According to who estimates in the world with hepatitis a suffer annually 1.4 million people, while in developing countries with low sanitary standards the disease mainly affects children under the age of 10 years, in countries with the average performance of sanitary-hygienic norms of older age groups and outbreaks are often epidemic in nature. In developed countries the disease is an affliction of persons in the risk group (closed religious community, the lovers of extreme tourism, etc.).
Classification of hepatitis And the nature of the disease and the severity of the process
A typical form of hepatitis A
Atypical form of hepatitis A
Also for the description of clinical manifestations of hepatitis A are used such characteristics as sharp or protracted course of disease without relapses or exacerbations, complications from the biliary tract or of other organs and systems.
The hepatitis a virus is transmitted exclusively by the fecal-oral route through contaminated food, water, household contacts. The source of infection is person with hepatitis a, especially if the disease is latent, atypical Busselton form.
Standing out from the body of the sick person together with the stool, the virus can contaminate waste water (in case of their insufficient degree of cleaning), wells, water, food and household items (past failure to observe elementary hygienic rules).
The most significant outbreaks of hepatitis A are recorded in the children’s groups, kindergartens, schools, centers, etc. In this regard, the peak incidence of hepatitis A include for the autumn-winter period, due to the long period of incubation and the beginning of training.
Penetrating into the body, the virus migrates via the gastrointestinal tract in the small intestine, where the mucosa through the intestinal wall is introduced into the lymphatic system and together with the flow of blood gets into the liver and affects its cells (hepatocytes). The replication of the virus within the hepatocyte leads to its destruction (cytolysis), which is accompanied by the release of blood liver enzymes. As a result of these processes is a disruption of the metabolism of proteins, fats, carbohydrates, and bile pigments, reduced synthesis of vitamins, amino acids, blood clotting factors, glucose, slow down and stop the process of detoxification and excretion of metabolites and foreign particles (xenobiotics).
The clinical picture of hepatitis A develops over four periods of disease incubation, initial (predzheltushnogo), the height of the disease (jaundice) and recovery (poliamory).
The incubation period for hepatitis A is a total of 14-28 days, but may vary within the range 8-50 days. During the whole incubation period, the disease does not manifest itself, but can be detected in the diagnostic laboratory tests.
After the end of the incubation period of the virus occurs gradual development of the clinical picture of the disease with the following symptoms
- increasing the temperature to 38-39
- loss of appetite
- bitter taste in mouth
- bad breath
- pain in the right upper quadrant (obtuse or similar to colic)
- dark urine
- discoloration of feces
- the increase in size of the liver
- jaundice (sclera, palate and face, ending with the limbs).
Depending on the severity of the disease the intensity and duration of symptoms (fever, pain, jaundice) may vary. For Busselton atypical forms of the hepatitis A peculiar absence of jaundice in the presence of all other symptoms. Erased, atypical form of hepatitis And is characterized by weak intensity of simptomokomplekse short-term increase in temperature, barely noticeable jaundice, slight increase in liver size. Atypical subclinical form of hepatitis A are asymptomatic, to diagnose the disease is possible only on the basis of laboratory tests.
The clinical picture hepatitis A, regardless of the severity of the process can be complicated by the development of the following violations
- prolonged duration of disease (from 3 to 6 months)
- cholestatic syndrome (stagnation of bile in the intrahepatic bile ducts, leading to jaundice and severe skin itching)
- exacerbation (relapse) of the disease (in the vast majority of cases occurs because of disorders of the immune system, or the layering of hepatitis b)
- biliary dyskinesia
- the accession of infections of the respiratory or urinary tract
- liver failure.
Diagnosis hepatitis A is a liver specialist, gastroenterologist or infectious disease.
- External examination of the patient, analyzing the patient’s complaints and data of anamnesis.
- Specific laboratory diagnosis ELISA (enzyme immunoassay) or RIA (radioimmunoassay) analysis of blood for the presence of specific antibodies to hepatitis A virus anti-HAVIgM anti-HAVIgG.
- General laboratory diagnostics
- biochemical analysis of blood
- liver function tests (determination of the presence and number of liver enzymes in the blood)
- determination of bilirubin (total and fractions) in the blood
- determination of protein fractions in the blood
- urine test for urobilin and bile acids.
Often therapy hepatitis A is carried out in a hospital, but for minor illnesses treatment is possible at home.
Compliance with motor mode
- erased, Busselton form of the disease with mild polupostelny mode, be allowed a meal at a communal table, use the sink and toilet
- moderate and severe course of the disease bed rest 3-5 days.
- Compliance during the acute period of the disease diets 5A by Pevsner, with a gradual transition to the diet 5 within six months from the onset of the disease.
- Drug therapy. The use of drugs in hepatitis And limited. Justified the use of a choleretic funds (holekinetiki), drugs that stimulate bile synthesis (choleretica) and multivitamin complexes.