Acute hepatitis

     The sources of infection are patients and virus carriers. HAV and HEV are mainly transmitted through fecal-oral routes, such as through daily contact, drinking water, and food. HBV, HCV, and HDV are mainly transmitted through body fluids, such as blood transfusions and blood products, preventive vaccinations, drug injections, and acupuncture, with close contact in daily life being a secondary route. Hepatitis B in infants and young children can be transmitted from mother to child through the placenta, delivery, breastfeeding, and feeding. HCV is mainly transmitted through blood transfusions. HBV and HCV can lead to sexual transmission through saliva, semen, and vaginal secretions.

　　Sudden progressive neurological and psychiatric changes in hepatitis patients, from personality abnormalities and drowsiness to behavioral abnormalities, all indicate the onset of hepatic encephalopathy, or hepatic coma. Such patients are caused by central nervous system poisoning, with severe conditions and high mortality rates, and immediate rescue is required.

　　Persistent low fever　The early stage of viral hepatitis may have low fever, but it should subside soon after onset. If the low fever persists, especially after several days of jaundice, it indicates a tendency for hepatitis to worsen. Clinical hints: ① The patient has toxicemia. ② There is a possibility of progressive necrosis of liver cells, which is a sign of potential subacute liver necrosis.

　　Jaundice deepens　Jaundice is one of the signs of severe liver cell dysfunction. If the patient's urine color gradually deepens, resembling tea color, and the yellowing of the sclera and skin changes from orange-yellow to golden or brown-black yellow, it indicates liver cell failure and predicts a severe condition.

　　Gastrointestinal symptoms gradually worsen　Hepatitis patients may have symptoms such as anorexia, aversion to greasy food, nausea, vomiting, abdominal distension, and other gastrointestinal symptoms, which should subside after about a week of treatment. If the appetite worsens, and symptoms such as stubborn nausea, vomiting, hiccups, and abdominal distension appear, it indicates the aggravation of hepatitis and necrosis and变性 of liver cells.

　　Hemorrhage　The appearance of gingival bleeding, epistaxis, ecchymosis of the skin and mucous membranes, or hematemesis or hematochezia in hepatitis patients indicates a disturbance in coagulation function, which also reflects the severity of liver cell damage, marking the liver cells' approach to failure.

　　Ascites　The appearance of ascites in hepatitis patients indicates that the hepatitis has entered the stage of liver cirrhosis. The reduction of albumin in plasma, increased portal vein pressure, decreased renal perfusion, may lead to complications such as infection, gastrointestinal bleeding, renal failure, and electrolyte disturbance.

　　Symptoms after acute hepatitis infection: The patient recently appears with low fever, general malaise, decreased appetite, accompanied by nausea, vomiting, aversion to greasy food, discomfort in the liver area, and yellow urine, and these symptoms do not improve after rest.

　　Classification and symptoms of acute hepatitis B: Acute hepatitis B is divided into acute acute hepatitis and acute without acute hepatitis.

　　1, Acute acute hepatitis

　　(1) Pre-jaundice period: The onset is usually slow, with mild fever or no fever, joint pain, and rash commonly occurring. Common symptoms include malaise, decreased appetite, aversion to greasy food, nausea, vomiting, abdominal pain, and diarrhea. This period lasts on average for 5-7 days.

　　(2) Jaundice period: Fever subsides,自觉 symptoms slightly improve, jaundice appears in the sclera and skin, reaching a peak within 1-3 weeks. Deep yellow urine may appear with transiently lighter stool. Liver area pain, liver enlargement, soft texture, with tenderness and percussion pain. This period lasts for 2-6 days.

　　(3) Recovery period: The patient's jaundice gradually decreases and recedes, the color of the stool returns to normal, the itching of the skin disappears, the appetite improves, physical strength recovers, gastrointestinal symptoms decrease, jaundice recedes, and liver function returns to normal. This period usually lasts for 1-2 months.

　　2, Acute without acute hepatitis

　　This type is more common, accounting for more than 90% of acute hepatitis B. The symptoms are relatively mild, with general malaise, decreased appetite, nausea, abdominal distension, and other symptoms. The liver is enlarged, soft in texture, and has tenderness and percussion pain. The symptoms of this type of hepatitis are often overlooked in diagnosis. The course of the disease is about 2-3 months.

　　Patients with acute viral hepatitis should be isolated, and personal hygiene and fecal management should be strengthened for hepatitis A and E. To prevent the transmission through blood and body fluids, hepatitis B, C, and D should be prevented. Vulnerable populations can be vaccinated with the hepatitis A attenuated live vaccine and the hepatitis B vaccine for active immunization; human serum or placental globulin can also be used to prevent hepatitis A, and hepatitis B immune globulin injection can be applied to prevent hepatitis B infection after being accidentally pricked by a syringe containing hepatitis B patient's body fluids.

　　One, typing It can be divided into acute acute hepatitis and acute non-acute hepatitis.

　　Two, medical history There is a history of close contact with hepatitis patients, blood and body fluid infection history, and a history of water and food contamination in the outbreak area.

