Viral hepatitis

　　The etiological classification of viral hepatitis is currently recognized as having five types of hepatitis viruses, namely hepatitis A, B, C, D, and E, respectively written as HAV, HBV, HCV, HDV, and HEV. Apart from the hepatitis B virus, which is a DNA virus, the others are RNA viruses. Hepatitis G has been reported, but the pathogen isolation has not been successful to date. In recent years, there is still controversy about the relationship between hepatitis G virus, which belongs to the Flaviviridae, and the single-stranded DNA transfusion-transmitted virus (TTV) and human hepatitis.

　　Viral hepatitis is a systemic disease. The virus not only invades the liver but can also invade other organs. Common complications of hepatitis B include arthritis (12%～27%), glomerulonephritis (26.5%), nodular polyarteritis, etc. Uncommon complications include diabetes, fatty liver, aplastic anemia, polyneuritis, pleurisy, myocarditis, and pericarditis, among which diabetes and fatty liver are worthy of attention. A few patients may have post-hepatitis hyperbilirubinemia.

　　The symptoms of viral hepatitis vary with the severity of the disease, and its specific clinical manifestations are described as follows.

　　I. Acute hepatitis

　　It is divided into acute jaundice type hepatitis and acute non-jaundice type hepatitis, with an incubation period of 15 to 45 days, with an average of 25 days, and a total course of 2 months to 4 months.

　　1. Pre-jaundice period There are symptoms such as chills, fever, fatigue, decreased appetite, nausea, aversion to oil, abdominal discomfort, pain in the liver area, and urine color gradually deepens. This period lasts an average of 5 to 7 days.

　　2. Jaundice period Fever subsides, jaundice appears in the sclera and skin, and自觉 symptoms improve. Liver enlargement with tenderness and percussion tenderness, some patients with mild splenomegaly. This period lasts from 2 weeks to 6 weeks.

　　3. Recovery period Jaundice gradually subsides, symptoms improve and disappear, liver and spleen return to normal, liver function gradually recovers. This period lasts from 2 weeks to 4 months, with an average of 1 month.

　　II. Chronic hepatitis

　　Patients with a history of hepatitis B, C, D, or hepatitis B surface antigen (HBsAg) carriage, or acute hepatitis course lasting more than 6 months, and currently still have hepatitis symptoms, signs, and abnormal liver function can be diagnosed as chronic hepatitis. Common symptoms include fatigue, general discomfort, decreased appetite, discomfort or pain in the liver area, abdominal distension, low fever. Signs include dark complexion, jaundice of the sclera, which may have spider nevus or liver palm, liver enlargement, moderate liver texture, and tenderness upon percussion. Severe splenomegaly may cause deepening of jaundice, ascites, lower limb edema, bleeding tendency, and hepatic encephalopathy. According to the degree of liver damage, clinical classification can be divided into the following types.

　　1. Mild The condition is relatively mild, symptoms are not obvious, or there are symptoms and signs, but biochemical indicators only 1 to 2 mild abnormalities.

　　2. Moderate Symptoms and signs are between mild and severe. There are abnormal changes in liver function.

　　3. Severe There are obvious or persistent symptoms of hepatitis, such as fatigue, decreased appetite, abdominal distension, loose stools, etc., which may be accompanied by liver disease facial appearance, liver palm, spider nevus, or enlargement of the liver and spleen. Exclusion of other causes and no portal hypertension. Laboratory examination of serum, alanine aminotransferase (ALT) repeatedly or continuously elevated: albumin decreased or albumin/globulin (A/G) ratio abnormal, gamma globulin significantly increased. If albumin ≤ 32g/L, bilirubin > 85.5μmol/L, prothrombin activity 60%～40%, and one of the three tests is positive, it can be diagnosed as severe chronic hepatitis.

　　III. Severe hepatitis

　　1. Acute severe hepatitis The onset is acute, the progression is rapid, the jaundice is deep, and the liver is small. Within 10 days of onset, there is a rapid appearance of neurological and psychiatric symptoms, a marked tendency to bleed, and the possibility of liver odor, ascites, hepatorenal syndrome, and a prothrombin activity below 40% after excluding other causes. Cholesterol levels are low, and liver function is significantly abnormal.

