Is hepatitis an infectious disease? Hepatitis B - what it is, how it is transmitted, symptoms, treatment of acute and chronic forms of hepatitis B. Testing for the hepatitis B virus

Hepatitis is an inflammation of the liver caused by factors of various etiologies. In the process of its development, it can be completely cured or have consequences in the form of fibrosis (scarring), cirrhosis or liver cancer.

This group of diseases is classified according to various parameters. Research into various types of liver inflammation is ongoing constantly in our time, their lists are being replenished, and new strains of viral hepatitis are being identified. Nevertheless, there are aspects by which today it is customary to distinguish between different types and stages of this disease.

Forms of hepatitis according to clinical course

There are acute and chronic hepatitis. Acute hepatitis most often occurs when infected by viruses, as well as as a result of exposure to potent substances, such as poisons. Lasts up to three months, after which a transition to a subacute (protracted) form is possible. After six months, the disease transforms into a chronic form. Chronic hepatitis often occurs as a continuation of acute hepatitis or can develop independently (for example, as a result of prolonged alcohol abuse).

The modern classification of chronic hepatitis is based on the following key evaluation criteria: etiology, pathogenesis, degree of activity (chronic aggressive and chronic persistent hepatitis), stage of chronicity.

There is also recurrent (returning) hepatitis, in which symptoms of the disease reappear several months after acute hepatitis.

According to severity

This criterion applies to the patient rather than to the disease itself. So, hepatitis can be mild, moderate or severe. Fulminant hepatitis refers specifically to the extremely severe course of the disease.

By etiology

Infectious hepatitis is caused, most often, by hepatitis viruses A, B, C, D, E, etc. Infectious hepatitis can also occur as a component of such infections: rubella virus, cytomegalovirus, herpes, syphilis, leptospirosis, HIV (AIDS) and some others. Non-viral hepatitis is formed as a result of exposure to any toxic substances that have a hepatotropic effect (for example, alcohol, certain medications). This type of hepatitis gets its name from the name of the damaging agent - alcohol, drugs, etc. Liver damage can also occur as a result of autoimmune processes in the body.

According to pathomorphological characteristics

The process can be localized exclusively in the liver parenchyma or also involve the stroma, be located in the form of a local focus or have a diffuse position. And finally, the nature of liver damage is assessed: necrosis, dystrophy, etc.

Viral hepatitis

Acute and chronic viral hepatitis seem to be a fairly relevant subject of global health attention in our time. Despite the obvious achievements of science in the diagnosis and treatment of hepatotropic viruses, the number of patients with them is steadily growing.

Key points in the classification of viral hepatitis are reflected in Table No. 1.

Table No. 1. Classification of viral hepatitis.

Etiology of viral hepatitis

Today, there are 8 known types of viruses that can cause viral hepatitis. They are designated by Latin letters.

This is the hepatitis A virus - Hepatitis A virus or Botkin's disease: HAV; B – HBV; C – HCV; D – HDV; E – HEV; F – HFV; G – HGV; TTV – HTTV and SAN – HSANV.

Hepatitis B and TTV viruses are DNA-containing viruses, while the others have RNA in their structure.

Also, in each type of virus, genotypes and sometimes subtypes are determined. For example, the hepatitis C virus currently has 11 known genotypes, which are designated by numbers, and many subtypes. Such a high mutation ability of the virus leads to difficulties in its diagnosis and treatment. The hepatitis B virus has 8 genotypes, which are designated by letters (A, B, C, D, E, etc.)

Determining the genotype of the virus - genotyping - is important for prescribing the correct treatment and the possibility of predicting the course of the disease. Different genotypes respond differently to therapy. Thus, HCV genotype 1b is more difficult to cure than others.

It is known that infection with HBV genotype C can cause a prolonged presence of HBeAg in the blood of patients.

Sometimes infection occurs simultaneously with several genotypes of the same virus.

Hepatitis virus genotypes have a specific geographic distribution. For example, HCV genotype 1b prevails in the CIS. In the Russian Federation, genotype D of HBV is detected more often. At the same time, genotypes A and C are much less common.

Epidemiology

The source of infection is a virus carrier or a sick person. Moreover, people with an asymptomatic form of infection, as well as with an anicteric or erased course, are especially dangerous. The patient is contagious already in the incubation period, when there are no obvious signs of the disease. Infectiousness persists in the prodromal period and the initial phase of the height of the disease.

Of all hepatotropic viruses, HBV is the most resistant to the adverse effects of the external environment. And hepatitis A (Botkin's disease) and E viruses are less tenacious in the external environment and die quickly.

Due to the urgency of the problem, it is necessary to mention the combination (co-infection) of hepatitis and HIV (AIDS) viruses. The majority of the risk group consists of drug addicts (up to 70%), who become infected with both HIV and hepatitis viruses, more often C. The presence of HIV (AIDS) and the hepatitis C virus correlates with a higher likelihood of severe liver damage. This also requires adjustment of HIV (AIDS) therapy.

What are the routes of infection?

The mechanisms of transmission of viral hepatitis are divided into 2 large groups:

1. Parenteral or hematogenous. Inherent in infection with hepatitis viruses B, C, D, G. Parenteral viral hepatitis often becomes chronic, and virus carriage can develop.
2. Enteral or fecal-oral. In this case, water, food and contact (through dirty hands) transmission routes are distinguished. Typical for infection with hepatitis viruses A, E, F. In the vast majority of cases, chronic virus carriage does not occur.

It is logical to assume that the most dangerous are hepatitis viruses transmitted through contact with blood (B, C, D, G).

The routes of transmission of parenteral hepatitis viruses are varied:

• Injecting drug use without maintaining personal hygiene and sterility. This route of transmission is relevant for all of the above pathogens, but the hepatitis C virus is currently most often transmitted this way.
• Transfusion of blood and its components.
• Poor quality sterilization or reuse of instruments when providing medical care, as well as during salon procedures (manicure, pedicure), tattooing, piercing, etc.
• Unprotected sexual intercourse. They play a significant role in the epidemiology of viral hepatitis. But the hepatitis C virus is transmitted in this way only in 3-5% of cases.
• From an infected mother to the fetus and newborn during pregnancy (vertical transmission) or during childbirth (intranatal).
• Sometimes the transmission route remains unverified (unknown).

Acute viral hepatitis

In a typical (icteric) course, it has 4 periods or stages: incubation, prodromal, icteric, convalescence.

