Hepatitis B Virus Infection Causes Prevention

Viral hepatitis type B is an infectious disease caused mainly by liver disease caused by the hepatitis B virus. Clinical manifestations are loss of appetite, nausea, upper abdominal discomfort, pain in the liver area and fatigue. Some patients of this viral infection may have jaundice, fever and large liver with liver damage. Some patients can become chronic and even develop cirrhosis, and a few can develop liver cancer.

Ailment Name:    Viral hepatitis type B

Visiting department:    Infectious Diseases

Common causes:    Caused by hepatitis B virus

Common symptoms:    Fatigue, loss of appetite, nausea, oiliness, upper right abdominal pain, etc.

How is irritable bowel syndrome treated?

General treatment of irritable bowel syndrome includes establishing good habits and avoiding gas-producing foods.

Disease Overview

Can hepatitis B be completely cured? What is the scientific basis?

Chronic hepatitis B (hepatitis B for short) refers to those who have been tested positive for hepatitis B virus, whose course of disease is more than six months, or whose onset date is not clear, and who have clinical manifestations of chronic hepatitis. 

Its clinical manifestations include fatigue, loss of appetite, nausea, bloating and pain in the liver area. 

For hepatitis B, because of its greater harm, the prognostic effect may not be cured, and we must actively prevent it.

Basic Information

What is the Cause of Hepatitis B Infection?

The cause of hepatitis B virus is hepatitis B virus, abbreviated as HBV, and hepatitis B virus is a DNA virus. The genome is double-stranded, circular, and incompletely closed DNA. The outermost layer of the virus is the outer membrane or envelope of the virus. The inner layer is the core. 

The nucleoprotein is the core antigen (HBcAg) and cannot be detected in serum. 

HBsAg-positive sera showed three types of particles under the electron microscope, round and filamentous particles with a diameter of 22 nm, and a smaller number of 42. 

Spherical particles, also known as Dane's particles are complete HBV particles.

HBV is very resistant to the outside world and can tolerate disinfectants at normal concentrations. It can tolerate 4 hours at a high temperature of 60 ° C. 

It can be inactivated by boiling for 10 minutes, high-pressure steam disinfection and 2% peroxyacetic acid immersion for 2 minutes.

Clinical manifestation

1. What are the Acute hepatitis manifestations?

It is divided into acute jaundice hepatitis and acute non-jaundice hepatitis. 

Hepatitis B has a long incubation period, ranging from 45 to 160 days, with an average of 120 days. The total course of disease is 2 to 4 months.

(1) In the early stage of jaundice, chills, fever, fatigue, loss of appetite, nausea, oiliness, abdominal discomfort, pain in the liver area, and urinary color gradually deepen. 

This period lasts for an average of 5 to 7 days.

(2) Jaundice fever regression, yellow staining of sclera and skin, consciousness improved with jaundice appearing, liver with tenderness, throbbing pain, and some patients with mild splenomegaly. 

This period is 2 to 6 weeks.

(3) Recovery period: Jaundice gradually subsides, symptoms alleviate or even disappear, liver and spleen return to normal, and liver function gradually recovers. This p

2. What are the Chronic hepatitis manifestations?

Patients with a history of hepatitis B or HBsAg or acute hepatitis for more than 6 months, but who still have symptoms, signs, and abnormal liver function, can be diagnosed as chronic hepatitis. Common symptoms are fatigue, general discomfort, loss of appetite, discomfort or pain in the liver area, abdominal distension, low fever, signs of dull complexion, yellow staining of the sclera, spider moles or liver palms, large liver, medium or full texture and tingling pain.

Severe spleen may have deep jaundice, peritoneal effusion, lower extremity edema, bleeding tendency and hepatic encephalopathy. According to the degree of liver damage, it can be divided into:

(1) Mild Patients with mild disease, no obvious symptoms or symptoms and signs, but only 1 or 2 mild abnormalities in biochemical indicators.

(2) Moderate symptoms and signs, those between mild and severe. Abnormal changes in liver function.

(3) Severe or persistent symptoms of liver inflammation, such as fatigue, poor appetite, bloating, loose stools, etc., may be accompanied by liver disease, liver palms, spider moles, or hepatosplenomegaly, while other causes are excluded and no portal hypertension Patients. 

