Hepatitis A (Botkin's Disease, Epidemic Hepatitis) is a severe infectious disease that occurs with general intoxication and is mainly affecting the liver.
In the early twentieth century, the disease was called catarrhal jaundice, since, according to assumptions, it developed as a result of blockage of the mucus of the common bile duct in inflammatory processes in the duodenum.
SP Botkin disagreed with this assumption and put forward his theory of the possible cause of the disease, which indicated its infectious origin, which was confirmed by quite weighty arguments (not only the liver was affected, but also the nervous system, the kidneys, the spleen, and so on.) However, in spite of this, only in 1940, by the efforts of the prominent national figure of medicine MP Konchalovsky, in honor of the author, who first discovered the infectious origin of jaundice, the disease was called "Botkin's disease."
Causes of Hepatitis A.
The causative agent of Hepatitis A is a filtering virus that is found in the washings of the nasopharynx, blood and liver, excreted with feces and urine. This virus is contagious exclusively for humans and can only be detected by an electron microscope. In addition, the filtering virus is able to maintain its viability on the hands, products, objects and in water for several weeks; At room temperature or in a dried state - for several months, and at freezing, the vitality of the virus increases to several years.
An ill person is the main source of infection. It can be infected by other people from the last days of the incubation period and throughout the course of the disease, but the first infectious is considered the first week of the disease. The carriers of the virus are a very dangerous source of spreading the disease, since they are, in fact, almost healthy, they do not adhere to elementary measures that can protect both the members of their families and people around the disease.
Infection with hepatitis A occurs through food, contaminated water and contact by household. First of all, the virus gets into food products from the hands, contaminated with the use of the phone, whirlpools when visiting the toilet, railways, trams, buses, and more. In most cases, infection occurs in two ways:
- When transfusion of plasma, blood and serums;
- When injected with insufficient sterilized needles and syringes, during prophylactic vaccinations;
- When using infected water or food (through the mouth).
Most epidemic hepatitis is observed in the spring, in the early winter and late autumn months. The incubation period lasts from two to fourteen days. The syringe or haematopoietic form of Botkin's disease is considered to be less contagious, characterized by a longer incubation period (from three to eleven months) and may occur throughout the year. The transmission of an infection from an infected mother to the fetus is not excluded.
When infected through the mouth, the hepatitis A virus enters the gastrointestinal tract, and in the injection form - into the lymph or blood, and in both cases it reaches the liver, starting to multiply in it. Epidemic hepatitis causes degenerative and inflammatory changes with violation of the integrity of gallstone capillaries and the disintegration of liver cells, resulting in bile first entering the flow of lymph, and then into the bloodstream. Almost simultaneously with the liver affects the endocrine and nervous system, gall bladder and reticulo-endothelial tissue of the spleen. Sometimes, due to the fact that in the blood are absorbed elements of decay of liver cells (proteins), various allergic reactions are possible.
Symptoms and signs of hepatitis A.
In its clinical course, hepatitis A is divided into three stages: prodromal (pregelvicular), icteric and stage of recovery.
Perechovtany period most often begins feverishly dyspeptic syndrome. Patients complain about appetite loss, breakdown, general malaise, pain in the liver, nausea and vomiting, blistering. Often there is an increase in total body temperature to 37-38.5 C. In its duration, the pre-war period varies from several days to two or three weeks.
The period of illness, or the jaundice, comes quickly enough. After the onset of a more or less pronounced improvement in the general condition, jaundice suddenly develops. First of all, patients have jaundice of sclera, then soft and solid palate, skin of the face and trunk, and a little later and the limbs.
Often, its full development of jaundice reaches the fourth - the seventh day. Patients develop headaches, adynamia, itchy skin, insomnia, irritability. The pulse becomes rare, blood pressure is reduced. At the same time, the liver increases, it is often prone to increase the spleen. Urine becomes dark due to the fact that bilirubin, which is delayed in the blood, begins to partially secrete with it as urobilin. Cal, on the contrary, is discolored due to the fact that very little bilirubin enters the intestine.
