

Hepatitis A is one of the most common infections in the world. Many people move this disease in childhood, which is associated with greater prevalence of hepatitis A in children's institutions, in conditions of a closed team. Children carry the infection much easier than adults, many carry the asymptomatic form of hepatitis A and acquire lifetime immunity. In adults, hepatitis heavy forms are more common, requiring hospitalization, which is most likely due to various concomitant diseases.

The greatest spread of viral hepatitis A acquired in countries with warm climates and unsatisfactory sanitary conditions. Therefore, the probability of catching hepatitis A increases when trips to hot countries: in Egypt, Tunisia, Turkey, Central Asia, India, etc.

Hepatitis E. Common in countries of Southeast Asia, Africa, Central America. In our latitudes, hepatitis E is occurring much less.

Hepatitis A virus

Hepatitis Virus is extremely resistant to external influences and can be kept for a long time in the environment.

• Withstand boiling for 5 minutes.
• Chlorination - 30 minutes.
• Processing formalin - 3 hours.
• Withstands the processing of 20% ethyl alcohol.
• Withstands the acidic medium (pH 3.0).
• In water at a temperature of 20ºС, it lives 3 days.
• In meat and mollusc dishes at a temperature of 80 ºС is active for 20 minutes.

How can I get hepatitis a

The source of infection is a sick person who highlights viruses to the environment with a fee. Viruses, falling into water, food, penetrate the body of a healthy person and can cause a disease. Especially dangerous dishes prepared from insufficiently thermally processed seafood. In addition, often infection occurs when eating vegetables and fruits, which can themselves contain hepatitis A viruses or can be washed with infected water.

A less common transmission mechanism of infection - through infected blood. This happens when blood transfusion, using drug addicts of common syringes, as well as with homosexual contacts.

Hepatitis A and E virus development

Hepatitis virus via mouth penetrate the intestines, from there, sucking into blood, penetrate into the cells of the liver, causing their inflammation by attack by their own immune cells of the body. Then the viruses fall into bile ducts, and from there in the intestine and the environment.

The sick person is dangerous for the incubation period around the last week and in the first week of the disease. The incubation period is the period from infection to the first manifestations of the disease. In the case of hepatitis, it is 14-28 days. And in the case hepatitis E. can reach 60 days (on average 40 days).

While the virus is in blood, there is no jaundice, there are general signs of intoxication, the infection proceeds under the mask of ARVI.

The appearance of a jaundice means that there is no longer viruses in the blood, the immune response is fully formed. but viral Hepatitis A.often flows without jaundice.

The appearance of jaundice indicates a defeat of 70% of the liver, so all patients with jaundice are shown treatment under hospital. However, in most cases, when compliance with the regime and adequate treatment, the structure and operation of the liver is restored completely.

Symptoms of hepatitis A and E

Borgeless period of hepatitis A and E virus

A rude period can continue within 1-2 weeks. It is observed general symptomswhich are very similar to the manifestation of influenza and colds.

• Reduced appetite.
• Fatigue.
• Malaise.
• Fever (usually 38-39ºС, rarely the temperature rises to 40 ºС).
• Pain in muscles and joints.
• Headache.
• Cough.
• Rubble.
• Throat pain.
• Nausea and vomiting.
• Abdominal pain.

The jaundice period for the virus of hepatitis A and E

The first symptom, which makes it hardened - this damage urine. Water becomes dark brown, "dark beer color." Then yellow eye sclers and mucous eyes, mouth, which can be determined by raising the language to the upper heaven; Yellowing is also more noticeable on the palms. Later yellow skin.

With the beginning of the jaggble period, general symptoms are reduced, the patient usually becomes easier. However, in addition to the yellowing of the skin and mucous membranes, heaviness and pain in the right hypochondrium appears. Sometimes there is a discoloration of feces, which is associated with the blockage of bile moves.

Complete recovery occurs after 1-2 months.

Heavy forms with hepatitis A and E virus

Heavy forms of the disease include the so-called cholestatic formsWhen stagnant bile occurs, due to inflammation of the walls of bile ducts. At the same time, there is a breakdown, skin itching occurs, which is caused by skin irritation with bile components.

The lightning hepatitis is especially dangerous, in which massive necrosis of the liver is developing, acute hepatic insufficiency and often the death of the patient. For hepatitis A. The lightning form occurs extremely rare, and when hepatitis E.- Its frequency is 1-2%. However, a special danger hepatitis E. Presents for pregnant women - lightning frequency 25%

Mortality hepatitis A. ranges from 1 to 30%. Mortality increases with age, as well as chronic media of other viral hepatitis.

