Congenital syphilitic cirrhosis

　　The pathological changes of this type of hepatitis are similar to those of hepatitis A, with balloon-like change of liver cells, punctate or focal necrosis and inflammatory cell infiltration in the portal area. The main cells are lymphocytes and mononuclear macrophages. There is obvious cholestasis. Electron microscopy shows that the liver cell damage in this disease may be related to T cell-mediated immune response.

　　Congenital syphilitic cirrhosis of the liver patients may have complications such as electrolyte imbalance, upper gastrointestinal bleeding, ascites, hyponatremia, hepatic encephalopathy, etc. At the same time, syphilis is a serious infectious disease, patients must be treated in a timely manner.

　　According to the clinical characteristics, liver function tests, and reference to epidemiological data, exclude HAV, HBV, HCV infection, and acute liver damage caused by other reasons.

　　The incubation period is 10-60 days, averaging 40 days. According to the three surveys of戊型肝炎 epidemic in China, the incubation period is 15-75 days, averaging 36 days. Adult infection is often clinical, while children are subclinical. Clinical symptoms and liver function damage are relatively severe, generally subclinical, with acute onset, jaundice is common, half have fever, accompanied by fatigue, nausea, vomiting, liver pain, about 1/3 have joint pain, common cholestasis, such as skin itching, the color of feces becomes lighter than that of hepatitis A, most liver enlargement, splenomegaly is rare, most patients have jaundice subsiding around 2 weeks, the course of the disease is 6-8 weeks, generally not developing into chronic. Pregnant women infected with HEV have severe condition, prone to liver function failure, especially the mortality rate in the late stage of pregnancy is high (10%-39%), and abortion and stillbirth can be seen. The cause may be related to low serum immunoglobulin levels.

　　HBsAg positive individuals with co-infection of HEV, the condition worsens, and it is easy to develop into acute severe hepatitis.

　　Congenital syphilitic cirrhosis of the liver is caused by congenital syphilis, there is no effective preventive measure, it should actively respond to the call for 'eugenic and healthy breeding', improve the quality of the population, conduct a comprehensive premarital examination, and do regular prenatal checks.

　　1. Enzyme-Linked Immunosorbent Assay (ELISA)

　　Detects anti-HEVIgM in serum, which is an indicator for diagnosing acute hepatitis E. It uses recombinant or artificially synthesized polypeptides as antigens. In China, this method was used to detect 111 cases of acute hepatitis E, with a positive rate of anti-HEV of 86.5%. In 32 convalescent patients, the positive rate of anti-HEV was 6.3%, indicating that the duration of anti-HEV is short, and 63% turn negative within 5 to 6 months after the disease.

　　2. Protein Blotting Test

　　This method is more sensitive and specific than ELISA, but the operation method is more complex and the detection time is longer.

　　3. Polymerase Chain Reaction

　　Used to detect HEV-RNA in the serum and feces of patients with hepatitis E, this method has high sensitivity and specificity, but it is easy to cause laboratory contamination and false positives during the operation process.

　　4. Immunoelectron microscopy technology and immunofluorescence method

　　Used to detect HEV particles and HEV antigens (HEAg) in the feces, bile, and liver tissue of patients with hepatitis E, but both methods require special equipment and technology, and HEV exists for a short time in liver tissue, bile, and feces, with a low positive rate, and should not be used as routine examinations.

　　1. Rational nutrition is the main focus, and alcohol should be avoided.

　　2. Diet should be in line with the patient's taste and easy-to-digest light food. It should contain a variety of vitamins, have sufficient calories, and an appropriate amount of protein; fats should not be restricted too strictly.

　　1. Early bed rest is most important, and as the symptoms improve, the amount of activity can be gradually increased, with the principle of not feeling tired, until the symptoms disappear, the isolation period is over, and liver function is normal, then discharge from the hospital. After 1-3 months of rest, work can be gradually resumed.

　　2. Diet should be in line with the patient's taste and easy-to-digest light food. It should contain a variety of vitamins, have sufficient calories, and an appropriate amount of protein; fats should not be restricted too strictly.

　　3. For those with reduced appetite or vomiting, 10% glucose solution 1000-1500ml should be added with 3g of vitamin C, 400mg of Hepatol, and 8-16U of regular insulin for intravenous infusion, once a day. Energy mixture and 10% potassium chloride can also be added. For those with severe heat symptoms, use modified茵陈胃苓汤; for those with both heat and dampness, use modified茵陈蒿汤 and胃苓合方; for those with liver qi stagnation, use逍遥散; for those with spleen deficiency and dampness, use Pingwei San. Some suggest using large doses of Chishao for deep jaundice is effective. Generally, acute hepatitis can be cured.