　　2. Subacute severe hepatitis After 10 days of onset, there is still extreme fatigue, anorexia, severe jaundice (bilirubin > 171 μmol/L), abdominal distension, and the formation of ascites. There are often obvious bleeding phenomena, the liver generally does not shrink significantly, and hepatic encephalopathy is more common in the late stage of severe liver dysfunction. Serum alanine aminotransferase (ALT) levels may increase or not increase significantly, while total bilirubin levels significantly increase, indicating bilirubin separation. The A/G ratio is inverted, and the level of gamma globulin increases. The prothrombin time is prolonged, and the prothrombin activity is decreased.
　　3. Chronic severe hepatitis Patients with chronic hepatitis cirrhosis or a history of hepatitis B surface antigen carriage, with imaging, laparoscopic examination, or liver biopsy supporting the clinical manifestations of chronic hepatitis, and who appear with clinical manifestations and laboratory changes of subacute severe hepatitis are considered chronic severe hepatitis.

　　IV. Cholestatic hepatitis

　　The onset is similar to acute jaundice hepatitis, but the自觉symptoms are usually mild, with obvious liver enlargement, skin itching, and light-colored stools. Serum alkaline phosphatase, gamma-glutamyl transferase, and cholesterol are all significantly increased, with deep jaundice and a significant increase in bilirubin. The increase in transaminases is small, and the prothrombin time and prothrombin activity are normal. The mismatch between mild clinical symptoms and deep jaundice is a characteristic feature.

　　V. Liver cirrhosis after hepatitis

　　Early-stage liver cirrhosis must rely on pathological diagnosis, ultrasound, CT examination, and laparoscopic examination, which has the most reference value.

　　Hepatitis A in viral hepatitis is caused by infection with hepatitis A virus-contaminated food, so the prevalence is largely dependent on the environmental hygiene conditions, degree of transmission, and the living economic conditions and health knowledge level of the area. The main route of transmission of hepatitis B virus is through blood, so the most important mode of transmission is vertical transmission from mother to child and nosocomial infection. The preventive measures are as described below.

　　1. Manage the source of infection

　　Isolate acute hepatitis A patients until they are no longer infectious. People with chronic hepatitis, asymptomatic carriers of hepatitis B virus (HBV), and hepatitis C virus (HCV) should be prohibited from donating blood and engaging in catering, child care, and other work. For patients with HBV marker-positive liver disease, treatment and management guidance should be provided based on their symptoms, signs, and laboratory examination results.

　　2. Cut off the route of transmission

　　The prevention of hepatitis A and E should focus on preventing fecal-oral transmission, strengthening water source protection, food safety, and personal hygiene, and improving fecal management. For hepatitis B, C, and D, the focus is on preventing transmission through blood and body fluids, strengthening the screening of blood donors, strictly controlling the use of blood and blood products. If there is a discovery or suspicion of a wound or needlestick infection with hepatitis B virus, high-titer hepatitis B immune globulin injections can be used for interventional examination and treatment. Equipment should be strictly disinfected to control mother-to-child transmission.

　　3. Protect susceptible populations

　　Artificial immunity, especially active immunity, is the fundamental measure for preventing hepatitis. However, due to genetic heterogeneity, some hepatitis viruses (such as HCV) do not have vaccines that can be widely applied. The hepatitis A vaccine has been used, and the hepatitis B vaccine has been promoted in China with good results. For infants born to pregnant women with positive hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), high-titer hepatitis B immune globulin (HBIG) should be injected within 24 hours of birth, followed by a single dose of hepatitis B vaccine, and then HBIG and vaccine should be injected again one month after birth.

　　Early detection, early diagnosis, early isolation, early reporting, early treatment, and early handling of viral hepatitis are necessary to prevent its spread.

　　The examination of viral hepatitis includes blood count, urinalysis, liver function, and etiological examination, and the specific examination methods are described as follows.

　　1. Blood count

　　In acute hepatitis, white blood cells are normal or slightly elevated. In severe hepatitis, white blood cell counts can increase. Liver cirrhosis can have reduced white blood cells, red blood cells, and platelets.

　　2. Urinalysis

　　Urobilinogen and urobilin detection are simple and effective methods for detecting hepatitis, and also help in the differential diagnosis of jaundice.

　　3. Liver function

　　Increased serum alanine aminotransferase and aspartate aminotransferase have important diagnostic value. Increased serum bilirubin in jaundice. In cases of moderate chronic hepatitis and above, liver cirrhosis, and severe hepatitis, albumin levels decrease.