Who more often sicks hepatitis A and E virus

• People traveling to countries where the incidence is higher (endemic regions)
• Children attending children's preschool institutions
• Employees of children's preschool institutions
• Employees in the field of catering
• Sewer Services and Water Supply
• People whose members are sick hepatitis A
• Homosexuals
• Drug addicts

It should be noted that in countries with high prevalence hepatitis A.As well as in the countryside, many people have hepatitis and in childhood, and more often with light or asymptomatic forms, by purchasing lifelong immunity. Whereas people living in cities are sick with hepatitis, and much less often, so they have a greater risk to get infected with a patient with a person, as well as when traveling to endemic areas.

Prevention of hepatitis A and E virus

General prevention measures are reduced to the elementary principles of general hygiene. It is necessary to wash your arms before eating, wash fruits and vegetables with water, which is not in the purity of which there is no doubt. Do not use insufficiently treated meat, fish, especially seafood.

Immunoglobulin

With the help of normal human immunoglobulin, the so-called passive immunization is achieved, i.e. Man introducing ready-made antibodies (protective proteins) against hepatitis A viruses. The duration of the action of these antibodies is 2 months. With the introduction of the drug at the beginning of the incubation period, it prevents the development of the disease.

Immunoglobulin can be used in people who closely in contact with sick, no later than 2 weeks after the alleged infection; as well as people in the endemic region.

Immunoglobulin is safe, well tolerated; Infection of HIV infection through it is impossible, since the virus is inactivated in the manufacture of the drug.

Vaccination

In Russia, vaccines are available, which are raised on the culture of cells and inactivated viruses inactivated by formalin. There are several vaccines of this type: "Gep-A-In-Vac" (Russia), "Avaksim" (France), "Havrix" (Belgium), "Vakta" (USA).

Vaccination can be held for children, starting in 2 years. After a single vaccination, the immunity is formed in 1-4 weeks (depending on the type of vaccine), therefore it can be used in 1-4 weeks and more than a trip to countries with high propagation of hepatitis A. After one-time immunization, immunity is formed for 2 years; After twice - more than 20 years.

Adult vaccine is introduced intramuscularly - 2 doses with an interval of 6-12 months. For children at the age of 2-18 years, 2 half doses at the interval per month and the third - after 6-12 months are injected intramuscularly.

Complications of hepatitis A and E

Hepatitis Aarising against the background of complete health almost always ends with recovery. In the elderly patients with concomitant diseases, especially in the chronic carrier of other viral hepatitis, the forecast deteriorates, more often is the prolonged course of the disease.

A small number of patients after weeks and months after the suffering disease may have recurrence, i.e. Returns of all symptoms of the disease: intoxication, jaundice. But even in these cases, hepatitis does not go into a chronic form.

Moreover, viral hepatitis E.may cause hemolysis - the destruction of blood cells - erythrocytes, which can lead to damage to the kidneys and acute renal failure.

Liver disorders after transferred hepatitis A. They are extremely rare, mainly in age patients. However, there are cases when hepatitis A proceeds in a rude form, under the Master of ARVI, when the patient does not comply with the bed regime; This can lead to formation in the liver of scar tissue - hepatic fibrosis, which is dangerous by the development of dyskinesia of bile ducts - violation of the normal passage of bile.

When hepatitis E in 5% of cases there is cirrhosis of the liver.

Diagnosis of hepatitis A.

The diagnosis is primarily based on clinical data - i.e. manifestations of the disease.

To confirm the diagnosis of viral hepatitis, a number of laboratory tests are carried out. IN biochemical analyzes Blood can be found a significant increase in bilirubin and hepatic enzymes, which confirms the damage to the liver.

Then spend differential diagnosis viral hepatitis. The specific diagnosis of hepatitis A is based on the determination of antibodies in the virus in the blood, while the specific antibodies are determined characteristic of acute hepatitis.

Mode and diet with acute hepatitis

During acute hepatitis, it is better to observe the bed regime. In the position lying the blood supply improves internal organs, Including the liver, which helps the normal recovery of liver cells.

With acute hepatitis, a special kind of diet is shown - diet number 5.

The food must be used 5-6 times a day, in warm form.

