Acute jaundice viral hepatitis

　　Cholestatic hepatitis is caused by the destruction of liver cells, reconstruction of liver tissue, and obstruction of bile ducts by hepatitis virus, leading to an increase in both conjugated and unconjugated bilirubin in the blood, resulting in yellowing of the skin, mucous membranes, and sclera of the eyes. Usually, when the concentration of bilirubin in the blood is higher than 2-3 mg/dL, these parts will appear with visible color.

　　The yellowing phenomenon of viral hepatitis is mainly caused by the invasion of hepatitis virus into the liver and its replication within liver cells. Under the action of the body's immune response, it damages liver cells together, causing liver cells to swell, break down, leading to inflammatory infiltration of liver tissue, congestion, edema, exudation, liver cell degeneration, and necrosis, and a series of changes. This affects the normal state and structure of liver tissue, damages the various functions of bilirubin metabolism in the liver, causing bilirubin to be unable to be normally excreted from the bile duct system into the blood. When bilirubin circulates through the blood to various organs in the body, these organs can turn yellow.

　　Alcohol is one of the causes of the occurrence of jaundice hepatitis.

　　1. Hepatic encephalopathy.

　　2. Hemorrhage.

　　3. Hepatorenal syndrome.

　　4. Secondary infection.

　　In traditional Chinese medicine, the prognosis of this disease is related to the nature of jaundice, the strength of the physique, and factors such as treatment and nursing. Yang jaundice, Yin jaundice, and acute jaundice have different properties and degrees of severity, but they can transform into each other under certain conditions. If a patient with Yang jaundice has a weak physique and severe pathogenic factors, the jaundice may deepen rapidly, and symptoms of severe heat toxicity may transform into acute jaundice; Yang jaundice can also transform into Yin jaundice due to damage to the spleen Yang and the transformation of dampness from cold; Yin jaundice, heavily affected by damp-heat, can also transform into Yang jaundice; if acute jaundice has severe heat toxicity, internal collapse of the heart and spleen, or massive hemorrhage, symptoms of failure of liver and kidney Yang can appear; if Yin jaundice does not improve after long-term treatment, it can transform into accumulation and distension.

　　Jaundice prodromal period

　　Children may have swollen cervical lymph nodes. These indicate that the symptoms at the onset of the disease, in addition to commonality, also have their own characteristics. Only with experience and knowledge in this aspect can an early diagnosis be made. Common symptoms include loss of appetite, nausea, aversion to oil, vomiting, discomfort in the upper abdomen, and bloating, with a few cases having pain in the liver area, diarrhea, or constipation. It lasts for several days to 2 weeks. Most symptoms appear slowly, with general malaise and fatigue as the initial signs, and children often have a low fever. About 1/3 of patients have an acute onset, with mild to moderate fever, and some have high fever with chills, presenting remittent fever. The symptoms of acute jaundice hepatitis can be divided into: dyspepsia type with mainly gastrointestinal symptoms; influenza type starting with fever, headache, and upper respiratory symptoms; biliary disease type starting with severe upper abdominal pain, chills, high fever, jaundice, and leukocytosis; rheumatic type with early muscle and joint pain accompanied by fever; sepsis type with chills, remittent fever, and rapid onset of jaundice; some patients have symptoms similar to malaria or encephalitis; 4% to 5% of patients may have urticaria, papules, and erythematous rashes.

　　Jaundice period

　　Some patients may exhibit short-term obstructive jaundice, with clay-colored stools and significant liver function impairment. Gastrointestinal symptoms improve before the peak of jaundice and the beginning of its regression. In cases of cholestatic hepatitis, enzyme and bile separation phenomena may be observed during this period. It lasts for about 2 to 6 weeks, mainly characterized by the onset and deepening of jaundice. Initially, the urine turns deep yellow, followed by jaundice of the sclera and skin, with the peak of jaundice reaching within 1 to 2 weeks. At this time, most patients no longer have fever, but gastrointestinal symptoms and fatigue become明显加重, the color of the stool becomes lighter, the liver becomes enlarged with tenderness upon percussion, and there is itching and bradycardia. A few acute jaundice hepatitis patients may rapidly develop mental and neurological symptoms (lethargy, restlessness, confusion, coma) within 10 days after onset. After excluding other causes, with progressive liver shrinkage, deepening jaundice, abnormal liver function, especially prolonged prothrombin time, severe hepatitis can be diagnosed, with poor prognosis and high mortality.