1. Incubation period. The duration is determined by the etiological agent.
2. Prodromal period. The duration of this period directly depends on the severity of the disease. It manifests itself as an increase in body temperature, most often to subfebrile levels. However, sometimes the temperature remains at the normal level or, conversely, reaches 38–39 degrees and above. Along with an increase in temperature, the phenomena of dyspeptic and asthenovegetative syndromes are added. It can also manifest itself as a flu-like condition, pain in the joints and muscles, and skin rash, sometimes accompanied by itching, are common. After a few days, pain develops in the area of ​​the right hypochondrium and epigastrium. Towards the end of the period, signs of jaundice appear.
3. Jaundice period. Is the height of the disease. Lasts from several days to several weeks. It is characterized by icteric discoloration of the patient’s skin and mucous membranes, darkening of urine and lightening of feces. The severity of the yellow color does not always correlate with the severity of the patient's condition. Jaundice most often appears gradually, over one and a half to two weeks. Sometimes its appearance is sudden. Dyspeptic symptoms continue to progress. They usually bother the patient throughout the entire illness. The intensity of pain in the right hypochondrium may increase. Sometimes jaundice is accompanied by itchy skin, especially with hepatitis A (Botkin's disease). It is very important in such cases to distinguish viral liver damage from manifestations of obstructive jaundice due to cholelithiasis. Hemorrhagic complications in the form of bleeding occur. The central nervous system is often affected, which is manifested by headache, apathy, insomnia or, conversely, drowsiness, causeless euphoria. Extrahepatic manifestations of the pancreas (pancreatitis), the musculoskeletal system (arthralgia, myalgia), skin (various types of rashes) and others are also likely.
4. Convalescence or recovery. Lasts several months after the end of the icteric phase. Unexpressed manifestations of asthenovegetative syndrome persist. Laboratory parameters are gradually normalizing. Deviations in laboratory parameters that persist for more than 6–12 months suggest chronicity of the disease. In this case, further examination is necessary.

In addition to the typical course, there are anicteric and erased forms, which occur with minimal manifestations of liver damage. Their frequency, according to various sources, ranges from 2 to 80% of cases.

The latent course of the disease with the absence of obvious symptoms is distinguished.

The most dangerous form of acute viral hepatitis is fulminant hepatitis.

It is distinguished by a very severe course of the disease and a fairly rapid culmination in the form of acute liver failure. Fulminant hepatitis exists in early or late forms. The development of the early form occurs in the first two weeks of the jaundice period and has an aggressive course with a rapid transition to hepatic coma. The late form develops from the 15th day of jaundice and is also dangerous, although it progresses more slowly.

Complications

The most terrible complication of acute viral hepatitis is the formation of liver failure, which can lead to coma and death. With hepatitis A (Botkin's disease), this complication occurs much less frequently than with infection with viruses B, C, D, E, G.

Transformation into a chronic process with hepatitis B, C, D occurs much more often than with hepatitis A (Botkin's disease) and E.

More rare complications include biliary tract diseases and aplastic anemia.

Diagnostics

On examination, an enlarged liver is found, and sometimes the spleen is found. Hepatomegaly appears already in the prodromal period and persists for quite a long time.

Laboratory tests reveal changes in peripheral blood parameters, an increase (or decrease) in the number of leukocytes, lymphocytes, monocytes, and eosinophils. Anemia may occur later.

An increase in the activity of hepatic aminotransferases and aldolase is recorded, the maximum values ​​occur during the period of jaundice. An increase in bilirubin levels is also determined. At the height of the disease, the above is accompanied by signs of profound liver dysfunction: a decrease in the level of proteins, a-lipoproteins, and cholesterol. The functions of the blood coagulation system are disrupted towards hypocoagulation. Hypoglycemia (low blood sugar) often develops.

Specific diagnostics are shown in Table No. 2.

Table No. 2. Serological indicators (markers) of viral hepatitis.

Acute viral hepatitis is treated in an infectious diseases department.
General principles of treatment Instrumental examination methods are most often not required. In doubtful cases, ultrasound, MRI or CT, as well as liver puncture biopsy, are used.

• The protective regime is observed. A special diet is prescribed - table No. 5 or 5a (according to Pevzner), taking into account the severity of the disease.
• The basis of treatment for hepatitis A (Botkin's disease) and E is detoxification of the body, and for other types of viral hepatitis (B, C, D, G) it is one of the auxiliary therapies. For this purpose, enterosorbents, hemodilution, antioxidants and antihypoxants are used, and in some cases plasmapheresis is used. The volume of incoming fluid increases to 2–3 liters per day. Skin care and thermal comfort are required in order to improve microcirculation and activate the activity of the sweat and sebaceous glands.
• Therapy aimed at correcting protein synthesis by the liver and its recovery processes.

Protein food supplements, solutions of synthetic amino acids, infusion of protein preparations, multivitamins and microelements, especially potassium, are used.

• Treatment aimed at reducing the manifestations of liver necrosis and fibrosis.
• Correction of cholestasis symptoms.
• Correction of hemostasis parameters.
• Antiviral therapy. Unlike hepatitis A (Botkin's disease) and E, parenteral viral hepatitis (B, C, D, G and some others) are strict indications for etiological therapy.
• Specific immunoglobulins.
• Immunocorrective therapy.

Chronic viral hepatitis

Most often, the course of the disease is asymptomatic, sometimes there is an indication of acute hepatitis in the past: extremely rarely - A, E, more often - B, C, D. Sometimes the cause cannot be determined - unverified chronic hepatitis.

Clinical symptoms are very nonspecific: nausea, lack of appetite, weakness, discomfort in the right hypochondrium. There may be manifestations of jaundice, ascites, spider veins.

Examination almost always reveals hepatomegaly, and sometimes an enlarged spleen. Laboratory tests may reveal increased activity of serum liver transaminases, bilirubinemia, and identification of specific markers of chronic viral hepatitis. Moreover, laboratory test indicators often do not always reflect the true picture of the pathological process and the severity of liver damage.

Morphological examination of the liver is of great importance in diagnosis. This allows you to establish an accurate diagnosis, as well as determine the degree of activity and stage of development of the disease. Moreover, the hepatitis C virus can sometimes be detected only in liver tissue if blood tests are negative. The degree of activity of chronic hepatitis depends on the severity and severity of the processes of necrosis and inflammation in the liver.

The following morphological forms are known, characterizing the degree of activity of the pathological process: chronic persistent hepatitis (CPH) and chronic active hepatitis (CAH). It should be noted that persistent hepatitis does not always progress to active hepatitis, and CAH may not transform into liver cirrhosis. The formation of liver cirrhosis can also occur without previous CAH. Sometimes CPG and CAG can transform into each other. Obviously, this depends on the interaction of the virus and the state of the patient’s immune system.

Principles of treatment

What matters is the activity of the inflammation process, based on which the attending physician makes recommendations. However, there is a general approach to therapy that is prescribed to all patients.

• A gentle regimen is recommended. It is prohibited to work with physical and nervous overload. In case of exacerbation of the disease, bed rest is recommended. The use of drugs with potentially hepatotropic effects is excluded. Medicines that are slowly neutralized by the liver (analgesics, sedatives, some laxatives, etc.) are undesirable. Physiotherapy on the liver area is contraindicated. During the period of exacerbation, operations and vaccinations are carried out exclusively for health reasons.
• Diet No. 5, stopping drinking alcohol and smoking.
• Drug treatment. Antiviral therapy acts directly on the virus. The most commonly prescribed drugs are alpha-interferon, often in combination with ribavirin, and lamivudine. Research is underway to develop new, more effective drugs for the treatment of viral hepatitis. Antiviral therapy is selected separately for each patient, taking into account many factors. Outside of exacerbation, hepatoprotectors, drugs to improve metabolic processes, vitamins and minerals, and immunomodulators are used.
• Vaccination against HBV. It is recommended in some cases for patients with chronic hepatitis C to prevent HBV infection and the development of coinfection.