Allowed:

• Dried bread or bread yesterday's baking.
• Soups from vegetables, croup, pasta on a vegetable brave, as well as dairy soups.
• Dishes from low-fat beef, petrice birds or baked after boiling.
• Non-fat varieties of fish (cod, pike perch, navaga, pike, sazan, silver heck) in boiled or vapor form.
• Different types of vegetables and greenery, non-acid sauerkraut, ripe tomatoes.
• The crumbly semi-casual porridges, puddings, casserole, especially recommended oatmeal dishes, buckwheat porridge.
• Eggs - no more than one per day in the form of adding to dishes, protein omelet.
• Fruits and berries beyond very acidic, compotes, kisins, lemon (with tea).
• Sugar, jam, honey.
• milk with tea, condensed, dry, degreased cottage cheese, sour cream in small quantities, cheeses are unsolved (Dutch, etc.). Especially recommended cottage cheese and curd products.
• Butter creamy, vegetable oil (up to 50 g per day).
• Tea and fastening coffee with milk, non-acidic fruit and berry juices, tomato juice, decoction of rosehip.

Prohibited:

• All alcoholic beverages.
• Fresh bakery products, products from a dough.
• Soups on meat, fish, mushroom broths.
• Fatty varieties of meat, birds, fish (sermus, sturgeon, Beluga, Som).
• Mushrooms, spinach, sorrel, radishes, radish, green, pickled vegetables.
• Canned, smoked, caviar.
• Ice cream, products with cream, chocolate.
• Bean, mustard, pepper, horseradish.
• Black coffee, cocoa, cold drinks.
• Culinary fats, fat.
• Cranberry, acidic fruits and berries.
• Screw and fried eggs.

With pronounced vomit spend parenteral nutrition. Enter nutrients intravenously. Full high-calorie food is an important factor in the treatment of these patients.

Treatment of viral hepatitis A and E

As a rule, hepatitis A and C treatment do not require, in addition to severe forms of the disease. In these cases spend medicia treatment lies in disinfecting therapy, i.e. Reducing the level of toxins, which accumulate in blood due to liver damage. Usually this intravenous administration Different disinfect solutions.

Hepatitis A (Botkin's disease) - acute infectious viral liver disease with a benign course related to the group of intestinal infections. The disease is widespread in developing countries. This is due to the large population crowding and bad sanitary and hygienic living conditions. In developed countries, an incidence rate of hepatitis A annually decreases due to the hygienic skills formed in the population, as well as vaccination.

Yellowee stage of hepatitis A

Causes and risk factors

Hepatitis A causative agent refers to the RNA-containing Hepatovirus genus viruses. He is stable in external environmentAt room temperature retains activity for several weeks, dies under the influence of ultraviolet radiation and high temperatures.

The source of infection is a sick person who distinguishes the virus into the environment with wheel masses from the last days of the extension period and until the 15-20th day of the jaundice period. The role in the spread of infection of patients with rudeness (erased) forms of hepatitis A, as well as virus carriers.

The main routes of transmission of the virus are food and water. The contact-household transfer path (through personal hygiene objects, dishes) is also possible, however, it is much less common. The risk of infection is mainly associated with poor sanitary and hygienic skills and the use of non-tested water treatment.

Hepatitis A is widespread in developing countries, which are characterized by a large crowdness of the population and bad sanitary and hygiene living conditions.

To hepatitis A susceptible adults and children of all ages, including breast.

Forms of the disease

Depending on the clinical picture, two forms of hepatitis A are distinguished:

• typical (jaundice);
• atypical (rude, erased).

Symptoms of the jaundice form of hepatitis A

Stages of the disease

IN clinical picture Viral hepatitis A there are several consecutive stages:

1. Incubation period. It lasts from the moment of infection until the first signs of the disease, from 20 to 40 days (on average - 14-28).
2. Promotional period. There are symptoms of general ailment (weakness, an increase in body temperature, dyspepsia). Duration - 7-10 days.
3. Justice period. Dyspepsia is enhanced, yaper staining of the scler and skin appears. With the atypical course of the disease, the jaggility of the skin is minimally expressed and is often not noticed by either the patients themselves nor the people around him. Duration - 5-30 days (on average - 15).
4. Reconvocation period. Symptoms of the disease gradually disappear, the patient's condition is improving. The duration is individual - from several weeks to several months.

Hepatitis A in most cases ends with complete recovery for 3-6 months.

Symptoms

Viral hepatitis A usually begins acutely. The long period may proceed in different clinical versions: dyspepsive, feverish or asthenovegetative.

For feverish (flu-like) forms of the production period are characteristic:

• increasing body temperature;
• general weakness;
• head and muscular pain;
• ensure in the throat, dry cough;
• rhinitis.

