Acute hepatitis B

　　Acute viral hepatitis is mainly caused by hepatotropic hepatitis viruses A, B, C, D, and E; some non-specific hepatotropic viruses, such as cytomegalovirus, Epstein-Barr virus, and herpes simplex virus, can also cause hepatitis, but it is less common. Currently, the acute viral hepatitis occurring in China is mainly hepatitis A; hepatitis E is prevalent in the southern part of Xinjiang, but scattered cases occur in many other regions across the country. Viral hepatitis can be divided into enterically transmitted infectious hepatitis and blood-transmitted serous hepatitis. Enterically transmitted hepatitis has self-limiting lesions, while blood-transmitted hepatitis can develop into chronic hepatitis.

　　Acute hepatitis B can easily lead to the occurrence of the following diseases:

　　1. Hepatic diabetes

　　The clinical manifestations are similar to type 2 diabetes, but the differences are that in hepatic diabetes, insulin is significantly increased during fasting while C-peptide remains normal, and insulin levels rise significantly after glucose intake while the C-peptide peak is still slightly lower than normal. This is because the liver's ability to inactivate insulin is reduced, promoting insulin elevation. Additionally, the reduction in the inactivation of glucagon in the liver, combined with the decrease in insulin receptors on liver cells, leads to resistance to insulin. Therefore, although insulin levels rise, blood glucose remains high. At the same time, C-peptide is less affected by the liver, so C-peptide levels are not high, indicating that there is no obvious abnormality in the secretory function of β-cells. To differentiate from type 2 diabetes, insulin and C-peptide release tests can be used.

　　2、脂肪肝

　　机制尚不清，特点为一般情况良好，单项ALT轻，中度升高，血脂增高，B型超声检查可见脂肪肝波形，确诊根据肝活检病理检查。

　　2, Fatty liver

　　The mechanism is not yet clear, characterized by good general condition, mild to moderate elevation of ALT, increased blood lipids, fatty liver waveforms visible on B-ultrasound examination, and diagnosis is based on liver biopsy pathological examination.

　　3, Liver cirrhosis

　　The development of chronic hepatitis into liver cirrhosis is the result of liver fibrosis, the mechanism of which has not been fully elucidated and is also seen in subacute, chronic severe hepatitis, and asymptomatic HBsAg carriers with latent onset.

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　　Typical symptoms of acute hepatitis BThe liver is the main metabolic organ of the human body, which can be stimulated by a variety of etiological factors, such as pathogenic microorganisms, metabolic influences, and physical and chemical damage. However, the liver's response to different stimuli is quite consistent, and the clinical manifestations of acute liver damage are roughly similar regardless of the pathogen. On the whole, acute hepatitis B is not significantly different from other viral-induced acute viral hepatitis, or even acute liver damage caused by drugs, in terms of clinical manifestations. Careful examination, especially in the medical history, still has its characteristics, and then serum markers are needed to determine.

　　Clinical course:The incubation period is 45-160 days, with an average of 90 days. The amount of virus infected may be a factor in the difference of incubation period, but it is not decisive. Both massive blood transfusion and needle transmission can have a longer or shorter incubation period. The clinical course can be divided into several stages.

　　Early stage of jaundice:Jaundice period: There are non-specific prodromal symptoms, such as low fever corresponding to transient viremia, joint pain, which is often misdiagnosed as an upper respiratory tract infection. At the same time, there is discomfort and fatigue, with prominent symptoms of anorexia and nausea and vomiting. Extrahepatic lesions and serum sickness-like syndrome may occur in the early stage of jaundice: joint pain and arthritis, urticaria and angioedema, vascular inflammatory lesions, renal lesions, purpura, serositis, myocarditis, pancreatitis, etc. The severity and duration of the symptoms in the early stage of jaundice can vary greatly, ranging from a few days to 2 weeks. It may also be without any obvious early symptoms of jaundice, but with jaundice as the earliest symptom.

　　Recovery period: Initially, the yellowing of urine is often found, reflecting the increased concentration of direct bilirubin in serum; followed by the yellowing of the sclera and skin, and the lightening of stool color. Jaundice reaches its peak within 1-2 weeks, at which time most patients experience a decrease in fever and significant improvement in gastrointestinal symptoms. Improved appetite is a common sign that the condition is beginning to improve from the acute phase. The liver is slightly enlarged, soft in texture, and may be tender to touch and percussion. A small number of patients may feel the spleen under the ribs. Spider angiomas may appear temporarily. The regression of jaundice is much slower than its rise, and the entire jaundice period is 1-6 weeks.With the disappearance of jaundice, symptoms gradually improve. Serum alanine aminotransferase (ALT) levels gradually decrease, and the decrease in bilirubin in acute hepatitis B often occurs earlier than the normalization of alanine aminotransferase (ALT). The vast majority of patients recover within 3-4 months. Acute hepatitis B in children recovers faster than in adults. During the convalescent period, patients may still experience fatigue and discomfort. After clinical and serological recovery, liver tissue damage decreases, but complete recovery requires more than half a year.