Viral hepatitis in children

Infection of children occurs both in utero - vertical transmission of the virus, and after birth.

Infectious hepatitis in children is caused by the same pathogens as in adults: hepatitis viruses A, B, C, D, E, F, G; rubella viruses, cytomegalovirus, herpes, HIV (AIDS), etc.

With intrauterine infection, fetal hepatitis forms in parallel with congenital malformations and damage to other organs in the newborn. Congenital hepatitis manifests itself immediately after birth, significantly worsening the adaptation processes of the newborn. The severity of clinical manifestations in newborns depends on the degree of damage by the infectious agent. As a rule, congenital hepatitis in a newborn child has an unfavorable prognosis. Such hepatitis is treated with etiotropic (acting on the pathogen) drugs.

Older children most often have hepatitis A or Botkin's disease and, less often, hepatitis B. Other types of hepatitis are quite rare in them.

The main points of the epidemiology of HAV in childhood are:

• Botkin's disease most often affects children aged 3–7 years.
• There is a clear seasonality with a peak incidence in autumn and winter.
• Contact is often family, also in children's institutions and schools.
• The outcome of Botkin's disease is complete recovery without becoming chronic or fatal.
• The younger the child is, the more common the anicteric form is.

In the epidemiology of viral hepatitis B in children, the route of transmission is of great importance. Intrauterine or intrapartum infection significantly worsens the prognosis. The course of hepatitis is often anicteric, and in children under one year of age and newborns it can be asymptomatic, which significantly complicates diagnosis.

Prevention of viral hepatitis

Prevention measures depend on the mechanism of transmission of the virus.

Prevention of hepatitis A and E. First of all, careful adherence to the rules of personal and general hygiene. You should always keep your hands clean, especially after using the toilet. It is also necessary to monitor the purity of water and food.

Prevention of hepatitis B, C, D, G. Protection from contact with someone else's blood and biological fluids in any way. Practice only protected sex.

There is an opinion in society that contracting hepatitis is equivalent to a death sentence. But not everyone knows that there are several varieties of this disease that can be successfully treated. The danger of hepatitis is that it is asymptomatic for a long time. The first signs of a pathological process occur when the disease has led to irreversible consequences.

Hepatitis is an inflammation of the liver tissue, it develops against the background of:

• viral infection of the body;
• toxic effects;
• reduction of immune defense.

Researchers have identified 6 viruses that provoke the development of hepatitis.

Hepatitis A, or Botkin's disease

Hepatitis A is diagnosed more often than other forms of pathology. The virus is transmitted through:

• failure to comply with personal hygiene rules (dirty hands);
• unwashed food.

Hepatitis A is prevented through vaccination and good hygiene.

For the first time, pathology manifests itself in the form of elevated temperature. The remaining symptoms characteristic of hepatitis A are in many ways similar to the clinical picture observed with influenza. Approximately 2-4 days after infection with the virus, the patient's urine becomes dark in color. Feces become colorless. As the pathological process develops, jaundice develops, which indicates liver dysfunction. However, it was during this period that the patient’s condition improved.

The course of the pathology takes from 1 week to 2 months. The duration of the rehabilitation period, during which the basic functions of the body are restored, is approximately 6 months. In most patients, hepatitis A occurs without complications. Bed rest is recommended during treatment. Therapy for hepatitis A involves taking hepatoprotectors (medicines that restore liver function) and adjusting the daily diet.

Hepatitis B (b, B), or Serum hepatitis

Hepatitis B often causes complications. Liver damage in this form of pathology is more severe.

Hepatitis B virus is transmitted:

• through blood;
• during unprotected sexual intercourse;
• through the placenta from mother to child.

The first symptoms indicating hepatitis B infection appear as:

• increased body temperature;
• general weakness;
• pain in the joints;
• attacks of nausea and vomiting;
• Less commonly observed is a change in the color of urine (darkens) and stool (lightens).

The clinical picture of hepatitis B is characterized by the appearance of skin rashes, an increase in the size of the liver and spleen. Jaundice usually does not occur with this form of pathology.

Hepatitis B is complicated in severe cases by cancer or cirrhosis of the liver.

The disease develops as a result of infection of the body with a virus containing DNA. The diagnosis is confirmed when specific antibodies are detected during a blood test. Treatment of the disease is carried out comprehensively. It provides for receiving:

• hormonal medications;
• immune drugs;
• hepatoprotectors;
• antibiotics.

Vaccination against hepatitis B is carried out several times. The serum is first administered a few hours after the baby is born. During the first year of life, 2 more vaccines are administered.

Hepatitis C

It is considered the most severe form of pathology. The disease is also known as post-transfusion hepatitis. More often, pathology develops due to transfusion of contaminated blood. In addition, infection occurs when using non-sterile medical devices and during cosmetic procedures. Less commonly, transmission of the virus occurs through unprotected sex or through the placenta from mother to child.

Today, in order to prevent the spread of the hepatitis C virus, donor blood is tested without fail.

The disease is often asymptomatic. The absence of pronounced signs indicating liver damage is observed in approximately 95% of patients. The remaining 5% of patients are diagnosed with jaundice, manifested as:

• dark urine;
• yellow skin and mucous membrane of the eyes.

Jaundice due to hepatitis C is mild and therefore usually goes unnoticed.

The asymptomatic course of the disease takes several years. The virus does not manifest itself in any way during this period, so the patient does not seek help. Sometimes complaints about deterioration of the condition are received when inflammation of the liver tissue has led to the development of cirrhosis of the organ. In such circumstances, the disease is difficult to treat.

In 70-80% of patients, hepatitis C becomes chronic. It carries the greatest danger, as it is often complicated by cancer or cirrhosis of the liver. Modern medicine cannot yet offer an effective vaccine against hepatitis C.

Hepatitis D

Hepatitis D (delta hepatitis) differs from other forms of the disease in its developmental features. The virus of this pathology remains inactive for a long time. It begins to multiply only if there is an infection with hepatitis B. The clinical picture for both pathologies is similar. The only difference between the diseases is that hepatitis D causes more severe complications.

Hepatitis E

Symptoms of hepatitis E resemble those characteristic of hepatitis A. The peculiarity of this form of pathology is that with complications caused by inflammation of the liver tissue, the affected area extends to the kidneys. Hepatitis E develops due to consumption of contaminated foods and poor hygiene. The maximum risk of contracting the virus is observed in countries with hot climates and poor water.

In most cases, the prognosis for recovery from hepatitis E is favorable.