According to statistics, the average duration of jaundice is two to three weeks, but often it lasts for two to three months. The patient is formally considered to be recovering after normalizing the size of the spleen and the liver, the disappearance of jaundice, with a generally satisfactory state and the termination of dyspeptic complaints. However, despite the external recovery, after discharge from the hospital, every patient should be under policlinic surveillance.
Botkin's disease in its course can be mild, moderate and severe.
In the mild (out-patient) form of hepatitis A, jaundice can practically not affect the general well-being of the patient and be very short-term (two to three days). There are cases where acute epidemic hepatitis occurs at all without jaundice. In such cases, for the diagnosis of this disease, the determination of activity of the enzyme aldolase (its activity is increased up to seven times) is used.
In severe forms of epidemic hepatitis, there are disorders of the neuro-psychic sphere: patients have drowsiness and inhibition. Ocular manifestations are very intense, petechia appear on the skin, enlargement of the heart borders, weakening of cardiac tones and tachycardia.
In the malignant form of Hepatitis A, which is still called the liver dystrophy, there is a massive diffuse liver necrosis in association with the progressive death of parenchyma. This form is characterized by jaundice, rapid decrease in liver, bleeding, fever, increasing liver failure and severe general condition with a number of symptoms that indicate a profound CNS change. Ultimately, all this can lead to the development of the hepatic coma.
The pace of development and the time of the onset of toxic liver dystrophy are different. In some cases, in patients already after the appearance of jaundice, there is a symptom of liver failure, and the disease takes a very terrible swift current, resulting in a fatal case in a few days. However, in most cases, liver dystrophy does not develop at such a rapid pace.
A few weeks later, after a successful occurrence of Botkin's disease, hepatic failure develops. Signs of this pathology are: nausea, vomiting (more often repeated), persistent anorexia, lethargy, increasing general weakness, insomnia at night and drowsiness in the afternoon, apathy. Prior to this significantly increased liver, begins to decrease rapidly, its edge is mild, and the area of liver dullness decreases.
Quite often from a mouth there is a specific sweet smell. For the picture described, the most characteristic is the growth of brain phenomena (tremor, increased tendon reflexes, excitement). During the next two or three days, the patient falls into an unconscious state, which then passes into a coma.
Hepatitis A treatment
Patients diagnosed with hepatitis A are subject to immediate hospitalization in the infectious department. Duration of isolation of patients for at least four weeks. In periods of development and an outbreak of the disease, bed rest is mandatory. The patient is assigned a diet consisting of easily digestible products enriched with vitamins. In hemorrhagic events, intramuscularly, vikazol is prescribed, and inside it is vitamin K. In case of prolonged severe course of the disease, as well as in the presence of itching, corticosteroids (most often prednisolone) are prescribed, and glucose solution is injected subcutaneously and intravenously.
In complicated cases, as well as in the presence of concomitant diseases, prescribe antibiotics (teramycin, penicillin, etc.). To improve the flow of bile, conduct repeated duodenal sensing.
Treatment of patients with toxic dystrophy is complex, which includes glutamic acid, corticosteroid hormones, neomycin, a low-protein diet with a large amount of fluid.
In most cases, hepatitis A ends with a complete recovery, and this also applies to severe cases. However, there are patients in whom this disease becomes chronic, characterized by periodic exacerbations with a violation of the proper functioning of the liver.
The chronic course of Hepatitis A can be acquired as a result of late hospitalization, various disorders of the diet and hygiene regimes, mental and physical over-stresses, alcohol consumption, and in the case of diseases that have joined (gastroenterocolitis, flu, etc.). These forms in case of liver failure events for patients may end in a fatal case.
Of great importance to prevent the spread of hepatitis A have some hygienic measures, especially if there is an epidemic outbreak. To protect against epidemic hepatitis virus infections, measures should be taken to prevent them from flooding. Before using vegetables and fruits, they should first be washed thoroughly, and then rinse with boiling water (before this it is necessary to boil for about fifteen minutes).