　　Recovery period

　　About 5% of adults may have long-term liver pain or discomfort, decreased appetite, and fatigue, commonly known as post-hepatitis syndrome. These symptoms usually begin to gradually disappear around 2 weeks and may take 2 weeks to 4 months to recover, with an average of 1 month. Most of these symptoms disappear within 2 weeks, and children have a shorter course and recover faster, with recovery within 1 to 2 months.

　　One, attention to daily life diet: Viral hepatitis is preventable. The focus of prevention should be on improving the health level of the whole society, emphasizing the improvement of dietary, drinking water, and personal hygiene habits, such as washing hands before meals and after defecation, washing hands after coming back from outside, not eating unclean food, and not drinking unboiled water. Secondly, hospital disinfection and isolation should be strengthened, and medical equipment should be strictly disinfected to block iatrogenic transmission.

　　Two, timely injection after contact with patients: After contacting with hepatitis B patients, a dose of hepatitis B high-titer immune globulin should be injected immediately, followed by the first dose of hepatitis B vaccine 2-4 weeks later. The second and third doses of hepatitis B vaccine should be injected one month and six months later, respectively. For patients with hepatitis A, intramuscular injection of gamma globulin containing anti-hepatitis A antibodies should be administered within two weeks.

　　Three, isolation of contacts: Children who have been in contact with hepatitis patients can also transmit the disease to another person, and the disease will spread from one person to another, increasing in number. To prevent this situation from occurring, it is necessary to isolate and observe the contacts until the incubation period ends.

　　1. Blood count: The total white blood cell count is normal or slightly low, and the neutrophil count may decrease while the lymphocyte count increases relatively.

　　2. Urinalysis: Acute jaundice hepatitis patients have urobilinogen and urobilin before the onset of jaundice.

　　3. Abnormal changes in liver ultrasound and electrocardiogram.

　　4. Liver function tests:

　　(1) Serum bilirubin: During the jaundice period, the serum bilirubin level increases daily, usually reaching its peak within 1 to 2 weeks.

　　(2) Serum enzyme measurement:

　　Alanine aminotransferase (ALT): It begins to rise before the appearance of jaundice and reaches its peak during the acute phase. Acute hepatitis can have extremely high enzyme activity, and during the recovery period, the serum bilirubin level decreases slowly.

　　Aspartate aminotransferase (AST): Approximately 4/5 of AST is present in the mitochondrial (ASTm) and 1/5 in the cytoplasm (ASTs) of cells. When mitochondria are damaged, the serum AST level increases significantly, reflecting the severity of liver cell damage.

　　③ During viral hepatitis, the ALT value is higher than the AST value, especially in acute cases, the increase in AST is not as great as that of ALT.

　　5. Detection of HBV viral markers:

　　The dietary requirements for acute jaundice type hepatitis are: food should be fresh, delicious, light, easy to digest, suitable for cold and hot, non-irritating, moderate, and rich in nutritional liquid food, semi-liquid food, and soft food; patients with acute jaundice type hepatitis are also required to avoid spicy and刺激性 food, especially smoking and drinking (the main component of alcohol is ethanol, which needs to be metabolized and decomposed in the liver after entering the blood, and the metabolite acetaldehyde has a strong toxicity to liver cells, which can worsen the degree of damage to liver cells with existing lesions) and the implementation of dietary nursing guidance for acute jaundice type hepatitis based on dialectical implementation.

　　There is no specific effective drug for the treatment of acute jaundice type hepatitis, emphasizing nutritional support and early strict bed rest, gradually increasing activity as symptoms subside, supplemented with appropriate medication, avoiding smoking, drinking, overwork, and drugs that damage the liver, and the indications for antiviral treatment are different for each type, and specific problems should be analyzed specifically.

　　Water Shock Therapy: Patients with jaundice type viral hepatitis often have water metabolism disorders, and there is a phenomenon of water retention in tissues. By using mercurial diuretics or diuretin (pay attention to prevent hypokalemia during the treatment process) to fully excrete the retained water, and at the same time, let the patient drink water or infuse a larger dose of vitamin C (generally added 2000-3000mg) glucose solution to replace the excreted water. By repeating this process, it can flush out bilirubin accumulated in the liver, blood, and tissues, making it excreted in urine, thus shortening the jaundice period. The specific method is: a. Drink 1500ml of water on an empty stomach in the morning, finish it within 30-40 minutes, and then inject 1ml of salicylate mercury intramuscularly every 3-4 days, 5-6 times as one course. b. Infuse 1000ml of 10% glucose solution, add 2000-3000mg of vitamin C and 1-2g of potassium chloride, once a day (consider giving diuretin to promote diuresis), 10-12 times as one course.