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Hepatitis Diagnosis Treatment Symptoms and Drugs


Hepatitis Diagnosis Treatment, Drugs and Symptoms

Hepatitis is a collective term for liver inflammation. Usually refers to the destruction of liver cells by a variety of pathogenic factors-such as viruses, bacteria, parasites, chemical poisons, drugs, alcohol, autoimmune factors, liver function and a series of uncomfortable symptoms in the body and abnormal liver function indicators.


Because of the different causes of hepatitis, although there are similar clinical manifestations, there are often significant differences in etiology, serology, injury mechanism, clinical history and prognosis, extrahepatic damage, diagnosis and treatment.
It should be noted that most of the hepatitis in our lives refers to viral hepatitis caused by hepatitis A, B, C and other hepatitis viruses.

 Is transaminase elevated necessarily the cause of hepatitis?

Transaminase is mainly present in liver cells, but its elevation is not comprehensive as an indicator to determine whether or not hepatitis is present.

Table of Content

  1.       Classification
  2.       Clinical Manifestations
  3.       Inspection
  4.       Diagnosis
  5.       Treatment


Basic Information

English name:    Hepatitis

Visiting department:    Department of Infectious Diseases, Hepatitis, Gastroenterology

Common causes:    Caused by viruses, bacteria, parasites, drugs, alcohol, etc.

Common symptoms:    Loss of appetite, bloating, greasy food, nausea and vomiting, fatigue

Contagious:    Yes

Way for spreading:    Viral hepatitis is contagious and can be transmitted through daily contact, blood-borne transmission, mother-to-child transmission, and iatrogenic and sexual contact.

What is the Classification of Hepatitis?

1. Classification according to the cause

Can be divided into viral, bacterial (such as amoeba) drug, alcoholic, toxic, autoimmune, non-alcoholic fatty and so on.

2. According to the length of the disease

Can be divided into acute hepatitis, chronic hepatitis and so on.

3. According to the presence or absence of jaundice

Acute hepatitis can be divided into acute jaundice hepatitis and acute jaundice-free hepatitis.

4. According to the severity

Chronic hepatitis can be classified as mild, moderate, or severe.

Clinical Manifestation of Hepatitis

I. What are the Symptoms of Hepatitis?

The clinical manifestations of hepatitis differ from cause to cause. Common symptoms include: loss of appetite, bloating, anorexia,
Nausea, vomiting and fatigue.

II. What are the Signs of Hepatitis?

Some patients have yellow stained sclera or skin, fever, hepatic pain, hepatomegaly, tenderness, and spider moles and liver palms in some patients. Ascites, oliguria, bleeding tendency and disturbance of consciousness, coma, etc. are seen in severe hepatitis.

Hepatitis Tests or Examination

I. What is the Laboratory inspection for Hepatitis?

(1) Liver function test.
(2) Serological examination (detection of virus-specific markers, which is helpful for typing of viral hepatitis).
(3) Other related tests (blood routine, renal function, protein, fat and glucose metabolism, serum immunological tests, etc.).

II. Imaging examination

Including abdominal ultrasound, CT, magnetic resonance examination, etc.

III. What is the Pathological examination of liver puncture?

It is of great value in the diagnosis of various types of hepatitis. Through liver tissue electron microscopy, immunohistochemical detection and observation with the KnodellHAI scoring system, correct data can be obtained on the etiology, etiology, inflammatory activity, and fibrosis of hepatitis. Conducive to clinical diagnosis and differential diagnosis.

What is the Diagnosis for Hepatitis?

According to medical history, clinical manifestations and examination results.

What is the Treatment for Hepatitis?

Different treatment principles and measures are adopted according to the etiology, course of disease and the severity of hepatitis.


Viral hepatitis: How far is it from elimination?

July 28, 2017 is the seventh World Hepatitis Day with the theme "Eliminating Hepatitis". In Hebrew, Baruch is blessed, and Samuel is a Hebrew prophet.
Blumberg obviously accepted the blessing, and he discovered it at the age of 38. It was the discovery of the hepatitis B virus that opened the prelude to the diagnosis, treatment, and prevention of viral hepatitis.