　　4. Viral hepatitis etiology examination.

　　Patients with viral hepatitis should eat easily digestible foods rich in protein, vitamins, and minerals, and avoid greasy, hard-to-digest, high-salt, and high-fat foods. The specific dietary precautions are as follows.

　　1. Avoid foods high in fat and cholesterol:Patients with hepatitis have reduced bile secretion due to poor liver function, which affects fat digestion, causing fat to accumulate in the liver, leading to fatty liver. Therefore, patients with hepatitis should avoid eating fatty meat, animal fat, egg yolks, and animal viscera; in addition, these foods can damage the spleen and stomach, exacerbate dampness, and make the illness difficult to recover.

　　2. Avoid spicy and hot刺激性 foods:Spicy foods such as chili, chili sauce, onion, pepper powder, and curry powder can exacerbate inflammation and damage liver cells. Alcoholic beverages and刺激性 drinks (coffee, cocoa, strong tea) have an exciting effect, while patients with hepatitis have a low liver function and weakened detoxification, so they should be avoided.

　　3. Avoid fried, stir-fried, and deep-fried foods:Due to the formation of propenal during fat combustion, which is a gas with a pungent smell, it can circulate through the blood to the liver, stimulating the liver parenchymal cells, and can also reflexively cause biliary spasm and stimulate the bile duct, reducing bile secretion, which is not conducive to the metabolic activity of the liver, so they should be avoided.

　　4. Avoid coarse fiber foods:Such foods as cabbage, Chinese cabbage, chive, etc., can promote the production of cholecystokinin, causing the gallbladder to contract strongly, making it impossible for the sphincter of the bile duct to relax, thereby affecting the outflow of bile, obstructing the normal metabolism of the liver and the function of the digestive system, so they should be avoided.

　　5. Abstain from drinking白酒 (Strong Liquor), 啤酒 (Beer):The main component of alcohol is ethanol, and its detoxification mainly occurs in the liver, with about 95% or more of the alcohol being oxidized and decomposed in the liver. Patients with hepatitis have incomplete liver function and reduced detoxification ability. Alcohol can promote the generation and accumulation of fat in the liver, leading to fatty liver. In addition, it can also cause further damage to the already damaged liver cells, gradually lose detoxification ability, and prolonged drinking can lead to alcohol accumulation poisoning, worsen the condition, and even cause liver cirrhosis. Excessive alcohol consumption by liver patients also poses a risk of sudden death.

　　6. It is not advisable to eat too much white sugar and molasses:Viral hepatitis not only damages the liver but also damages the islets in the pancreas. Eating too much sugar puts an excessive burden on the damaged islets, which is prone to induce diabetes. Eating too much sugar will also synthesize neutral fats in the liver, leading to fatty liver and exacerbating the destruction of liver function. Therefore, patients with hepatitis should limit their intake of sugar.

　　Medication can be chosen, there are many kinds of liver-protecting and enzyme-reducing drugs, but there are not many truly effective ones. During the treatment process, it is absolutely forbidden to abuse drugs. It is necessary to truly find the cause of the elevated alanine aminotransferase (ALT) levels, treat the cause, and then good results can be achieved. During the treatment and medication process, patients should follow the following 3 principles:

　　1. Choose the correct and effective liver-protecting and enzyme-reducing drugs to treat elevated alanine aminotransferase (ALT) levels caused by various causes. Effective drugs are mainly traditional Chinese medicine and its effective components extracts, generally choosing drugs containing chemicals such as schisandrin B, glycyrrhizin, oleanolic acid, silymarin, etc. As long as the patient uses the enzyme-reducing drug correctly, alanine aminotransferase levels can be effectively controlled.

　　2. The course of treatment must be guaranteed. After the drug for enzyme reduction returns alanine aminotransferase (ALT) levels to normal, the dosage of the enzyme-reducing drug should be gradually reduced, and it is forbidden to discontinue medication suddenly. The course of treatment for enzyme-reducing drugs should be more than 1 year, even if liver function returns to normal, it should be maintained at the lowest level of consolidation treatment.

　　3. While maintaining liver protection and enzyme reduction, it is necessary to take 'root-cause' measures against the cause. In short, to solve the problem of elevated alanine aminotransferase (ALT) levels persistently, it is necessary to understand the cause, take appropriate medication, and then it can be effective.