Hepatitis G

Hepatitis G is characterized by symptoms similar to those of hepatitis C. But the first form of pathology is less dangerous for humans than the latter. In particular, the development of hepatitis G does not lead to cirrhosis or liver cancer. When both forms of pathology are combined, these complications occur frequently.

How to protect yourself from hepatitis

If there is a person in the family with hepatitis A, you must wash your hands thoroughly and regularly with soap and do not use the patient’s utensils.

1. Although hepatitis B and C viruses are not transmitted through the air or through saliva, it is not recommended to use personal hygiene items of a sick person.
2. Use contraception during sexual intercourse.
3. Monitor (require) compliance with the rules for disinfection of devices used in medical institutions by dentists and hairdressers.
4. Comply with sanitary and epidemiological standards.

Hepatitis A, B and C pose the greatest danger due to their relatively high prevalence. At the same time, we must not forget about the prevention of other forms of the disease.

Pregnant women are at risk

The greatest danger for women during pregnancy is hepatitis E. During this period, the body's protective functions are weakened. In addition, if infected in the third trimester of pregnancy, the probability of death reaches 9-40%. The fetus almost always dies in such circumstances.

It is important to follow preventive measures during pregnancy.

Diet food

Regardless of the form of hepatitis, the carrier of the virus must exclude from the daily diet foods that burden the liver. These include spicy, sour and poorly digestible foods.

Dietary nutrition for hepatitis includes the following:

1. Fat-containing products. The patient is allowed to eat butter and vegetable (sunflower, olive) oils.
2. Vegetable and milk soups, as well as soups containing fruits, noodles or cereals.
3. Lean meats (beef, rabbit, veal). It must be steamed.
4. Beef sausages.
5. Dietary and doctor's sausages.
6. Low-fat fish (pike perch, cod, carp).
7. Dairy products. It is better to consume homemade products that are low in fat. Sour cream can only be used as a dressing.
8. One egg per day without yolk.
9. Fresh vegetables and fruits. They can be consumed boiled.

The exact list of prohibited and permitted products is compiled by the attending physician.

Hepatitis vaccination

The main measure to prevent infection and spread of viral hepatitis is vaccination. They reduce the activity of the disease, creating conditions for controlling its development and complete cure. Viral hepatitis is relatively difficult to treat. This is especially true when treating chronic forms of diseases. Typically, in such circumstances, the effect of therapy is aimed at maintaining vital body functions and relieving symptoms.

In case of liver damage, hepatoprotectors are mainly used, which are not always able to suppress or stabilize the development of the inflammatory process in the tissues of the organ. In the treatment of viral hepatitis, specific antiviral drugs show good results. However, they are not able to completely cure the patient. A number of hepatitis causes liver cancer and cirrhosis. Therefore, many patients have to undergo treatment for the rest of their lives after suffering from the disease.

Vaccines against hepatitis viruses

Modern medicine offers effective vaccines against viral hepatitis A, E and B. However, drugs that can prevent infection with hepatitis C have not yet been developed. To prevent hepatitis A and E, vaccines that contain live, killed or recombined viruses are used. In the treatment of these diseases, gamma globulin is also used, which in some cases can prevent the development of pathology.

Vaccination against hepatitis B has recently been carried out using a T-cell vaccine (DNA vaccine).

Who is at risk

In modern conditions, vaccination against hepatitis viruses is mainly prescribed to people at risk. The selective procedure is due to financial reasons: drugs are expensive to produce, so not every person is able to pay for them.

The risk group for infection with hepatitis A and E viruses includes:

• housing and communal services employees, including people maintaining sewer systems;
• tourists, sailors and other persons visiting countries and territories where the likelihood of contracting the virus is extremely high;
• group associations of people and so on.

The risk group for hepatitis B infection includes people who are constantly in contact with blood. These are, first of all, medical employees: employees of the blood transfusion station, surgeons and others.

Vaccination is mandatory in cases where an epidemic of pathology has been identified in a particular area.

Vaccination against viral hepatitis is carried out free and paid. Therefore, anyone who wants to protect themselves from infection can go to the clinic to undergo the procedure.

Routes of transmission of parenteral hepatitis

Viruses that cause parenteral hepatitis belong to different families. But they are united by one fact: they are very tenacious in the external environment. For example, the hepatitis B virus can remain alive for three to six months at room temperature. And when frozen (at a temperature of -20 degrees) it lasts for more than ten years. Hepatitis viruses are also resistant to most disinfectants.

The source of infection is virus carriers, as well as all patients with parenteral viral hepatitis in any form of the disease. That is, patients with both acute and chronic viral hepatitis pose a danger. Moreover, a person becomes infectious from the middle of the incubation period. This is the most dangerous situation, since during this period the disease does not yet manifest itself. A person does not even know that he is sick and now certain measures must be taken so as not to infect others.

Parenteral hepatitis B and C viruses are found in all biological fluids of the body, but in maximum concentration in blood and semen. To infect a person, a small drop of infected blood is enough, not even visible to the human eye.

Based on this, the following transmission routes are distinguished:

Parenteral - during surgical and dental procedures, during tattooing, manicure, intravenous injections using contaminated instruments;

Sexual - during sexual contact with an infected partner without using condoms;

Vertical - infection of a child from an infected mother in utero or directly during childbirth;

Contact-household - when using razors, toothbrushes, manicure accessories of an infected person.

When communicating, shaking hands when meeting, hugging and kissing, just like with HIV, the viral infection is not transmitted.

According to modern data, about 240 million people around the globe are chronically infected with hepatitis B, and approximately 150 million people suffer from hepatitis C! It is not only injection drug addicts or people with promiscuous sex who get hepatitis. Given the widespread prevalence of the infection, other people are also at risk when undergoing routine dental and manicure procedures. When visiting nail salons in general, you need to be very careful, because as practice shows, not all masters process the tools properly.

Symptoms of viral hepatitis B, C

The incubation period for hepatitis B is 50-180 days, and for hepatitis C on average 6-8 weeks. At this time, the disease does not make itself felt in any way. After the incubation period, the pre-icteric period begins, lasting on average four to ten days. During this period, general weakness, fatigue, joint pain, skin rashes, and fever may occur. Such symptoms are completely nonspecific, so at this stage they are often associated with other diseases.

In the next period - icteric, the clinical picture of viral hepatitis becomes more pronounced.

The course of viral hepatitis B and C may be accompanied by symptoms such as:

Enlarged liver, spleen;

Darkening of urine;

Discoloration of stool;

Yellowness of the skin, sclera;

Itchy skin;

Heaviness in the right hypochondrium;

Weakness;

Loss of appetite;

Nausea and vomiting may occur.

Typically, the jaundice period lasts two to six weeks, but in some people it can even last several months. In the future, several development options are possible. In an uncomplicated course, viral hepatitis ends in recovery after three to four months. However, unfortunately, such a successful outcome does not always occur. It is noteworthy that hepatitis C often has few symptoms and no jaundice, but ultimately ends very badly. In this regard, he received the name "gentle killer."