　　Three, symptoms Mostly acute onset. Common symptoms include fever, nausea, aversion to oil, anorexia, abdominal distension, clear stools, and marked fatigue. Most patients have mild to moderate liver enlargement, soft texture, and often have tenderness or percussion pain. The spleen can be slightly enlarged, and some have jaundice.

　　Four, auxiliary examination (I) Disease diagnosis examination Liver function tests such as serum alanine aminotransferase (ALT), bilirubin test, and liver tissue biopsy are helpful for diagnosis. (II) Pathogen typing examination Currently, immunological, enzymatic, and molecular biological methods are commonly used for pathogen detection. Immunohistochemistry and immunoelectron microscopy of liver tissue are helpful for pathogen typing.

　　1. Hepatitis A: IgM type antibody (anti-HAVIgM) has value for early diagnosis and can be used for immunoelectron microscopy to detect hepatitis A virus (HAV) particles in feces, and polymerase chain reaction (PCR) to check the virus RNA (HAV-RNA) in blood and feces.

　　2. Hepatitis B: IgM type antibody (anti-HBclgM) has value for early diagnosis and can be used for blood HBSAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, hepatitis B virus DNA polymerase, and PCR detection of hepatitis B virus DNA (HBV-DNA).

　　3. Hepatitis C: Serum antibodies (anti-HCV), serum hepatitis C virus RNA (HCV-RNA), etc., and immunohistochemical methods for detecting HCV antigens in liver tissue are relatively specific methods.

　　4. Hepatitis D: Serum antigen (HDAg) and antibody (anti-HDV), serum virus RNA (HDV-RNA), and immunohistochemical methods can be used to detect HDAg in liver tissue.

　　5. Hepatitis E: Serum antibodies (anti-HEV) can be detected, and immunoelectron microscopy can be used to detect HEV antigens in feces or bile. HEV antigens can be detected in liver tissue using immunofluorescence.

　　For acute hepatitis, in addition to integrated traditional Chinese and Western medicine treatment, dietary therapy is also an important means to promote the recovery of acute hepatitis patients. When acute hepatitis patients use food for treatment, the principle of 'high in protein, high in carbohydrate, high in vitamin, and low in fat' should be emphasized.

　　1. High proteinProtein plays an important role in the liver, so it should be supplemented in large quantities when there is an abnormality in the liver. When acute hepatitis patients consume protein, attention should be paid to the amount, and more attention should be paid to the quality. Foods rich in amino acids can be consumed, such as eggs, milk, soy products, etc., and meat can be selected from rabbit meat, chicken, fish, lean pork, etc.

　　2. High carbohydrate. Carbohydrates are the main source of human body heat. Hepatitis patients should pay attention to the supplementation of carbohydrates, but the supplementation of carbohydrates should be appropriate and not excessive. Glucose, sucrose, honey, and fruit juice have diuretic and detoxifying effects and are also conducive to the disappearance of jaundice and the recovery of liver function.

　　. High vitamin. When the liver is abnormal, the intake of vitamins is reduced and consumption is increased, leading to vitamin deficiency, and appropriate vitamin supplementation is needed. Patients can eat more fruits and vegetables to supplement sufficient vitamins.

　　. Low-fat. Hepatitis patients can consume 40-60 grams of fat per day, and should not consume too much.

　　5. Acute hepatitis patients should also pay attention toAvoid spicy, greasy foods, smoking and drinking, avoid cold and raw foods, to prevent exacerbating the burden on the liver, which is not conducive to the recovery of the condition.

　　General Treatment

　　Appropriate rest, during the period when hepatitis symptoms are obvious, especially in patients with jaundice, bed rest should be maintained until the symptoms and jaundice are significantly improved before getting up to move around, gradually increasing the amount of activity or extending the duration of activity, and the degree of activity should be that the patient does not feel tired. Reasonable diet, mainly liquid food, eat small and frequent meals, ensure adequate water supply to promote diuresis and jaundice excretion, and supplement vitamin B complex and vitamin C. Pay attention to the supplementation of vitamin K in severe jaundice. Avoid alcohol, overexertion, and the use of drugs harmful to the liver.

　　Medication Treatment

　　Early application of interferon 3 million U, subcutaneous or intramuscular injection, once every other day, 3-6 months as a course of treatment. Patients with jaundice in the acute stage can be treated with Yin Chen Huang Tang. Patients with nausea, aversion to oil, and vomiting should be given glucose plus vitamin C and vitamin B, or aspartate potassium magnesium solution, intravenous drip. Hepatitis virus and antiviral drugs can also be used.

　　Antiviral Treatment

　　Clinical antiviral treatment is one of the treatment methods for acute hepatitis. Since acute hepatitis B is caused by the hepatitis B virus, and the replication of the hepatitis B virus in the patient's body is active and highly infectious during acute hepatitis B, it is the best time for antiviral treatment. The Hepatitis Treatment Center of the Jiangxi Military Police General Hospital adopts the "Bioimmunotherapy DC-Ⅱ Cell Therapy", which is currently the most effective treatment for viral hepatitis. The high-concentration medication is directly delivered to the local liver through advanced liver cell dialysis equipment, and the high-concentration medication can quickly kill the hepatitis B virus. Generally, patients' symptoms improve and the virus load decreases significantly after about 10 days.