Viral hepatitis is a disease caused by viruses and characterized by anorexia, jaundice, and hepatomegaly. Fever may be present in the prodromal stage.
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 results in compression of intrahepatic bile canaliculi leading to obstructive jaundice later on. There is evidence of involvement of the gastrointestinal tract, heart, spleen, pancreas, etc.
Symptoms
Pre-icteric stage
Fever comes with a slight chill
Body aches and pains all over
Nausea, vomiting, and sometimes diarrhea
Anorexia is a prominent symptom
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 within 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 the case of Hepatitis, B serology plays an important role in the diagnosis
Besides antigen test in the blood plays an important role
Complication and sequelae
Hemorrhage due to hypoprothrombinemia
Ascites and edema
Acute hepatic failure
Post hepatitis syndrome
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma
Treatment
Diet should contain more carbohydrates with moderate protein and fats
Plenty of oral fluids
Rest in bed
Prognosis
In most cases, recovery occurs within 3-15 weeks. The 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 our greatest liver medicines. Congestion, inflammation, fullness, enlargement, stitching, and shooting tearing pains from the liver region through to the back inferior right angle of the 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 day 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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