　　For patients with hepatitis B, there is no fixed isolation period. For inpatients, they can be discharged as long as liver function is stable. HBsAg carriers in the convalescent period should be followed up regularly. For personnel in direct contact with food and childcare workers, they should undergo a health examination annually. Patients who recover from the acute phase should maintain normal liver function for half a year before HBsAg becomes negative. Chronic patients should be transferred from direct contact with food and childcare work. For suspected cases that have not been diagnosed, they should suspend their original work and strictly screen blood donors according to national regulations.

　　HBsAg carriers refer to individuals with positive HBsAg, without symptoms and signs of hepatitis, and normal liver function tests. After half a year of observation, there are no changes. Such individuals should not be treated as current hepatitis patients, except for not being able to donate blood and not engaging in direct contact with food and childcare work. They can work and study normally, but follow-up should be strengthened. Carriers should pay attention to personal and occupational hygiene to prevent contamination of the surrounding environment by their saliva, blood, and other secretions. Utensils, razors, toothbrushes, and lavatory utensils should be kept separate from those of healthy individuals.

　　Strengthen health education and management, prevent iatrogenic transmission, ensure one needle and one syringe per person, advocate for disposable syringes, thoroughly disinfect items contaminated with blood, and strengthen the management of blood products.

　　The hepatitis B vaccine is highly effective and safe, and can be administered according to the 0, 1, 6-month schedule, intramuscularly in the deltoid muscle, with a blood-derived vaccine of 10-30μg per dose and a recombinant vaccine of 5-10μg. The antibody titer of anti-HBs produced is positively correlated with the protective effect, and it is generally considered that >10U/L has a protective effect. For patients undergoing hemodialysis and other immunocompromised individuals, the dose or number of vaccinations should be increased. Hepatitis B immunoglobulin (HBIg) is mainly used for newborns of HBeAg-positive mothers and can be used in combination with the hepatitis B vaccine. Most HBIg produced in China is U/ml, and the dosage should be 0.075-0.2ml/kg.

　　Serum biochemical tests for acute hepatitis B:

　　ALT activity rises sharply and then declines slowly. ALT levels are generally ten to several times higher than the normal high value. The ALT value indicates the degree of inflammation activity and is not significantly related to the severity of tissue damage. If the peak value does not subside or AST exceeds ALT after the ALT peak, be vigilant for the possibility of progressing to severe or chronic hepatitis.

　　Jaundice is visible when total bilirubin is above 50μmol/L, and the mean peak value of acute hepatitis B is about 120μmol/L. The level of total bilirubin indicates the degree of stem cell damage, and rapid development of high-level bilirubinemia suggests severe lesions. Those with continuous and rapid increase should be vigilant for the possibility of severe hepatitis.

　　The bilirubin and urobilinogen in urine will increase; while the urobilinogen in feces will decrease.

　　Lactate dehydrogenase (LDH) indicates the degree of liver damage, and when its increase exceeds that of transaminases, severe hepatitis may occur. When the lesion is severe, alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γGT) may slightly increase.

　　Serum viral markers

　　HBeAg can appear before the increase of ALT, and the earliest disappearance occurs in the self-limiting course. HBVDNA appears several weeks before the onset, and gradually decreases after the peak of ALT. The viral markers of acute Hepatitis B are far less important than those of chronic Hepatitis B. Because most acute Hepatitis B is a self-limiting disease. Antibodies can be obtained after infection with the hepatitis B virus.

　　Dietary structure should be reasonable: more vegetables and fruits should be eaten to supplement sufficient vitamins and fiber, which also helps to promote digestion. When liver function is reduced, it often affects fat metabolism, so many patients with chronic hepatitis also have post-hepatitis fatty liver. Therefore, the diet should be low in fat, low in sugar (excessive sugar entering the human body is easily converted into fat), and high in protein. Protein diet should include plant protein and animal protein, such as soy products, beef, chicken, fish, etc.

　　Canned foods, fried and fried foods, instant noodles, and sausages should not be consumed in large quantities by patients with hepatitis. The preservatives and food pigments in canned foods will increase the burden on the liver's metabolic and detoxification functions. Fried and fried foods are high in fat and difficult to digest and absorb, which can easily cause malabsorption of fatty acids. The oil in repeatedly fried foods may contain carcinogens, which are not conducive to preventing the development of hepatitis into liver cancer.

　　The vast majority of acute Hepatitis B is a self-limiting disease, which can be recovered simply through rest, nutrition, and general symptomatic treatment. However, a few cases may recur or develop into chronic hepatitis. There is no specific treatment, and the main emphasis is on symptomatic and supportive treatment. The recovery of the condition is mainly a natural result, and general treatment can significantly shorten the natural course of the disease.

　　Acute Hepatitis B does not require antiviral treatment.