In 2013, a scientist identified key receptors for hepatitis B virus entering liver cells, and based on this, established a model of hepatitis B virus cell infection, which will accelerate the development of new anti-HBV drugs.
Hepatitis A B C Diagnosis

July 28, 2017 is the seventh World Hepatitis Day, with the theme "eliminate hepatitis"

If you turn the time back to the day of 1925, in Brooklyn, New York, a family of lawyers welcomes the birth of a boy and names him Baruch Samuel Blumberg. In Hebrew, Baruch is blessed, and Samuel is a Hebrew prophet. 
Blumberg apparently accepted the blessing.
He discovered the hepatitis B virus at the age of 38, and at the age of 51, he won the Nobel Prize in Physiology or Medicine.

Epidemiological surveys show that up to a third of the world's population has been infected with the virus, and 350 million of them have developed chronic infection. 
It was the discovery of the hepatitis B virus that opened the prelude to the diagnosis, treatment, and prevention of viral hepatitis.

To commemorate Blumberg's outstanding contribution in the field of hepatitis, in 2010, the World Health Organization (WHO) decided to start his birthday in 2011 as World Hepatitis Day. The theme slogan of the first World Hepatitis Day was: This is hepatitis.

Hepatitis B virus found

Humans have a long history of understanding hepatitis. The first record of jaundice hepatitis was recorded as early as 2000 BC, and the disease has been considered infectious because it often occurs in areas with high population densities and poor sanitation.
From 460 BC to 375 BC, Hippocrates, the originator of Western medicine, mentioned "epidemic jaundice" in "Medical Diseases", and jaundice was also described in China's "Yellow Emperor's Canon".

Indian Ayurveda also describes it. Most of these ancient jaundice descriptions were viruses Clinical manifestations of hepatitis.

Hepatitis Treatment Tests and development

In 1908, S. McDonald speculated that there might be a virus that can cause liver disease, but how it spreads is a mystery. 
In 1947, British doctor F.O. MacCullum, who was engaged in liver disease research, suggested that there might be two viruses:

  1. One that transmitted hepatitis A through the fecal-oral route, called hepatitis A.
  2. The other that transmitted through the blood, called hepatitis B.


Blumberg, who was a U.S. naval officer in World War II at the time, was just retiring and was studying for a doctor of medicine at Columbia University School of Medicine. But Blumberg's interest was not in hepatitis. 
After graduating as a resident at Columbia University Presbyterian Medical Center for several years, he turned to Oxford University for a PhD in Biochemistry. His research interest at the time was:

Why in the same environment, some people are susceptible to a certain disease, while others are not? 

To answer this question, he took blood samples from around the world, analyzed the differences in blood protein components, and tried to study the association between protein diversity and disease susceptibility.
For example, using the new technology at that time-starch gel electrophoresis-to observe the nuances of human and animal serum proteins during migration, and then to discover the polymorphism and distribution characteristics of the proteins. 
He did make several new discoveries, but did not make a big breakthrough.

Blumberg and colleagues began to change their minds: if many serum proteins have polymorphic mutations, this mutation may be antigenic. 
Patients who receive multiple blood transfusions may produce corresponding antibodies if they do not have polymorphic mutations themselves.

Baruch Samuel Blumberg (1925.7.8-2011.4.5)

According to this idea, in 1960 they began to introduce the new technology of the time, immunoelectrophoresis, which is a method for the analysis of antigen composition by combining agar electrophoresis and two-way agar diffusion.

Their hypothesis was quickly supported by experimental results:
A patient who had undergone multiple blood transfusions had serum that responded to the serum of multiple individuals in a particular population.
Although it was later confirmed that this was due to serum low-density lipoprotein polymorphisms in the population, it showed that this research idea might lead to some interesting findings.

Hepatitis Diagnosis and Research

The facts did not disappoint them either. In 1963, Blumberg discovered that antibodies apparently unrelated to low-density lipoprotein polymorphisms were detected in hemophiliacs with multiple blood transfusions. 
Because it can initially react with the blood of an Australian, it is called "Australian antibody".

Human studies have found that "Australia" is rare in ordinary Americans, but more common in patients with leukemia, so Blumberg initially speculated that "Australia" may be a risk factor for leukemia.

However, a long-term clinical observation of leukemia patients found that one patient who did not initially detect "Australian Antibodies" developed liver inflammation at the same time as the Australian Antibodies were detected. This finding began to point to the fact that "Australia" may be related to clinical hepatitis. 
More subsequent research showed that Australia is a component of this hepatitis virus.