Laboratory examination of serum, alanine aminotransferase repeatedly or continuously increased: albumin decreased or abnormal A / G ratio, gamma globulin significantly increased, where albumin ≤32g / L, bilirubin> 85.5μmol / L, thrombin 60% to 40% of the original activity, one of the three tests can be diagnosed as severe chronic hepatitis.

3. What are the manifestations of Severe hepatitis?

(1) Acute severe hepatitis has rapid onset, rapid progress, deep jaundice, and small liver. 

Within 10 days after the onset, neuropsychiatric symptoms quickly appear, bleeding tendency is obvious, and liver odor, peritoneal effusion, hepatorenal syndrome, and prothrombin activity are less than 40%.

 Excluding other causes, low cholesterol and liver function Obviously abnormal.

(2) Ten days after the onset of subacute severe hepatitis, there is still extreme fatigue, poor appetite, severe jaundice (bilirubin> 171 μmol / L), abdominal distension and formation of peritoneal effusion, and there are obvious bleeding phenomena, and the liver is generally reduced in size not prominent, hepatic encephalopathy is more common in the later stage of severe liver damage. Serum ALT is not increased or increased, while total bilirubin is significantly increased, that is, bile enzyme separation, A / G ratio inversion, and gamma globulin, Prothrombin time prolonged and prothrombin activity was <40%.

(3) Chronic severe hepatitis has chronic hepatitis cirrhosis or a history of hepatitis B surface antigen carrying, imaging, laparoscopy or liver puncture to support chronic hepatitis manifestations, and the clinical manifestations and laboratory changes of subacute severe hepatitis are Chronic severe hepatitis.

4. What is Cirrhosis after hepatitis?

Hepatitis B cirrhosis is the result of the development of chronic hepatitis B. Early liver cirrhosis must rely on pathological diagnosis (the liver tissue has both diffuse fibrosis and pseudolobular formation), ultrasound and CT examinations. 

Laparoscopy has the most reference value. Clinical diagnosis of cirrhosis refers to patients with chronic hypertension who have manifestations of portal hypertension, such as abdominal wall and esophageal varicose veins, peritoneal effusion, liver shrinkage, splenomegaly, portal vein and splenic vein diameter widening, and exclude other causes that can cause portal hypertension.

 According to the degree of hepatitis activity, it is divided into active and stationary cirrhosis.

5. What are Hepatitis B surface antigen (HBsAg) carriers?

HBsAg carriers actually include healthy carriers, chronic HBV infection, and even patients with liver cirrhosis.

 The study found that only 10% to 29% of HBsAg carriers had normal liver tissues, and most had liver tissue damage to varying degrees. 

The definition of HBsAg carriers in China is: HBsAg positive, but no symptoms and signs of hepatitis, normal liver function tests, no changes within half a year.

Liver Examination

1. What is Liver function test?

(1) Serum enzymatic detection: The concentration of alanine aminotransferase (ALT) in liver cells is 104 times higher than that in serum. 

As long as there is 1% necrosis of liver cells, the serum concentration can be doubled, and the positive rate of acute hepatitis is 80 % To 100%.

Aspartate aminotransferase (AST) has the highest concentration in the myocardium, so when determining the effect on liver function, the effect of heart disease should be ruled out first.

80% of AST is in the mitochondria of liver cells. In general, liver damage is mainly caused by ALT. 

If the serum AST is significantly increased, it often indicates that the liver cells are severely necrotic.

The release of AST into the blood from mitochondria, the degree of increase in serum transaminase is roughly parallel to the severity of the disease, but in severe hepatitis, bilirubin may increase continuously, but transaminase may decrease, that is, bile enzyme separation, indicating that liver cell necrosis is serious. 

Serum ALT and AST levels are most commonly used to reflect the degree of liver cell damage.

(2) Serum protein detection: Clinically, serum protein is often used as a biochemical indicator of liver protein metabolism, which reflects the liver's synthetic function. 

When chronic hepatitis cirrhosis occurs, serum albumin often decreases, globulin levels rise, and γ-globulin Ascent mainly.

(3) Serum bilirubin detection: The liver has the functions of uptake, transport, binding, and excretion in bilirubin metabolism. 

Bilirubin levels increase due to liver function damage. 

Except for cholestatic hepatitis inside and outside the liver, bilirubin levels It is directly proportional to the severity of liver damage.