In the dyspeptic variant of the wagely period of the manifestation of intoxication, weakly are expressed. Typically, patients make complaints of different digestive disorders (belching, bitch in the mouth, bloating), pain in the field of epigastria or right hypochondrium, defecation disorders (constipation, diarrhea or their alternation).

The asthenovogetative form of the production period in viral hepatitis is not specific. It is manifested by weakness, lethargy, adamicity and sleep disorders.

The transition of the disease in the jaggptious stage is characterized by improving the overall state, normalizing the body temperature against the background of the gradual development of jaundice. However, the severity of dyspeptic manifestations in the jaggptious period not only does not weaken, but, on the contrary, is amplified.

With a severe course of viral hepatitis, and in patients can develop hemorrhagic syndrome (spontaneous nasal bleeding, hemorrhage on the skin and mucous membranes, phetechial rash).

When palpation detect moderately painful, protruding from the hypochondrium liver. In about 30% of cases, an increase in the spleen is noted.

As the jaundice is increasing, calf and darkening of urine occur. After some time, the urine acquires a saturated dark color, and the feces becomes light gray (a sharp chair).

The jaundice period is replaced by the reconvaluation stage. The gradual normalization of laboratory indicators and improving the general condition of patients occur. Lost the recovery period can until six months.

Diagnostics

The diagnosis of hepatitis A is carried out according to the characteristic clinical symptoms of the disease, the physical research data of the patient and laboratory tests. When biochemical blood research detects:

• bilirubinemia (increasing the concentration of bilirubin mainly due to the bound form);
• significant increase in the activity of hepatic enzymes (AST, Alt);
• reduction of the prothrombin index;
• decrease in albumin content;
• lowering the thymol and increase in the sub-samples.

Changes in general blood test are noted: raising SEE, lymphocytosis, leukopenia.

Specific diagnosis is carried out on the basis of detection of antibodies with RIA and ELISA. The most accurate method of serodiagnostics is the detection of viral RNA in the blood using a polymerase chain reaction (PCR).

A virological study with the release of directly the virus itself in clinical practice is not carried out due to the high complexity of this method.

Treatment

In most cases, hepatitis A is treated outpatient; Hospitalization is shown only by epidemiological indications or in the event of a severe course of the disease.

Viral hepatitis A usually begins acutely. The long period may proceed in different clinical versions: dyspepsive, feverish or asthenovegetative.

• meals 5-6 times a day in small portions;
• exception from the diet of fatty and sharp dishes, as well as products stimulating the synthesis of bile;
• the inclusion in the diet of a sufficient number of plant and dairy products.

Ethiotropic disease therapy has not been developed, so therapeutic measures are aimed at eliminating symptoms. With pronounced intoxication, patients prescribe abundant drink (roshovnik decoction, mineral water without gas), intravenous drip administration of crystalloid solutions, vitaminotherapy. To improve the functions of the digestive system, the use of lactulose is shown. In order to prevent cholestase, antispasmodic drugs are used.

Possible complications and consequences

Viral hepatitis A usually proceeds in a light form or form of moderate severity, they are not characteristic of any complications. In rare cases, the virus can provoke an inflammatory process in a biliary system, which can be:

• cholecystitis;
• cholangitis;
• biliary dyskinesia.

Acute hepatic encephalopathy in hepatitis A developing extremely rarely.

Forecast

Forecast with viral hepatitis A favorable. The disease in most cases ends with complete recovery for 3-6 months. Vironessiance and chronization of the pathological process in the liver for this type of hepatitis are not characteristic.

In developed countries, an incidence rate of hepatitis A annually decreases due to the hygienic skills formed in the population, as well as vaccination.

Prevention

Common preventive measures aimed at preventing the spread of hepatitis A virus include:

• providing the population with high-quality drinking water;
• careful control over wastewater discharge;
• control over the observance of sanitary-hygienic requirements by employees of catering enterprises, the foodstocks of therapeutic and children's institutions.

In the case of an outbreak of hepatitis in an organized team, quarantine measures are carried out. Ill is isolated for 15 days, because from the 14-15th day from the beginning of the jaundice period, the selection of the virus is stopped. Over contacting persons, medical observation has been carried out for 35 days. In the focus of infection, disinfection is carried out. Admission to learning or work of persons who suffered hepatitis A is carried out only after the onset of complete clinical recovery.

It is possible to conduct specific prophylaxis of hepatitis A by vaccination. Introduction of the vaccine is recommended for children older than one year and adults living in the regions with high rates The incidence of hepatitis A, as well as departing in these regions.

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