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
- Classification
- Clinical Manifestations
- Inspection
- Diagnosis
- 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.
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.
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:
- One that transmitted hepatitis A through the fecal-oral route, called hepatitis A.
- 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.
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.
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.
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
 |
| 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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