In 1970, British virologist David Dane observed the entire particle of the virus (later named Dane's particle) with an electron microscope. Because "Australia" is closely related to post-transfusion hepatitis, it is in line with the concept of hepatitis B proposed by MacCullum. 
Since the 1970s, this "Australia-resistant" hepatitis virus has been named Hepatitis B virus (HBV).

78 Hepatitis B virus. A and B are subviral particles composed of surface antigen proteins, and C is intact hepatitis B virus Dane's particles.

Development of hepatitis B vaccine

After the hepatitis B virus was discovered, research into vaccines was on the agenda. 
There are a large number of small spherical particles composed only of viral surface antigen proteins in the serum of hepatitis B infected persons.

Blumberg realized that these non-infectious viral proteins could be used to prepare hepatitis B vaccine and developed a preparation process. 
In 1975, he transferred the patent to the pharmaceutical company Merck to produce a commercial vaccine.

Hepatitis Medicinal Vaccines and Medicines

After rigorous clinical trials, the FDA approved the clinical application of blood-borne hepatitis B vaccine in 1981. 
In the mid-1980s, due to the development of genetic recombination technology, genetically engineered hepatitis B vaccines were widely used because they were safer and more stable, and blood-borne vaccines withdrew from the historical stage.

The use of hepatitis B vaccine has greatly reduced the prevalence of hepatitis B. 
In Taiwan, where the vaccine was used earlier, the prevalence of hepatitis B dropped from 10.9% in 1984 to 1.5% in 1989, while in Japan it fell from 3% to 0.3%.

Currently, the number of people with chronic hepatitis B infection worldwide has decreased from 350 million to about 250 million, and the prevalence of chronic hepatitis B infection in children under five years of age dropped from 4.7% before vaccination to 1.3% in 2015.

Discovery of HCV

Because hepatitis B can be transmitted through blood transfusions, US legislation in 1972 mandated that all blood donors be screened beforehand.
By the late 1970s, with the advent of more sensitive detection methods, developed countries generally required blood donors to test for hepatitis B virus, which greatly reduced viral hepatitis caused by blood transfusions.
But doctors have found that despite strict blood screening of blood donors, many people still develop hepatitis after blood transfusions. Therefore, doctors called the hepatitis caused by the unknown virus after blood transfusion as "non-A, non-B hepatitis".

To find the hepatitis virus, scientists examined the blood of these hepatitis patients. 
Although various methods such as electron microscopy, artificial culture, and immunology have been used to find the virus, no trace of the "non-A, non-B hepatitis" virus has been found.

In 1983, the American Chiron Corporation decided to fund a large-scale research project to solve this problem. 
Scientists from the Centers for Disease Control and Prevention and Chiron have invested in the research program.

The scientists first infected chimpanzees with non-A, non-B hepatitis, and then provided the chimpanzee's infected serum to Chiron for analysis. 
Until 1989, Michael Houghton and others eventually cloned the virus using molecular biology techniques. 
Since this is the third "hepatophilic virus" that has been found to specifically infect the human liver, it is named Hepatitis C virus.

A subsequent clinical investigation confirmed that 80% to 90% of non-A, non-B hepatitis was caused by hepatitis C virus infection.

Different from the use of electron microscopy, artificial culture or immunological methods in the past, this is the first time that scientists have applied molecular biology techniques to directly discover viruses and clone gene sequences, opening up a new field for the discovery of infectious pathogens, and it is a scientific research Great progress. 

After 1990, with the promotion of sensitive and efficient HCV blood test methods, viral hepatitis caused by blood transfusion in developed countries has fallen to one in 100,000.

Development of hepatitis C antiviral drugs

Compared with hepatitis B, the harm after hepatitis C infection is greater. 
Chronic infection after hepatitis B infection mainly occurs in infants and young children, and more than 90% of adults are infected or acute.
However, the chronicity rate after hepatitis C infection is 60% to 85%. 
Unless effective antiviral treatment is performed, chronic hepatitis C can develop into end-stage liver diseases such as cirrhosis and liver cancer.

Another difficulty of Hepatitis C is that unlike the surface protein of Hepatitis B virus, which is highly conserved and easy to develop vaccines, the sequence of the outer membrane protein of Hepatitis C virus is highly variable, making vaccine development difficult.
This makes the development of antiviral drugs for hepatitis C particularly urgent.

For the development of antiviral drugs, an efficient and stable drug research platform is essential. Ralf F.W.Bartenschlager of the University of Heidelberg, Germany and Charles M.