(4) Prothrombin time (PT): This can sensitively reflect the liver's synthesis of coagulation factors II, IX, IX, X , and the length of PT in liver disease is positively correlated with the degree of liver damage, which is of great value in judging disease progression and prognosis.

2. What is Detection of hepatitis B virus markers?

i. HBsAg and anti-HBs: HBsAg positive indicates that HBV is currently in the infection stage, anti-HBs is an immunoprotective antibody, and positive indicates that it has developed immunity to HBV. 

The diagnosis of chronic HBsAg carriers is based on those without any clinical signs and symptoms, normal liver function, and HBsAg positive for more than 6 months.

ii. HBeAg and anti-HBe: HBeAg-positive is an indicator of active replication and infectivity of HBV. 

The change of the test serum from HBeAg-positive to anti-HBe-positive indicates that the disease is relieved and the infectivity is weakened.

iii. HBcAg and anti-HBc: HBcAg positive indicates that there is a complete direct response of HBV particles, active replication of HBV, and it is rarely used in clinic due to the complicated detection method. 

Anti-HBc is a marker of HBV infection, and anti-HBcIgM positive indicates that it is in the early stage of infection and there is virus replication in the body. Anti-HBc total antibodies are mainly anti-HBcIgG.

As long as they have been infected with HBV, this antibody is positive regardless of whether the virus has been cleared. 

HBsAg, HBeAg, and anti-HBc positives in chronic mild hepatitis B and HBsAg carriers are highly contagious, and the indicators are difficult to convert negatively.

Molecular biological markers: detected by molecular hybridization or PCR method, HBV DNA in serum is positive, and directly reflects the active replication of HBV is infectious.

3. What is Liver biopsy?

It is the main indicator for the diagnosis of various types of viral hepatitis, and it is also the exact evidence for the diagnosis of early liver cirrhosis, but it is not the first choice because the traumatic examination is not universal.

4. What is Ultrasound and computer tomography (CT)?

Ultrasound is widely used. The diagnostic indicators of chronic hepatitis and hepatitis cirrhosis have been identified and can help to distinguish liver cirrhosis from liver cancer and jaundice. 

CT examination is also of great value in monitoring the progress of chronic hepatitis B, finding space-occupying lesions in the liver, and the above diagnosis.

How can we diagnose Hepatitis B?

The diagnosis of hepatitis B is based on the above symptoms, signs, laboratory tests, pathology, and imaging tests. 

The diagnosis must be made based on the serum HBV markers and HBV DNA test results.

Hepatitis B is divided into different clinical types according to clinical characteristics and laboratory tests, including acute hepatitis B, chronic hepatitis B, hepatitis B cirrhosis, and primary liver cell carcinoma associated with hepatitis B virus.

Acute hepatitis B

Recently, there are weakness and digestive tract symptoms that can not be explained for other reasons, including yellow urine, yellow eyes and skin jaundice.

1.  Abnormal liver biochemical examination, mainly elevated serum ALT and AST, may have elevated serum bilirubin.
2.  HBsAg is positive.
3. There is clear evidence that serum HBsAg was negative within 6 months.
4. Anti-HBc IgM positive more than 1: 1000.
5.  Liver histology is consistent with changes in acute viral hepatitis.
6.  Serum HBsAg negative conversion and anti-HBs positive conversion during recovery period.

2. Chronic hepatitis B

1. Acute HBV infection remains HBsAg positive or HBsAg positive for more than 6 months.
2.  The duration of HBsAg positive is unknown and anti-HBc IgM negative.
3.  The signs and liver disease of patients with chronic liver disease, liver palm, spider mole, liver and spleen, etc.
4. Repeated or sustained increase in serum ALT, decreased plasma albumin and / or globulin, and elevated bilirubin.
5.  Liver pathology is consistent with the characteristics of chronic viral hepatitis.
6.  Serum HBeAg is positive or HBV DNA can be detected, excluding other causes that lead to elevated serum ALT.

3. Hepatitis B Cirrhosis

1. Serum HBsAg is positive or has a clear history of chronic hepatitis B.
2. Decreased serum albumin, or increased serum ALT or AST, or increased serum bilirubin, accompanied by hypersplenism (platelet and / or leukopenia), or clear esophagus, fundus varices, or hepatic Encephalopathy or ascites.
3.  The imaging findings of abdominal B-mode ultrasound, CT, or MRI have typical features of liver cirrhosis.
4. Diffuse fibrosis and pseudolobule formation in liver histology.