Possible adverse outcomes of viral hepatitis:

Chronization - observed in 10-15% of all cases with viral hepatitis B and in 80-85% of cases with hepatitis C.

Liver cirrhosis is the proliferation of fibrous tissue in the organ. Liver cirrhosis occurs in 20-40% of patients with hepatitis C.

Liver carcinoma - with hepatitis C, the risk of developing a malignant process in the liver is three to four times higher than with hepatitis B.

Diagnosis of viral hepatitis B, C

Laboratory tests are fundamental in the diagnosis of hepatitis. They represent the detection of specific antigens and antibodies, as well as viral genetic information, in the human body. The biochemical composition of the blood can change significantly in the presence of liver disease, so you should not neglect such an important analysis as liver tests.

Tests to detect hepatitis:

• Liver tests (ALT, AST, LDH, SDH, alkaline phosphatase, GLDH, GGT, thymol test);
• Biochemical blood test (albumin, globulins, bilirubin, prothrombin, fibrinogen);
• Analysis for the presence of hepatitis markers (antigens and antibodies specific to a specific hepatitis virus);
• PCR (detection of genetic information of viruses).

Biochemical blood tests and liver tests only indirectly indicate hepatitis; their indicators also change in other liver diseases. Therefore, to accurately confirm the diagnosis of hepatitis, it is necessary to conduct an analysis for the presence of hepatitis markers, as well as PCR.

Currently, rapid tests for hepatitis are becoming increasingly popular, allowing you to quickly and reliably determine the presence of hepatitis markers in the blood at home. They are a set of test strips impregnated with a chemical that changes color upon contact with a specific hepatitis marker. Such tests are quite easy to use, and the reliability of the results reaches about 99%.

The rapid test kit includes a test strip in a sealed package, a wipe with a disinfectant solution, a scarifier for pricking your finger, a pipette for collecting a blood sample from your finger (one or two drops are enough) and a chemical substance for diluting the blood sample.

Treatment of viral hepatitis B, C

All patients with parenteral hepatitis are subject to hospitalization. The patient must comply with bed rest and diet No. 5a according to Pevzner. Food should be sufficiently high in calories. The required calorie content is mainly achieved through proteins and carbohydrates. Lipid intake should be limited. Dishes are boiled, pureed, and always warm. It is recommended to eat small portions, but often.

It is mandatory for a patient with viral hepatitis to undergo detoxification therapy using enterosorbents and infusion solutions (hemodeza, glucose, Ringer's solution). To correct metabolic disorders, vitamin preparations, cocarboxylase, potassium orotate, etc. are prescribed.

In the treatment of patients with severe hepatitis, interferons (Viferon, Laferon) are used in long courses. The use of these drugs does not kill the virus, but slows down its further reproduction. When determining signs of an active inflammatory process, the patient is prescribed glucocorticosteroids (Prednisolone). For chronic forms of the disease, hepatoprotectors are used (Essentiale, Phosphonciale).

Prevention of viral hepatitis B, C

Parenteral hepatitis is a very dangerous disease. It can be avoided by taking certain precautions.

Preventive measures to prevent parenteral hepatitis:

Vaccination - carried out for newborns, as well as adults from certain risk groups (health workers, blood donors);

Do not use drugs;

Use condoms;

Maintain personal hygiene, do not use other people’s razors or toothbrushes;

Avoid dubious manicure and tattoo salons. Learn how to do a manicure yourself or visit a specialist with your own manicure tools.

Among all viral hepatitis, hepatitis B and C are the most common. These diseases are transmitted parenterally (through blood) and sexually, are predominantly asymptomatic and lead to the development of severe complications.

The danger of hepatitis B and C

According to WHO, about 240 million people in the world have chronic hepatitis B and about 780 thousand people die from this infection every year. Hepatitis C is less common - it affects about 150 million people, but the mortality rate from this infection is no lower - about 500 thousand patients die every year.

Hepatitis C is often called the “sweet killer” because it masquerades as completely different diseases or does not appear at all, but it constantly destroys the liver. Approximately 30% of patients with a chronic form of the disease develop cirrhosis if left untreated for 10-20 years.

In the Russian Federation in 2015, more than 12,000 cases of chronic hepatitis B and more than 40,000 patients with chronic hepatitis C were identified for the first time. Doctors diagnose acute forms of the disease much less frequently (an average of 2,000 cases per year). This is explained by the high frequency of the latent course of the disease or the immediate development of a chronic form of the disease.

The causative agent of hepatitis B

The causative agent of hepatitisB is a virus of the hepadnavirus family (often abbreviated HBV or HBV). It is very resistant to various chemical and physical influences, so simple washing and boiling is not enough to disinfect objects that have been in contact with the patient’s blood. This explains the progressive spread of infection among the world's population.

Recently, mutated strains of the HBV virus have been increasingly discovered in patients. “Mutant” strains more often lead to the development of a chronic form of the disease, which is less treatable and is generally considered more unfavorable prognostically than the disease caused by the usual “wild” strain of HBV.

The causative agent of hepatitis C

Hepatitis virusC(HCV or HCV) is a flavivirus that is represented by 11 genotypes. Each of them has its own geographic distribution, sensitivity to treatment with antiviral drugs, and the ability to cause certain characteristics of the disease. For Russia and the European region, viruses of genotypes 1, 2 and 3 are most relevant. The disease caused by HCV genotype 1 is less treatable and more often leads to the development of complications.

Routes of infection

The sources of parenteral hepatitis are both patients and carriers of the infection, and doctors only know approximate numbers about their number; in fact, there may be much more such people. Therefore, every person should know how hepatitis C and hepatitis B are transmitted.

You can become infected with these dangerous diseases in the following ways:

Viral hepatitis infection does not occur through hugs, kisses, or household contacts. However, relatives of sick people should take into account that the source of dangerous viruses are shaving utensils, toothbrushes, manicure and pedicure instruments of the patient, as well as other objects that receive blood.

Taking into account the routes of transmission of these infections, the following can be distinguished: Risk groups for infection with parenteral hepatitis:

• Injection drug addicts.
• People who have promiscuous sex.
• Sexual partners of patients with hepatitis.
• Relatives and cohabitants of patients with hepatitis.
• Medical workers.
• Homosexuals and people who prefer perverted forms of sex (with perverted sexual contacts there is a high probability of injury to the mucous membranes and, accordingly, infection).
• Children born to mothers with hepatitis.
• People suffering from illnesses that require blood transfusions or hemodialysis.
• Persons who often expose their body to tattooing and piercing.

Symptoms of parenteral hepatitis

Hepatitis B and hepatitis C have similar symptoms. From the moment the virus enters the body until signs of illness appear with hepatitis B, an average of 2-6 months passes, with C - 1.5-2 months. The onset of the disease can be acute or hidden.