Rice of the University ofRockefeller, USA, through in-depth research on the mechanism of HCV replication and infection, finally established a model of HCV replication and infection in laboratory cultured cells. In 2007, Arbutus biopharmaceutical company Michael J. 

Sofia screened a new drug that could effectively inhibit the replication of hepatitis C virus, Sofibwe, and obtained FDA approval in 2013, which greatly revolutionized the treatment of hepatitis C. These three scientists also won the "Lasker Prize", which is known as the "Nobel Prize weathervane" in 2016.

Since then, more and more effective hepatitis C antiviral drugs have been developed, and the cure rate of hepatitis C has reached nearly 100%.

In the foreseeable future, hepatitis C will become a "rare disease", which will also be the first viral infectious disease in human history to be completely cured by drugs.

Accelerate the development of new anti-HBV drugs
Compared with the rapid development of hepatitis C drug development, hepatitis B drug appears to be inferior.

Since 1998, lamivudine, which strongly inhibits the activity of hepatitis B virus polymerase, has been approved for the treatment of chronic hepatitis B.
Since then, the FDA has also approved a series of similar drugs that have a stronger virus suppression effect and are less prone to drug-resistant mutations. 

Although these drugs can strongly inhibit hepatitis B virus replication, less than one third of people can achieve the effect of continuously inhibiting virus replication after stopping the drug, and most people will have a rebound phenomenon after stopping the drug.
Treatment Drugs for Hepatitis Conditions of Livewr


The characteristics of the life cycle of hepatitis B virus make the complete removal of the virus genome much more difficult than that of hepatitis C. 
Hepatitis B virus is a double-stranded DNA virus whose viral genome can be hidden in the nucleus of liver cells to form a microchromosomal structure.

Hepatitis C virus is a single-stranded RNA virus, and its viral replication process exists only in the cytoplasm. 
These characteristics make the genome of hepatitis B virus more stable and more difficult to be attacked by immune molecules.

Another difficulty is the lack of efficient and practical HBV cell infection models for many years, which also limits the development of anti-HBV drugs.

However, a remarkable achievement in recent years is that researcher Li Wenhui of the Beijing Institute of Life Sciences identified key receptors for hepatitis B virus entering liver cells, and based on this established a model of hepatitis B virus cell infection, which will accelerate the development of new anti-HBV drugs.

In addition, with the solution of the problem of hepatitis C treatment drugs, more scientific research has been devoted to the research and development of hepatitis B drugs.

In recent years, a series of new target drugs have entered the clinical trial stage, and the elimination of hepatitis B has also dawned.

Other hepatitis viruses

In addition to the hepatitis B and C viruses, there are obviously other hepatitis viruses as the name suggests.

In 1973, a team of scientists from the National Institutes of Health, led by Steven Feinstone, confirmed that the virus that causes hepatitis A came from a stool sample of a prisoner volunteer. Hepatitis A is transmitted through the "fecal mouth" route. One disturbing fact is:
"If you have hepatitis A, you may have eaten some part of someone else's stool." But it is comforting that hepatitis A is a self-healing disease and generally does not cause serious consequences.

One example is Shanghai, in 1988, due to the consumption of Hepatitis A contaminated hairy fowl, there were 340,000 cases of Hepatitis A pandemic, an event that set the world's history of hepatitis A epidemic.

In the end, a total of 31 patients died, and these death patients themselves had some chronic diseases such as chronic bronchitis, emphysema, and chronic hepatitis B, cirrhosis and so on.
In 1981, a microbiologist Maurice Hilleman developed the hepatitis A vaccine.

In 1978, Mario Rizzetto, an Italian gastroenterologist, and John Gerin, a molecular virologist at Georgetown University, discovered the hepatitis D virus, but this rare virus is a defective virus and cannot be infected independently. It depends on the hepatitis B virus. survive.

In 1983, Mikhail Balayan of the Polio and Viral Encephalitis Institute in Moscow discovered the hepatitis E virus.
Like hepatitis A, hepatitis E is transmitted through the digestive tract from contaminated water or food and can cause epidemics in local areas. In 2012, Xiamen University professor Xia Ningshao developed the world's first hepatitis E vaccine.

Compared with hepatitis B and C which can cause chronic liver disease, the scale and pathogenicity of hepatitis A and E are relatively small.
Therefore, although vaccines are already available, universal vaccination is not provided to the public, but diet hygiene is emphasized to prevent illness from entering the mouth.