Treatment

1. What is the General Treatment of Hepatitis B?

Acute hepatitis and chronic hepatitis active period, need to be hospitalized, bed rest, reasonable nutrition, to ensure the supply of calories, protein, vitamins, alcohol is strictly prohibited. 

Patient  should gradually increase activities during the recovery period. 

Chronic hepatitis can do its best work at rest. Severe hepatitis should be absolutely bedridden, try to reduce the protein in the diet, ensure calories, vitamins, and can be transfused into human albumin or fresh plasma to maintain water and electrolyte stability.

2. What is the Antiviral Treatment of Hepatitis B?

Acute hepatitis generally does not require antiviral therapy, while chronic viral hepatitis requires antiviral therapy.

i.                  Interferon: Recombinant DNA interleukin (IFN-α) can inhibit the replication of HBV. The intramuscular injection the next day, for 6 consecutive months, only 30% to 50% of patients achieved a longer-lasting effect. The preferred drug for hepatitis C is interferon, which can be used in combination with ribavirin.

ii.               Lamivudine: It is a synthetic dideoxycytosine riboglycoside drug with anti-HBV effect. Oral lamivudine can significantly reduce serum HBV-DNA levels, and the negative rate of HBV-DNA over 90% after 12 weeks of medication. Long-term medication can reduce ALT and improve liver inflammation, but the HBeAg negative conversion rate is only 16% to 18%. After treatment for more than 6 months, HBV mutations can occur, but you can continue to take this drug. Side effects can be continued to take 1 to 4 year.

iii.            Famciclovir: It is a guanosine drug with long half-life and high intracellular concentration, which can inhibit the replication of HBV-DNA. This drug has mild side effects and can be combined with lamivudine interferon to improve the efficacy.

iv.             Other antiviral drugs: such as acyclovir, adefovir, entecavir, sodium phosphonate, etc. have a certain inhibitory effect on HBV.

3. What is Immunomodulator?

Commonly used are:

i.                  Thymosin α1 (Zidaxian) has a two-way immunomodulatory effect, which can reconstruct the immune function of patients with primary and secondary immunodeficiency.

ii.               Thymosin The immune response of the cells involved in the body induces the differentiation and maturation of T lymphocytes, amplifies the response of T cells to antigens, and regulates the level of T cell subgroups.

What is the Prevention of Hepatitis B Viral Infection Disease?

Hepatitis B virus is mainly transmitted through the blood, so the most important transmission methods are vertical transmission from mother to child and iatrogenic infection. The preventive measures are:

1. Manage the source of infection

Chronic hepatitis and asymptomatic, HBV carriers should be prohibited from donating blood and engaging in dietary nursery.

 For patients with HBV-positive liver disease, treatment and management guidance should be based on their symptoms, signs and laboratory test results.

2. Cut off the transmission route

The focus of hepatitis B is to prevent transmission through blood and body fluids, strengthen blood donor screening, and strictly control blood transfusion and blood product applications.

 If a wound or acupuncture is found or suspected to be infected with hepatitis B virus, high-potency hepatitis B immunoglobulin can be applied.

For the interventional examination and treatment of syringes, the instruments should be strictly sterilized to control mother-to-child transmission.

3. Protect vulnerable people

Artificial immunity, especially active immunity, is a fundamental measure to prevent hepatitis. 

Hepatitis B vaccine has been promoted in China to achieve good results.

 For babies born to HBsAg and HBeAg positive pregnant women, high-potency hepatitis B immunoglobulin (HBIG) is injected within 24 hours of birth. 

He was also vaccinated once with hepatitis B vaccine and then injected with HBIG and vaccine one month after birth.

Early detection, early diagnosis, early isolation, early reporting, early treatment, and early treatment of viral hepatitis B are needed to prevent the epidemic.

Author's Bio

Dr. Shawna Reason

Name: Shawna Reason

Education: MBBS, MD

Occupation: Medical Doctor / Virologist 

Specialization: Medical Science, Micro Biology / Virology, Natural Treatment

Experience: 15 Years as a Medical Practitioner

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