Viral Hepatitis


Definition

Viral hepatitis is a disease caused by virus and characterized by anorexia, jaundice and hepatomegaly. Fever may be present in prodromal stage.


Etiology

Hepatitis A virus (HAV)

Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Hepatitis D virus (HDV)

Hepatitis E virus (HEV)


Route of infections

Fecal oral route

Contact with carriers or patients


Pathology

There is zonal necrosis of centrilobular cells. The hepatic architecture is not damaged so that on regeneration there is no distortion of liver lobules. Swelling of inflamed parenchymal cells along with the infiltrated inflammatory cells result in compression of intra hepatic bile canaliculi leading to obstructive jaundice later on. There is evidence of involvement of gastro intestinal tract, heart, spleen, pancreas etc.


Symptoms

Pre-icteric stage

Fever comes with slight chill

Bodyache and pains all over

Nausea, vomiting and sometimes diarrhea

Anorexia is a prominent symptoms

Pain in right hypochondrium. This is never colicky in nature

On examination

Temperature: raised

Pulse: shows tachycardia

Jaundice: nil

Cervical lymphadenopathy may be present

Liver not palpable but tenderness elicited on deep palpation

Spleen: may be palpable, soft and tender



Icteric stage

Fever subsides

Anorexia, nausea, vomiting etc. persist

Urine becomes yellow, skin and eyes also become yellow and stools become pale

Pruritus develops

Weakness is present


On examination

Temperature: normal

Jaundice: present

Pulse: shows bradycardia

Liver: palpable - fingers, below the right costal arch, soft in consistency and tender

Spleen: may be palpable in 25-45% of cases


Investigations

Serum bilirubin level: raised

Blood examination: leucopenia with relative lymphocytosis, E.S.R is raised in Icteric stage

Urine: may show albumin, bile salts and bile pigments

Van Den Burgh's test: delayed direct or biphasic type

Thymol turbidity test: positive above 8 units. Serum alkaline phosphatase remains with in 25 K.A units/100cc

S.G.P.T increased to 100-200 units/cc or even more in early stage and is a sensitive index of liver cell necrosis

In case of Hepatitis B serology plays an important role in diagnosis

Besides antigen test in blood plays an important role


Complication and sequelae

Hemorrhage due to hypoprothrombinemia

Ascites and edema

Acute hepatic failure

Post hepatitis syndrome

Chronic hepatitis

Cirrhosis

Hepato-cellular carcinoma


Treatment

Diet should contain more carbohydrates with moderate protein and fats

Plenty of oral fluids

Rest in bed


Prognosis

In most of the cases recovery occurs within 3-15 weeks. Mortality rate for Hepatitis A is less than 0.2% and for B it is 0.1-1%.


Prevention

Blood donors screening

Sterilization of syringes

Disposable needles

To avoid street foods

To avoid street drinking water


Homeopathic medicines

Chelidonium Majus: One of out greatest liver medicines. Congestion, inflammation, fullness, enlargement, stitching and shooting tearing pains from liver region through to back inferior right angle of scapula.

Carduus marinus: Another good medicine, pain in the region of liver, left lobe very sensitive, fullness and soreness with moist skin. Constipation alternates with diarrhea.

Cinchona off: The main symptoms, worse every other days with shooting and pressive pains in the liver which is swollen and hard or bitter taste, tongue coated thickly yellowish.

Bryonia alba: The main symptoms are inflammation and many liver problems. Liver enlarged especially right lobe, lie like a load in hypochondria.


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