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Chronic viral hepatitis B: a favorable prognosis is real

Viral diseases in modern society are increasingly common. A significant portion of infectious pathologies are diseases transmitted from person to person. Viruses are capable of infecting many internal organs: the lungs, the gastrointestinal tract, the liver, and the kidneys. In a special group distinguish diseases transmitted by contact with the blood or other body fluids of the patient. Such pathologies include chronic viral hepatitis B.

Content

Features of chronic viral hepatitis B

Chronic viral hepatitis B is a medical term implying the introduction of a viral pathological agent into the liver tissue, followed by the development of an inflammatory process, accompanied by metabolic disorders and changes in other internal organs.

The causative agent of the disease is the Orthohepadnavirus (Orthohepadnovirus) virus, belonging to the Hepadnaviridae family.

Hepatitis B virus

Hepatitis B virus belongs to the family of gepadnaviruses

The hepatitis B virus is a representative of a whole group of infectious agents that infect the liver and the bile duct system. Most of these diseases belong to hemocontact, that is, transmitted in contact with the blood or other body fluids of the patient. Viral hepatitis A and E are distributed, spreading through the fecal-oral route.

Most blood-borne hepatitis are chronic diseases. Hepatitis D virus (delta virus) has a special status. It causes the development of the pathological process only while simultaneously infected with the hepatitis B virus.

The mechanism of interaction of hepatitis B and D viruses

Hepatitis B and D virus disease is more severe

Causes and factors of development

The main source of the disease is people infected with various forms of infection (cyclic, anicteric, chronic, integrative). The virus is found in almost all biological fluids of the body: blood, saliva, semen, urine, bile, breast milk. However, the first three are probably the most dangerous due to the high concentration of the infectious agent.

There are several ways to transmit the virus:

  • the parenteral route is implemented during blood transfusion (blood transfusion), organ and tissue transplantation, invasive procedures (operations, treatment, removal, prosthetic dentistry, intravenous narcotic drugs);
  • sexual way - with contacts without the use of barrier contraception;
  • contact-household way - when using one razor, toothbrush. In this case, the virus enters the body through the invisible eye wounds of the skin and mucous membranes;
  • vertical path - in the process of pregnancy and childbirth. In the first case, the fetus becomes infected with a virus from the mother through a defect in the placenta (for example, during its detachment). In the second situation, the child is infected through damage to the skin and mucous membranes as it passes through the birth canal of the mother and in contact with her blood.

Ways of Hepatitis B Virus Infection - Photo Gallery

The most frequent infection is blood-borne. Infection through sexual contact takes second place. Vertical and household paths are less common.

Hepatitis B virus enters the body, after which it recognizes its place of residence - liver cells - by the presence of specific protein structures (receptors) on the surface. Then, the genetic material of the infectious agent is unpacked, after which it is introduced into the nucleus, the central control body of the cell, containing all the information necessary for vital activity.

Hepatitis B virus (scheme)

Polymerase protein allows the virus to make copies of itself.

After that, the virus becomes the full owner of all cellular processes, directing them to the continuous reproduction and assembly of full-fledged infectious particles. The latter cause cell death (cytolysis), after which they enter the bloodstream and infect healthy structures of the liver. This process constitutes the replicative phase of an infectious pathology.

The immune system reacts to the presence of a foreign agent by the formation of specific proteins - protectors-antibodies. However, they can only affect the virus outside the cell. With the initial violation of the above processes, the integrative phase of the disease begins, in which the virus almost completely takes place in the nucleus of the liver cells of the host.

Scheme of the hepatic cell structure

Hepatitis A virus attacks the cell nucleus - the central post of vital activity management

Immune cells migrate from the vascular bed to the liver. Gradually, the place of the destroyed organ cells (hepatocytes) is occupied by others, but the complex structure of the organ is disturbed. Uncontrolled proliferation of tissue (cirrhosis of the liver) leads to compression of the vessels and bile ducts. Increased pressure in the circulatory system provokes stagnation in the abdominal organs - portal hypertension.

The normal structure of the hepatic lobule

The normal structure of the hepatic lobule suffers from cirrhosis of the liver.

The logical outcome of the long-term effect of the virus on the genetic material of hepatocyte cells is a special form of oncology, hepatocellular carcinoma.

What you need to know about hepatitis - video

Symptoms of the disease

The chronic form of hepatitis B is a consequence of an acute cyclical icteric process. The clinical picture is made up of various disorders in the liver and their consequences. Newborns and pregnant women have the same signs of illness as other people.

