Chronic hepatitis is a clinico-morphological syndrome that is caused by various causes and is characterized by a certain degree of hepatocyte necrosis and inflammation.
According to the International Classification of Diseases, the term “Chronic hepatitis” (CG) refers to such diffuse inflammatory liver diseases in which clinical, laboratory and morphological changes persist for 6 or more months 2, 6, 8, 9.
The most widespread currently received viral hepatitis B and C. The hepatitis D virus, in turn, is not viable without a preceding hepatitis B virus: it is their combination that determines the likelihood of the development and severity of chronic hepatitis B.
What happens in humans with hepatitis?
If the immune response is adequate, then the body itself will be freed from the pathogen, the virus leaves and the person with hepatitis recovers. This happens with hepatitis A, E, in most cases with hepatitis B.
If the immune defense forces are insufficient at the moment when the primary infection develops, then the virus remains in the liver (persistence). The disease becomes chronic. It occurs with hepatitis C, less commonly with hepatitis B.
Causes of Chronic Viral Hepatitis
Chronic hepatitis is etiologically closely associated with acute forms of viral hepatitis B, C, D, E, G, especially occurring in the mild icteric, anicteric or subclinical variant and taking a protracted nature.
Chronic viral hepatitis usually develops against the background of unfavorable factors - improper treatment of acute hepatitis, incomplete convalescence at the time of discharge, aggravated premorbid background, alcoholic or drug intoxication, infection with other viruses (including hepatotropic), etc.
The leading pathogenetic mechanism in chronic viral hepatitis is the disruption of the interaction of immune cells with hepatocytes containing the virus. At the same time, there is a deficiency of the T-system, macrophage depression, weakening of the interferonogenesis system, the absence of specific antibody genesis against virus antigens, which ultimately violates the adequate recognition and elimination of virus antigens on the surface of hepatocytes by the immune system.
Chronic viral hepatitis can cause hepatitis B, C, D.
- Hepatitis B virus is the most studied, it was discovered in 1965. The virus belongs to the family of hepadnaviruses, it contains deoxyribonucleic acid (DNA), the molecule of which is constantly being completed using the DNA polymerase enzyme. Hepatitis B virus is highly resistant to high and low temperatures, chemical and physical effects.
- The hepatitis D virus, or “delta agent,” is a partial RNA virus. It is referred to as defective viruses, since its replication in the human body requires prior (superinfection) or simultaneous (coinfection) infection with the hepatitis B virus, which acts as a helper virus. HBsAg covering the viral particle contributes to the manifestation of hepatotropic and cellular uptake of the hepatitis D virus
- Hepatitis C virus was isolated in 1989. It is an RNA-containing flavivirus coated with a lipid envelope. An important feature of it is genetic heterogeneity, resulting in the formation of a large number of different hepotypes, subtypes, mutants. In clinical practice, 6 genotypes of the hepatitis C virus are distinguished: 1а, 1в, 2а, 2в, За and 4а.
The cause of chronic autoimmune hepatitis is not completely clear.
This disease is not characterized by specific symptoms that indicate exactly how the hepatitis virus infected the patient.
The most common symptoms of hepatitis are unmotivated weakness, loss of appetite, weight loss, nausea. Patients may feel a sense of heaviness and dull pain in the right hypochondrium.
In some patients, for a long time, body temperature can be increased (up to 37 ° C), jaundice of sclera and skin, as well as skin itching appear. The enlargement of the liver is usually moderate, sometimes the size of the affected organ remains in the normal range for a long time.
If suspected of having hepatitis B, patients are tested for the presence of hepatitis B and C markers that can cause chronic liver disease. These are hepatitis B surface antigen (HBsAg), antibodies to the core antigen of the hepatitis B virus (anti-HBc), and antibodies to the hepatitis C virus (anti-HCV).
Other markers are used to clarify the diagnosis, determine the indications for treatment, the prospects for curing the patient and should not be used during routine screening.
Treatment of chronic hepatitis
In the appointment of primary therapy takes into account the cause of the disease. When viral hepatitis shows antiviral drugs, the treatment of hepatitis C involves the regular reception of Ribavirin and intravenous administration of the patient Interferon.
One therapeutic course lasts from several weeks to several months, depending on the symptoms and the stage of the disease.
Also used basic therapy of chronic viral hepatitis.
- Diet №5 (food 5-6 times a day, restriction of protein to 30-40 g per day with the development of hepatic encephalopathy (severe nervous system disorders), exclusion from the diet of spicy, fatty, fried, smoked food).
- Reception of vitamin (vitamins of group B, folic acid, ascorbic acid, lipoic acid) complexes courses lasting 1-2 months.
- Enzyme (aid digestion) preparations that do not contain bile.
- Limiting intense physical and psycho-emotional stress.
With a neglect of treatment and regimen, chronic hepatitis becomes liver cirrhosis, which is considered an incurable disease.
Chronic hepatitis C - how much live with it?
The age of infection is one of the proven factors affecting the rate of fibrosis in hepatitis C. In a one-dimensional analysis, it was found that cirrhosis develops in 20 years in only 2% of patients infected before the age of 20, 6% of those infected at the age of 21 - 30 years, 10% of those infected at 31 - 40 years, 37% of those infected at 41 - 50 years, and 63% of those infected at the age of more than 50 years.
The prognosis for each of the patients with hepatitis is strictly individual and his health depends on many factors:
- virus genotype;
- the amount of virus in the initial infection;
- duration of illness;
- the extent of liver damage;
- the presence of concomitant diseases;
- age of the patient;
- general health and immunity;
- whether a person is engaged in sports, and from physical exertion;
- body reactions to treatment.
In different people, chronic hepatitis C manifests itself in different ways: someone may experience painful sensations, while others feel one hundred percent. That is why, in response to a question, hepatitis c - how many live with it, it is impossible to give an exact figure.