Prevention and treatment of viral hepatitis in the World
Asia has always been an important link in the global viral hepatitis prevention and control landscape.

India and China used to be a high-risk area for chronic hepatitis B, with an infection rate of 10%, accounting for 1/3 of the global infected population.
 In the study of prevention and treatment of viral hepatitis in China, one of the pioneers who has to mention is Professor Tao Qimin of Peking University Institute of Hepatology (formerly the Department of Hepatology, Beijing Medical College). 
In the early 1970s, she first introduced the hepatitis B virus detection method and promoted it nationwide. 

In 1975, she started research on the purification and vaccine preparation of hepatitis B surface antigen protein simultaneously with foreign countries. At that time, the domestic Cultural Revolution had just ended.

Under the conditions of scientific research and no animal models were available, in order to verify the effectiveness and safety of the vaccine developed, Professor Tao Qimin injected himself with the fearless spirit of China’s first blood source, sex vaccine.

She succeeded! Thereafter, the blood-borne hepatitis B vaccine was gradually promoted nationwide until 1988, when the genetically engineered hepatitis B vaccine was put into use in China. 

Professor Tao won the first prize of National Science and Technology Progress for this. After the discovery of Hepatitis C, Tao Qimin also carried out the research and development of domestically produced Hepatitis C detection reagents, taking the first step to reduce the spread of Hepatitis C after blood transfusion in China.

In addition to the role of vaccines and drugs in the prevention and treatment of infectious diseases, the formulation and implementation of health policies also play a key role. 
In 2002, the Chinese government decided to include hepatitis B vaccine in children's planned immunization, and since 2005 all newborns have been given free hepatitis B vaccine.

With the promotion of hepatitis B immunoprevention, the prevalence of chronic hepatitis B and the transmission of hepatitis B in China have changed significantly, and they have dropped from high-endemic areas to low-endemic areas.

In 2012, the WHO sent a congratulatory letter to congratulate China on its tremendous success in controlling hepatitis B with the hepatitis B vaccine and regard China's success as a model for the region and the world. 
It is precisely because of adherence to the comprehensive prevention and treatment strategy based on hepatitis B vaccination, an 2014 epidemiological survey showed that the hepatitis B surface antigen carrying rate in children under 14 years of age in China has been less than 1%.

The anti-HCV positive rate in the Chinese general population was 0.43%. However, the current public does not know enough about hepatitis C, and non-specialists do not fully understand the long-term prognosis of chronic hepatitis C infection and the effectiveness of antiviral treatment.

In April 2017, the State Food and Drug Administration approved the first oral direct antiviral drug for hepatitis C, and the domestic original research on direct hepatitis C antiviral drugs will also be on the market, which will completely change the status of hepatitis C treatment in China.

In addition, based on the latest developments at home and abroad, the Chinese Medical Association's Hepatology Branch and the Infectious Disease Branch have repeatedly formulated and updated guidelines for the prevention and treatment of viral hepatitis, providing important technical guidance documents for the standardized treatment of hepatitis.

Despite the tremendous success of hepatitis B vaccine immunization and hepatitis C antiviral treatment, WHO reports indicate that viral hepatitis remains a major global health problem. 
According to information released by the WHO, as of the end of 2015, 325 million people worldwide still have chronic hepatitis.

In low- and middle-income countries, infected people have rarely been tested and treated; viral hepatitis caused 1.34 million people in 2015 Deaths, equivalent to TB deaths, outnumbered HIV deaths; new cases of hepatitis infection continue to occur, mainly hepatitis C.

The World Health Assembly in May 2016 first adopted the "Global Health Sector Viral Hepatitis Strategy 2016-2021", emphasizing that eliminating viral hepatitis is not only part of the global health cause, but also an integral part of the world's sustainable development goals, portion.
To this end, WHO called on the world to take action and proposed "to achieve the complete elimination of the health threats caused by chronic hepatitis B / C hepatitis by 2030".

The specific goal is to reduce the number of new viral hepatitis infections by 90% and the number of deaths from viral hepatitis by 65% ​​by 2030.
This is a global strategic goal for the prevention and treatment of viral hepatitis, and this goal is not very high, because despite the many challenges, global efforts to eliminate hepatitis are making progress.
 

Author's Bio

Doctor Shawna Reason, Virologist
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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