With an acute onset the following appear: signs of hepatitis:

• yellowness of the skin and whites of the eyes;
• darkening of urine;
• lightening of the stool;
• high body temperature;
• weakness, poor health;
• nausea.

The outcome of acute hepatitis is either complete recovery, or the transition of the disease to a chronic form, which is largely determined by the patient’s immunity. If hepatitis infection occurs in childhood, the risk of chronic infection is much higher. For example, in children in the first year of life, chronic hepatitis develops in 80-90% of cases. This explains the need for it to be carried out immediately after birth.

Quite often, due to the asymptomatic onset of the disease, the patient learns about his condition when a chronic inflammatory process in the liver leads to an enlargement of the organ and disruption of its function. In this case, unpleasant painful sensations appear in the right hypochondrium (due to stretching of the liver membrane), nausea, and digestive disorders. The biochemical blood test of such patients will also have corresponding deviations. Therefore, if you are concerned about the described symptoms or during the examination changes in biochemical blood parameters that reflect the condition of the liver are revealed (even if there are no complaints), it is necessary to be examined for viral hepatitis.

Complications

Complications of viral hepatitis pose a potential danger to the patient's life. Such complications include:

• Liver cirrhosis, with all its consequences - ascites, portal hypertension, bleeding.
• Liver failure.
• Liver cancer.

To prevent the development of these conditions, people at risk should regularly have their blood tested for hepatitis.

Parenteral hepatitis and pregnancy

Due to the fact that a child can become infected with viral hepatitis from his mother, all pregnant women are checked for the presence of HBV antigens in their blood, and women from risk groups are additionally examined for hepatitis C. Infection of the fetus from a sick mother is possible in utero with placental abruption and procedures that violate integrity of the membranes (for example, amniocentesis). In most cases, infection occurs during childbirth, so doctors recommend that such patients undergo a cesarean section, which is considered safer in such situations. The final choice depends on the woman’s condition and the activity of the infectious process.

Immediately after birth, children of mothers with hepatitis B are given immunoglobulin and vaccinated according to a special scheme. With hepatitis C, this is not possible, so children are regularly examined in order to detect the onset of the disease in time.

Breastfeeding if the mother has viral hepatitis B or C is not contraindicated.

Diagnosis of hepatitis B

To confirm that the patient has hepatitis B , and also to determine its form (acute or chronic), a special blood test is carried out for markers of hepatitis. There are quite a lot of these markers and they are not all searched for at once. The very first diagnostic test is the determination of HBsAg, the surface antigen of HBV, which is present in the blood of both patients and carriers.

If HBsAg is detected, the patient is prescribed other tests - (search for viral DNA), HBeAg, antibodies, etc. Based on the results of these tests, it is determined whether there is a disease and in what phase the infectious process is.

Markers are assessed as follows:

Diagnosis of hepatitis C

At the first stage of diagnosis, antibodies to HCV are detected. If they are present, HCV PCR is performed (viral RNA detection is qualitative). A positive result of this test confirms the presence of infection in the body. At the next stage, the viral load is determined (HCV quantitative PCR) and hepatitis C genotype . In addition, the patient’s liver must be examined using a biopsy or elastometry (a non-invasive method that allows one to determine the degree of liver fibrosis). All this data is necessary to choose treatment tactics.

Hepatitis B treatment

In the acute form of the disease, specific antiviral treatment is not carried out. Patients are recommended diet, rest, and detoxification therapy. If chronic hepatitis is detected, antiviral therapy can prevent the development of cirrhosis and improve the patient’s condition, but does not guarantee complete recovery. Treatment regimen for patients with chronic hepatitisB includes:

Features of hepatitis C treatment

With hepatitis C, diet and avoidance of alcohol are also important. Standard treatment regimens for the disease include the administration of pegylated interferons and ribavirin. These drugs are not always well tolerated by patients, especially when taken for a long time.

New drugs for hepatitis C (Ledipasvir, Sofosbuvir, etc.) have become a real breakthrough in medical science, but research in this direction is still ongoing.

Prevention of viral hepatitis

For hepatitisBThe most effective preventive measure is vaccination. It is carried out according to the following scheme: the child receives three doses of the drug - in the first days of life, per month and six months. Immunity develops in almost all vaccinated people and lasts for 10 years or more. Revaccination every 10 years is carried out if indicated (for example, if a person is at risk). Adults should also be vaccinated.

Other measures to prevent hepatitis B are the same as for hepatitis C, for which there is no vaccination: protected sexual contact, use of disposable syringes, minimizing visits to manicure, piercing, and tattoo salons if possible, compliance with safety measures at home (for relatives of a person with hepatitis), responsible attitude of medical personnel to their duties (disinfection of instruments), etc.

Viral hepatitis B is an inflammatory viral disease that primarily affects liver tissue. After a person recovers from this disease, he develops lasting, lifelong immunity. But a transition from the acute form to a progressive chronic form is possible.

Hepatitis B: what is it?

Hepatitis B (B) is a viral infection that primarily affects the liver and leads to a chronic progressive form of the disease, carriage of the virus, and the development of cirrhosis and liver cancer.

The main signs of hepatitis B are:

• nausea,
• loss of appetite,
• increased fatigue,
• jaundice,
• discomfort in the right hypochondrium,
• darkening of urine.

What are the characteristics of the hepatitis B virus?

1. The virus can easily withstand heating up to 100 ºC for several minutes; resistance to temperature increases if the pathogen is in the blood serum.
2. Repeated freezing does not affect its properties; after thawing it will still be infectious.
3. The virus cannot be cultured in a laboratory, making it difficult to study.
4. The microorganism is found in all human biological fluids, and its infectiousness is even a hundred times higher.

Inactivation of the virus is carried out by processing in autoclaves by heating to 120°C for 45 minutes, or in a dry-heat oven at 180°C for 60 minutes.

The virus dies upon exposure chemical disinfectants: chloramine, formaldehyde, hydrogen peroxide.

Causes and routes of transmission

According to WHO estimates, more than 2 billion people in the world are infected with the hepatitis B virus, and 75% of the world's population lives in regions with high incidence rates. Every year, an acute form of infection is diagnosed in 4 million people.

After the hepatitis B virus enters the blood of a still healthy person, it reaches hepatocytes (liver cells) through the bloodstream. In them, replication (multiplication) of the virus occurs, which infects an increasing number of new cells, while some parts of the DNA of the virus are integrated into the DNA of hepatocytes.

The immune system does not recognize the changed cells and perceives them as foreign. The production of antibodies begins to destroy the altered hepatocytes. Thus, the liver is destroyed, which leads to an inflammatory process and.

The vast majority of people with hepatitis B are people aged 15-30 years. Among those who died from this disease, the proportion of drug addicts is 80%. Persons who inject drugs are at greatest risk of infection.

How is hepatitis B transmitted?

A person should know how hepatitis B is transmitted. So that he can take action if he is near a carrier of the virus. The viral infection is found in:

• blood;
• vaginal discharge;
• sperm.

