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.
- Abnormal liver biochemical examination, mainly elevated serum ALT and AST, may have elevated serum bilirubin.
- HBsAg is positive.
- There is clear evidence that serum HBsAg was negative within 6 months.
- Anti-HBc IgM positive more than 1: 1000.
- Liver histology is consistent with changes in acute viral hepatitis.
- Serum HBsAg negative conversion and anti-HBs positive conversion during recovery period.
2. Chronic hepatitis B
- Acute HBV infection remains HBsAg positive or HBsAg positive for more than 6 months.
- The duration of HBsAg positive is unknown and anti-HBc IgM negative.
- The signs and liver disease of patients with chronic liver disease, liver palm, spider mole, liver and spleen, etc.
- Repeated or sustained increase in serum ALT, decreased plasma albumin and / or globulin, and elevated bilirubin.
- Liver pathology is consistent with the characteristics of chronic viral hepatitis.
- Serum HBeAg is positive or HBV DNA can be detected, excluding other causes that lead to elevated serum ALT.
3. Hepatitis B Cirrhosis
- Serum HBsAg is positive or has a clear history of chronic hepatitis B.
- 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.
- The imaging findings of abdominal B-mode ultrasound, CT, or MRI have typical features of liver cirrhosis.
- 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 |
Education: MBBS, MD
Occupation: Medical Doctor / Virologist
Specialization: Medical Science, Micro Biology / Virology, Natural Treatment
Experience: 15 Years as a Medical Practitioner
About Me | Linkedin | Quora Profile | Medium Profile | Twitter
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