Symptoms of liver damage and metabolic disorders - table

Affected area (impaired function) Signs of a malfunction in the body The cause of the symptoms
Cover fabrics
  • Itching;
  • hives;
  • redness of palms;
  • yellow skin
Violation of the process of removing the bilirubin pigment (product of the breakdown of hemoglobin)
Creating blood cells
  • Increased fatigue;
  • pale skin and mucous membranes;
  • dyspnea
Anemia (lack of red blood cells)
Blood clot formation (thrombus) Increased bleeding Lack of proteins that contribute to the formation of thrombus
Vascular wall
  • Spider veins;
  • redness of palms
Damage to vascular tissue (vasculitis)
Brain and spinal cord
  • Anxiety;
  • irritability;
  • muscle twitching;
  • mental disorders
Accumulation of bilirubin in the nerve cells of toxic pigment
Gastrointestinal tract
  • Nausea;
  • vomiting;
  • loose stools;
  • weight loss;
  • enlarged liver and spleen
Violation of the breakdown of fats in the intestine under the influence of bile acids
Musculoskeletal system
  • Pathological fractures;
  • bone fragility
Pathological changes in the effect on vitamin D tissue
Hormonal background
  • Sweating;
  • rapid pulse;
  • dry skin;
  • hair breakage
Pathological changes in the thyroid and other glands

Signs of Chronic Viral Hepatitis - Photo Gallery

Diagnosis Methods

To establish the correct diagnosis by a doctor, the following research methods are used:

  • finding out the possible mechanism of virus penetration into the body;
  • detection of yellow skin and mucous membranes, enlargement of the spleen, redness of the palms, vascular stars;
  • definition of reflexes, skin sensitivity and muscle strength (allows you to find violations of the brain and spinal cord);
    Neurologist examines a patient

    The accumulation of bilirubin in the blood adversely affects the work of the brain and nerves

  • complete blood count (reveals anemia);
  • biochemical analysis of blood (makes it possible to detect an elevated level of proteins normally contained mainly within the hepatic cells);
  • determination of time indicators of blood clot formation (demonstrates their significant lengthening);
  • ultrasound (establishes the size of the liver, spleen, the expansion of the hepatic vein);
    Ultrasound picture of the liver

    Ultrasound examines the density and size of the organ.

  • fibrogastroscopy (allows you to detect the presence of altered venous vessels in the lower third of the esophagus);
  • computed tomography (magnetic resonance imaging) (allows you to set the size of the liver, changing its structure);
    Tomographic picture of the abdominal organs

    Computed tomography is the ideal method for studying the anatomy of internal organs

  • determination of the presence of proteins in the blood of antibodies against the hepatitis B virus (confirms the infectious nature of pathological changes in the liver);
  • detection in the blood of copies of viral particles (certifies the fact of infection).

In differential diagnosis, hepatitis B is distinguished with the following diseases:

  • hepatitis C virus inflammation of the liver;
  • inflammation of the liver caused by the pathology of the immune defense reactions;
  • chronic inflammation of the gallbladder wall;
  • primary biliary cirrhosis;
  • syndrome of squeezing of hepatic vessels (Budd disease - Chiari);
  • malignant tumor of the gallbladder;
  • chronic systemic circulatory disorders.

Treatment methods

Therapeutic measures for chronic viral hepatitis B are determined by the infectious diseases specialist. Depending on the severity of the symptoms of the pathology, treatment can be carried out on an outpatient basis or in a specialized department of a hospital.

Drug therapy

Drug treatment, as a rule, includes several pharmacological agents with different mechanisms of action.

An essential component of therapy is the prescription of drugs that suppress the harmful effects of viruses on liver cells and reduce the activity of the inflammatory process.

Preparations for the elimination of inflammation in hepatocytes and the virus in the blood and inside the liver cells - table

Active component Pharmacological group Mechanism of action Trade names
Lamivudine Antiviral agent Stop reproduction of copies of viral particles in liver cells Lamivudine
Adefovir Antiviral agent Stop reproduction of copies of viral particles in liver cells Gepser
Entecavir Antiviral agent Stop reproduction of copies of viral particles in liver cells Baraclude
Telbivudin Antiviral agent Stop reproduction of copies of viral particles in liver cells Sebivo
Tenofovir Antiviral agent Stop reproduction of copies of viral particles in liver cells Viread
Interferon alpha Antiviral agent Preventing the introduction of viral material into the nucleus of the hepatic cell
  • Reaferon;
  • Alfarekin;
  • Intron
Prednisolone Steroid hormonal agent Stopping the destruction of liver cells by the action of immune mechanisms Prednisolone
Essentiale Hepatoprotector Restoration of damaged cell structures of hepatocytes
  • Karsil;
  • Prohepar;
  • Phosphogliv;
  • Essentiale forte

An important component of the treatment of the chronic form of viral hepatitis B is the prescription of drugs that eliminate metabolic disorders during an inflammatory process in the liver.