It is in these biological fluids of the carrier that the concentration of the virus is in large quantities.

There are several ways to transmit the hepatitis B virus:

• if you transfuse infected blood to a healthy person;
• using the same syringe several times;
• through medical equipment, if proper cleanliness is not done: during sexual intercourse;
• newborn from mother:
• infection at home.

The main route of infection with group B hepatitis is through blood or any other biological fluid. At the same time, the virus is very active, infection can occur within a few days, after the blood, for example, has completely dried on clothing or a hygiene item. Therefore, there is a danger of infection wherever there may be contact with the biological fluids of other people.

The risk of getting hepatitis B appears when visiting:

• beauty salons,
• manicure procedures,
• pedicure,
• tattooing, tattooing or piercing if the instruments are not sterile enough.

The method of transmission of hepatitis B to the child during childbirth is from the mother. To reduce the risk of further progression of the virus, the baby is vaccinated. Hepatitis B may appear in the future.

When skin areas, as well as mucous membranes of a healthy person, come into contact with any fluids of a patient, the probability of infection is not very high, which suggests that the hepatitis B virus practically does not spread in everyday life. Microdamage to the skin increases the risk of infection several times. The patient's fluids are dangerous even when dried!

The virus is transmitted through saliva, so there is a possibility become infected during a kiss if a healthy partner has microtraumas in the mouth, diseases of the teeth and gums, accompanied by bleeding.

Risk group

A specialist will quickly determine how hepatitis B was transmitted by finding out the area of ​​activity and lifestyle of the person being diagnosed.

Objects infected by the virus:

• Hepatitis is transmitted from a person who practices homosexual or promiscuous sexual intercourse.
• Healthcare workers.
• Drug addicts.
• Persons serving sentences in penitentiary institutions.
• Patients on hemodialysis.
• Blood recipients.
• Babies born from a mother infected with the virus.
• Family members of the infected person.
• Tourists who choose endemic areas as their vacation destination.

Forms of development

What is the probability that acute hepatitis B will become chronic?

1. The likelihood depends on the age at which a person becomes infected. The younger the age at which hepatitis B virus infection occurs, the greater the likelihood of developing chronic hepatitis B.
2. Almost 90% of infected infants develop chronic infection. The risk decreases as the child gets older. About 25% to 50% of children infected between 1 and 5 years of age will develop chronic liver disease caused by the virus.
3. The risk of chronicity in adulthood is about 10%. Worldwide, most people with chronic hepatitis were infected at birth or in early childhood.

The first signs in women and men

The first signs of hepatitis B:

1. Weakness, slight fever, headache, lack of appetite.
2. Then there are signs caused by indigestion: nausea, abdominal pain, vomiting. Impaired bilirubin metabolism causes dark urine and discolored stool.
3. After these symptoms begin to gradually disappear, jaundice develops - a corresponding staining of the skin and sclera of the eyes.

Most patients show no signs of the disease. Therefore, doctors consider any person as potentially infected, observing the necessary precautions during medical procedures and using disposable instruments.

Symptoms of hepatitis B in adults

The incubation period of viral hepatitis B varies quite widely; the interval from the moment of infection to the development of clinical symptoms can range from 30 to 180 days. It is often impossible to estimate the incubation period of the chronic form.

Acute viral hepatitis B often begins similarly to viral hepatitis A, but its pre-icteric period can also occur in an arthralgic form, as well as in an asthenovegetative or dyspeptic form.

With any type of intoxication, the central nervous system is primarily affected. Clinically, this is manifested by the appearance of the following cerebrotoxic symptoms:

• sleep disturbance;
• increased fatigue, weakness;
• apathy;
• disturbances of consciousness.

In severe forms of the disease, hemorrhagic syndrome may develop - periodic nosebleeds, increased bleeding of the gums.

Hepatitis in its acute form can result in complete recovery with the formation of stable immunity, or become chronic, which is often accompanied by wave-like periods of exacerbations, often seasonal in nature.

In the acute course of the disease, three periods can be distinguished:

• pre-icteric phase;
• icteric period;
• recovery.

Anicteric period

During this period, there are no specific manifestations of pathology yet. Symptoms that are characteristic of most viral diseases come to the fore:

• headache;
• the person’s well-being gradually deteriorates;
• there is a loss of appetite;
• lethargy;
• weakness;
• muscle and joint pain;
• the appearance of respiratory manifestations (cough, runny nose) is observed.

Jaundice is associated with the accumulation of bilirubin in the blood, a breakdown product of erythrocytes (red blood cells). Normally, bilirubin enters the liver, where it binds to proteins and, as part of bile, enters the intestines and is then removed from the body.

In case of liver damage, this function deteriorates, which leads to the accumulation of bilirubin in the blood and soft tissues, causing the latter to acquire a yellow tint.

Jaundice period of hepatitis B

Gradually the symptoms progress to the icteric period. They also appear in a certain sequence:

• darkening of the urine occurs, the color resembles dark beer;
• the sclera and mucous membranes of the mouth turn yellow, especially if you raise your tongue to the palate;
• The palms and skin are stained.

As jaundice appears, the general symptoms of intoxication decrease and the condition improves. There may be pain or heaviness in the right hypochondrium at the site of the liver projection. Sometimes there may be clearing of the stool due to blockage of the bile ducts.

In the case of timely use of specific drugs, the symptoms gradually disappear and convalescence occurs. If the body cannot cope with the infection, a chronic form of pathology occurs, often progressing to cirrhosis of the liver.

Chronic form

Chronic hepatitis B is manifested by the following symptoms:

• increased fatigue;
• weakness;
• drowsiness;
• decreased appetite;
• nausea, vomiting;
• bloating;
• characteristic symptoms of chronic hepatitis B, such as darkening of urine and jaundice, appear much later than in the acute form.

There are atypical forms of the disease:

• anicteric;
• erased;
• subclinical (virtually no symptoms);
• mild, moderate and severe;
• malignant.

Complications

According to statistics, up to 90% of people, after suffering an infection, get rid of the disease almost forever. But their “complete” recovery is considered relative, since it is most often accompanied by residual effects in the form of:

• difference between normal skin and yellowed pattern of dyskinesia or inflammation of the biliary tract;
• residual astheno-vegetative syndrome;
• infection can be a trigger for the development of Gilbert's syndrome.

Acute viral hepatitis B rarely leads to death (only in cases of severe fulminant course), the prognosis is significantly worse with concomitant chronic liver pathologies, with combined damage by hepatitis C and D viruses.

Death of those infected with hepatitis B often occurs several decades later as a result of chronicity and the development of cirrhosis and liver cancer.

Diagnostics

If a person has identified symptoms indicating that he has developed hepatitis B, or he has reason to believe that he could be infected with this disease, he urgently needs to visit a medical facility. During the appointment, the specialist will conduct an examination, examine the liver area using palpation and collect an anamnesis of the disease.

Confirm or deny Laboratory testing of blood and urine will help with the initial diagnosis.

