Illnesses of liver and gall-bladder

Acute viral hepatitis is diffuse inflammation of liver, viral etiology, which is accompanied by an icterus and reason of which is unconnected with pregnancy.

Classification.

After expressed of clinical displays :

1. Hidden forms:

- - subclinical.

2. Manifestal of forms:

- - anicteric;

- - icteric.

After the recurrence of flow :

1. Cyclic.

2. Acyclic.

After the degree of weight :

1. Easy.

2. Middle weight.

3. Heavy.

4. Extremely heavy.

Complication:

1. Acute and subacute dystrophy of liver (acute hepatic failure).

2. Functional

3. Extrahepatic

After consequences:

1. Recovery.

2. Less signs of pathology (hepatomegalia and hyperbilirubinemia).

3. Chronic hepatitis.

4. Cirrhosis of liver.

5. Primary cancer of liver.

Diagnostics of hepatitis

Clinical data.

Presence one or more syndromes:

- it is an intoxication syndrome;

- it is an asthenovegetative syndrome;

- it is a cholestatic syndrome;

- it is the inflammatory syndrome;

- it is a cytolytic syndrome;

- - other.

Laboratory indexes.

1. A global analysis of blood is leucopenia (possibly leucocytosis), lymphopenia, decline of RSE etc.

2. Biochemical indexes of blood are an increase of general bilirubin mainly due to direct, increase of activity of АLАТ, and in less degree АSАТ, dysproteinemia, increase of thymol test, decline of index of fibrinogenum, appearance of foods of disintegrations.

3. Specific inspection (an exposure is in blood) :

By the method of ІФА :

- it is hepatitis of А- of HAV IgM - even a single exposure is absolute proof of disease (appear in blood 4-5 days prior to the exposure of symptoms of disease and disappear through 6-8 months);

- it is hepatitis In - HBsAg (basic marker of infecting of НВ - by a virus, it appears from 3-5 week of disease and determined 70-80 days), HBeAg (a marker of epidemiology risk, active replication of virus and transmission is from a mother to the fetus; of the impression of fetus here rises to 90%), HBcAg (it is not determined in blood, but there can be antibodies to him are of HBcIgM and HBcIgG, that testifies to etiology of ГВГВ and about the prospect), HBcorAg, HBxAg, of HBc IgМ;

- it is hepatitis of С - анти- of HСV IgM (a diagnostic value is at chronic hepatitis);

- it is hepatitis of D - HBsAg (a marker active of virus at acute hepatitis), - of HDV IgM (appear on 10-15 day of disease and 2,5-3 months are kept);

- it is hepatitis of Е- of анти- of HЕV IgM.

By the method of PCR (on possibility) :

- it is hepatitis of А- of RNA of HAV;

- it is hepatitis In - DNA of HВV;

- it is hepatitis of С- of RNA of HСV;

- it is hepatitis of D - RNA of HDV;

- it is hepatitis of Е- of RNAof HЕV.

4. Urobilinuria.

About the unfavorable prognosis of hepatitis testify:

- it is appearance of hemorragic syndromes;

- it is an increase of level of general bilirubin anymore as 200 мкмл /л due to indirect;

- it is a decline of activity of АLАТ to the norm on a background growth of intoxication and height of level of bilirubin;

- it is a considerable decline of level general protein, A/G coefficient <1,

- it is a decline of протромбінового index ≤ of 50% and Fibrinogenum.

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