Treatment of metabolic disorders in hepatitis B - table

Active component Pharmacological group Mechanism of action Trade names
Lactulose Prebiotic Creating conditions for the development of beneficial bacteria in the intestine
  • Duphalac;
  • Lactulose;
  • Normase
Ionized iron Preparations for the elimination of anemia Increase in the amount of hemoglobin oxygen carrier protein in the blood
  • Sorbifer;
  • Ferroplex;
  • Ferrum Lek;
  • Ferrodok;
  • Ferroglobin
Bile acids Preparations for the elimination of stagnant bile and impaired digestion of fats in the intestines Improving the properties of bile, digestion of fats in the intestines
  • Ursofalk;
  • Ursosan;
  • Henofalk

Pharmacological treatment of chronic viral hepatitis - photo gallery

The elimination of the virus from the body is possible with an acute course of the disease. When hepatitis becomes chronic, it is only possible to achieve a low content of infectious particles in the blood and a decrease in the activity of the inflammatory process in the liver with the help of pharmacological agents.

Features of the diet

Diet - the basis of the treatment of chronic forms of viral hepatitis B. Recommendations of the doctor must be respected throughout life. The diet should include the following foods:

  • chicken, rabbit, turkey meat;
  • fillet of trout, cod, salmon, sea bass, hake;
  • kefir, cottage cheese, yogurt;
  • chicken egg protein;
  • sunflower, flaxseed, sesame oils;
  • freshly squeezed juices;
  • vegetable dishes;
  • berry fruit drinks and desserts.

Recommended products - photo gallery

The use of the following products may adversely affect the state of the liver tissue and the severity of the inflammatory process in it:

  • butter, margarine, lard, salted pork fat;
  • lamb, pork;
  • concentrated broths;
  • kidneys, stomachs, lungs, hearts;
  • smoked products;
  • canned foods;
  • exotic hot spices;
  • baking of pastry, sand, puff and other types of dough;
  • salt in excess;
  • alcohol-containing beverages.

Foods to be excluded from the diet for hepatitis - photo gallery

Complications and prognosis

The prognosis for the treatment of chronic viral hepatitis B is very relative and depends largely on the severity of the process, the rate of reproduction of the virus, the body's response to therapy and compliance with the doctor's recommendations (for example, a total ban on alcohol).

Even the timely treatment of acute cyclic icteric forms of hepatitis B in most cases leads to the formation of a chronic inflammatory process in the liver.

An expectant mother with hepatitis B needs to remember that she can pass the virus on to her child. For the birth of a healthy baby, you must follow all the recommendations of doctors. With hepatitis B, you can become pregnant if there are no reproductive and hormonal disorders. However, successful gestation of the fetus depends largely on the state of the liver, other organs and the stage of the process.

Survival of patients with chronic viral hepatitis B - table

The risk of death from the pathological process of the liver The risk of progression of the process in five years Five year survival rate
  • Males - 40–50%;
  • women - 15%
  • The transition of hepatitis to cirrhosis - 10–20%;
  • transition of cirrhosis to decompensated process - 20–30%;
  • transition of cirrhosis to hepatocellular carcinoma - 5–15%
  • With cirrhosis of the liver - 85%;
  • with decompensated cirrhosis - 15–35%.

Against the background of the progression of an infectious process in the liver, the following complications can develop:

  • cirrhosis of the liver, in which the spatial structure of the liver cardinally changes, compression of the vessels and bile ducts occurs;
  • malignant neoplasm (hepatocellular carcinoma);
  • portal hypertension, leading to obstruction of outflow of venous blood from the abdominal organs;
  • bleeding from esophageal varicose veins;
  • ascites (accumulation of fluid in the abdominal cavity);
    Ascites

    Ascites is a consequence of increased pressure in the portal vein system

  • hepatic coma;
  • death.

Preventive measures

To prevent infection with the hepatitis B virus, the following measures are used:

  • examination of donors of blood components, organs and tissues for the carrier of the virus;
  • use of barrier contraception during sexual intercourse;
  • disinfection and sterilization of medical instruments;
    Sterile packaged instruments

    Sterilization of medical instruments - the main measure of prevention of infection with the virus

  • timely detection and treatment of those infected with the hepatitis B virus;
  • dispensing disposable syringes to injecting drug users.

An important method of prevention is vaccination against the hepatitis B virus. It is carried out three-fold, the drug is injected into the muscle. The first injection is made in the maternity hospital in the first days of the child's life. The protective antibodies developed by the body help to eliminate the virus when it enters the body.

Chronic viral hepatitis B is a serious pathology requiring many years of treatment with drugs under the supervision of an infectious disease doctor and following the recommendations of the doctor. Full therapy leads to subsidence of the process, slowing the death of hepatic cells, improving metabolism, quality and longevity in general.

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