To diagnose this disease, in addition to the usual biochemical analysis for bilirubin and ALT, specific markers of hepatitis B are used:

• HBsAg antigen;
• HBeAG antigen.

In addition, specific diagnostics use the detection of antibodies to these antigens and to the specific HBcore protein, which appears in acute hepatitis B:

• anti-HBcore;
• anti-HBe.

Treatment

Treatment of hepatitis begins with a visit to the doctor and mandatory examination. This will allow you to prescribe an accurate treatment plan, as well as identify other possible diseases, if they are present. In any case, hepatitis B can be treated comprehensively.

Treatment for hepatitis B includes:

• detoxification therapy;
• maintenance therapy;
• strengthening the immune system;
• diet;
• therapy to suppress symptoms.

Treatment of acute hepatitis B

1. For mild forms of hepatitis B a gentle diet is prescribed, split meals - 5-6 times a day, semi-bed rest (you are allowed to get out of bed to eat, go to the toilet, and perform hygiene procedures).
2. For moderate hepatitis intravenous drip administration of detoxification solutions is prescribed. Treatment includes hepatoprotectors - drugs that protect liver cells from destruction, vitamins, sorbents - drugs that remove toxins from the body.
3. If you develop severe hepatitis B the patient is transferred to the intensive care unit, where, depending on the condition, symptomatic therapy is carried out.

The period of rehabilitation - recovery from acute viral liver damage - occurs differently for each patient. Some people are cured in a few weeks, while others may need 4-6 months to feel better.

• In general, the prognosis for acute hepatitis B is favorable: the disease ends in complete recovery in 90% of patients.
• In 5-10% of cases, when HBsAg remains in the body, a chronic form of the disease develops, accompanied by a high risk of complications (cirrhosis, hepatocellular cancer, impaired motility of the gallbladder, sphincter of Oddi).

Interestingly, the transition to a chronic form of the disease is more typical for mild hepatitis (anicteric, with a latent course).

How to treat chronic hepatitis B?

When chronic hepatitis B is diagnosed, comprehensive treatment is carried out:

• medications with antiviral effects are used, such as lamevudine, adefovir and others;
• drugs are prescribed that inhibit the growth of liver sclerosis, that is, interferons;
• immunomodulators are also needed to normalize the immune reactions of the patient’s body;
• hepatoprotectors are important, helping the liver fight at the cellular level;
• You can’t do without vitamins and minerals.

Depending on the severity of the disease, therapy can be carried out either on an outpatient or inpatient basis. The decision about whether the patient needs hospitalization or not is made individually by the doctor, depending on the clinical manifestations of hepatitis and the severity of the exacerbation.

For patients who have been diagnosed with hepatitis B disease, there are several options for the development of events:

• A person undergoes complex therapy and gets rid of a viral infection, acquiring stable immunity to this disease;
• In a patient, the acute form of hepatitis B becomes chronic, which can be accompanied by serious complications for the body;
• After treatment, the patient becomes a carrier of the hepatitis B antigen, which will not cause him concern for decades. For 20 years, this virus can be present in the patient’s blood without visible clinical manifestations;
• A patient who does not go to a medical facility in a timely manner develops cirrhosis or liver cancer, which requires emergency surgical intervention.

After treatment is completed, individuals develop the virus antigen in their blood for many years. These people become carriers of this infection and are required to be systematically examined and also undergo tests.

Diet and proper nutrition

In the acute period, bed rest and strict dietary nutrition are indicated. The diet for hepatitis B in the acute period is aimed at maximally sparing the organ with adequate nutrition. The acute process requires adherence to Diet No. 5A, in which food is prepared only grated or well-cooked. Soups can be made with finely chopped vegetables. Some dishes are prepared baked, but without a distinct crust. Diet: 5 times a day.

In case of chronic hepatitis B, adherence to diet No. 5 is not necessary, but when drawing up a menu it is worth keeping a guide to it. Experts say that in the chronic stage it is important to adhere to a healthy diet. Proper healthy eating involves consuming enough proteins, fats, carbohydrates and beneficial microelements

What should you not eat?

It is prohibited to use:

• fresh and rye bread;
• products made from butter or puff pastry;
• millet and all legumes;
• broths;
• fatty meats, fried meats, sausages, smoked meats;
• offal and canned food;
• cream and fat cottage cheese;
• mushrooms, legumes, pickled vegetables, turnips, radishes, cabbage, sorrel, garlic, onions;
• fruits that are sour and rich in fiber;
• cocoa, coffee, chocolate, carbonated drinks.

Allowed foods

Dishes and food allowed for consumption in acute and chronic forms of hepatitis B:

• yesterday's bread;
• unleavened pastries with various fillings;
• biscuits, marshmallows;
• soups cooked in water, milk, low-fat broth;
• chicken ham and sausages;
• from meat - chicken, veal, rabbit;
• from fish - pollock, hake, blue whiting;
• steamed and baked omelettes;
• steamed meatballs and cutlets;
• milk, low-fat fermented milk products;
• all types of cereal porridges;
• vermicelli and pasta;
• vegetable salads seasoned with sunflower oil or low-fat sour cream;
• vegetable fats;
• Bee Honey;
• fruits and vegetables in baked, boiled, raw form;
• non-acidic vegetable, berry and fruit juices;
• green tea.

With hepatitis, the processes of bile formation are disrupted, which leads to impaired absorption of vitamin K in the gastrointestinal tract and its deficiency. Foods containing vitamin K:

• parsley,
• watercress,
• basil,
• cilantro,
• cabbage (broccoli, Chinese cabbage, white cabbage),
• celery root,
• prunes,
• avocado,
• cashews, pine nuts.

Forecast

1. Acute viral hepatitis B rarely leads to death. The prognosis worsens with mixed infection with hepatitis C and D viruses, the presence of concomitant chronic diseases of the hepatobiliary system, and the fulminant course of the disease.
2. In the chronic form, patients die several decades from the onset of the disease as a result of the development of primary cancer or cirrhosis of the liver.

Is it possible to get re-infected with hepatitis B?

No, after you have had hepatitis B, you have developed antibodies that protect you from the virus for life. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from diseases associated with viruses and destroy them.

Prevention of hepatitis B

To avoid hepatitis B infection, doctors recommend adhering to the following recommendations:

1. Give your child a vaccination, but with a separate, expensive medicine, instead of the standard, scheduled one.
2. observe the rules of personal hygiene - do not use other people’s hygiene products;
3. try to eat food enriched with vitamins and microelements, and also give up unhealthy foods;
4. give up alcohol and smoking;
5. Do not take various medications unnecessarily, because many of them weaken the liver;
6. try to avoid visiting beauty salons of dubious nature;
7. try not to give birth to a child at home, resorts, etc.

Hepatitis B is a liver disease that can lead to serious consequences for the entire body. If unpleasant symptoms occur, be sure to make an appointment with a gastroenterologist to undergo diagnostics and make an accurate diagnosis.

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