What Are the Signs of Hepatitis B in Children?

Hepatitis B (Hepatitis B) is a systemic infectious disease mainly caused by liver damage caused by hepatitis B virus (HBV) infection. It is mainly transmitted through blood transfusion, blood products, inadequate disinfection of syringes, mother-to-child transmission, and close contact in life. 85% of childhood hepatitis B is infected by mother-to-child transmission. Hepatitis B virus can cause acute hepatitis, can also develop into chronic hepatitis, and even cause cirrhosis and liver cancer. Although the rate of childhood hepatitis B virus infection has decreased significantly through widespread vaccination recently, children and adult patients who have progressed from childhood still account for a significant proportion of chronic hepatitis B, so it is important to control childhood hepatitis B .

Basic Information

Visiting department: Gastroenterology
Multiple groups: child
Common causes: Caused by HBV infection
Common symptoms: Fatigue, easy fatigue, loss of appetite, nausea, oiliness, discomfort in the upper abdomen, bloating, right upper abdominal pain, etc.

Contagious: Have
way for spreading: Inadequate disinfection of blood transfusions, blood products, syringes, mother-to-child transmission, etc.

Causes of Hepatitis B in Children

The pathogen of hepatitis B is a double-stranded DNA virus with a shell, which belongs to the hepaviridae family. Its diameter is 42 nanometers. Its lipoprotein shell carries the hepatitis B surface antigen, HBsAg. Inside the outer membrane is the viral core, which consists of core antigens. Hepatitis B virus is highly resistant and has strong transmission activity and infectivity.

Clinical manifestations of viral hepatitis B in children

Acute hepatitis can occur after the incubation period of 4 weeks to 6 months after hepatitis B virus infection. Among them, 70% to 80% of acute hepatitis completely recovers from the course of 2 to 4 months, and a few patients whose disease course is longer than 6 months are chronic hepatitis. Another 1% to 2% of patients develop severe hepatitis.

Acute hepatitis B

Onset is more insidious than hepatitis A, most without fever, and few with high fever, which can lead to fatigue, fatigue, loss of appetite, nausea, oiliness, upper abdominal discomfort, abdominal distension, right upper abdominal pain and other manifestations. About 50% of patients have jaundice, yellow urine or strong tea-like appearance. Some patients may have hepatosplenomegaly, and a few patients have palmar and spider nevus. Liver function often has elevated transaminase. The course of disease is usually 2 to 4 months.

2. Chronic hepatitis B

The duration of acute hepatitis B or occult hepatitis is more than 6 months. Symptoms are more common in children. No jaundice or mild jaundice. The liver is slightly enlarged and the spleen is palpable. Changes in liver function are often characterized by fluctuations in alanine aminotransferase (ALT). When the symptoms are severe, fatigue, loss of appetite, abdominal distension, tenderness in the liver area, chronic liver disease, dark skin, hepatosplenomegaly, skin bleeding tendency, spider nevus, liver palm, etc. Hepatic impairment was more significant, and ALT continued to increase repeatedly. Elevated plasma globulin and decreased white / globulin ratio.

3. Severe hepatitis B

Rare, often with deep jaundice, severe gastrointestinal reactions, frequent vomiting, extreme weakness, persistent high fever, abnormal behavior, lethargy, disturbance of consciousness and even coma. Child patients are also prone to edema, severe abdominal distension, ascites, bleeding tendency, and combined hemolysis. Liver function suggests that serum bilirubin is significantly increased, transaminase is increased, albumin content is significantly decreased, and coagulopathy is severe. In severe cases, bile enzyme separation may occur, and mortality is extremely high.

Liver function suggests that serum bilirubin is significantly increased, transaminase is increased, albumin content is significantly decreased, and coagulopathy is severe. In severe cases, bile enzyme separation may occur, and mortality is extremely high.

Hepatitis B virus test in children

1. Liver function test

Including bilirubin, alanine aminotransferase, aspartate aminotransferase, total protein, albumin, globulin, etc.

2. Etiological examination

Including two pairs of HBs (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc). HBV-DNA and so on.

3 Pathological examination

Histopathological examination of liver puncture.

4 other

Coagulation function, blood glucose, blood ammonia, electrolytes, urine sugar, urine routine, etc.

Diagnosis of Hepatitis B in Children

The diagnosis of hepatitis B must include the presence or absence of familial agglomeration, blood transfusion, or blood transfusion products, whether the hepatitis B vaccine has been vaccinated and the production of effective protective antibodies, the corresponding clinical symptoms and signs, liver function abnormalities, and the etiology examination is the main basis for diagnosis .

Differential diagnosis of viral hepatitis B in children

1. Cytomegalovirus hepatitis

It is the most common pathogen in infant hepatitis syndrome. It can cause acute onset, jaundice, hepatomegaly, abnormal liver function, and unsustainable delay. When cytomegalovirus infection only manifests as liver damage, clinical and hepatitis B are difficult Identification, the main point of identification is the serum cytomegalovirus DNA or cytomegalovirus IgM positive.

2. Drug-induced hepatitis

Its characteristics are: history of previous useful medicines, recently taking drugs that are harmful to the liver, such as antituberculosis drugs, antipyretics, antithyroid drugs, antitumor drugs, antibiotics, Chinese medicine and so on. The clinical symptoms are generally mild, single ALT (glutamin transaminase) is elevated, and eosinophils are increased; the symptoms gradually improve after stopping the drug, and ALT returns to normal.

Hepatitis B virus treatment in children

The general principles are: proper rest, reasonable diet, supportive treatment, and selective use of medications. Avoid alcohol, prevent overwork, and avoid using liver-damaging drugs.

1. Treatment of acute hepatitis

(1) Patients in the acute stage should rest in bed. Symptoms are obviously improved, and the amount of activity can be gradually increased. The principle of not feeling tired is to be discharged until the symptoms disappear, the isolation period expires, and liver function is normal. After the recovery of liver function, it is necessary to rest for 2 to 3 months, and follow-up observation for 1 year.

(2) Give a light, digestible, nutrient-rich diet and add sufficient vitamins. When eating less, you can infuse heat and nutrition with intravenous fluids.

(3) Inpatients should take measures to isolate blood-borne diseases.

(4) Liver-reducing enzymes and traditional Chinese medicine preparations can be used appropriately. Glycyrrhizin preparation, bicyclic alcohol, reduced glutathione, Yiganling, etc.

(5) Antiviral treatment. Acute hepatitis is mostly self-limiting and generally does not require the use of antiviral drugs.

2. Treatment of chronic hepatitis

Including liver protection and enzyme reduction, anti-fibrosis and antiviral treatment.

Chronic hepatitis B, if persistent asymptomatic, normal liver function, and no liver fibrosis do not require drug treatment; when liver function is damaged, active virus replication, or liver fibrosis occurs, active treatment is required, antiviral Comprehensive treatment-based, liver protection and enzyme reduction, supplemented by anti-fibrosis.

The main drugs used in children against hepatitis B virus infection are interferon (INF) (1 year and older), nucleotide analogs: lamivudine (3 years and older), adefovir dipivoxil (12 years of age), Tenofovir (12 years) and Entecavir (16 years). Among them, -interferon (IFN-) is the antiviral drug of choice for children with chronic hepatitis B.

For anti-fibrotic drugs, you can choose compound Biejia Ruangan tablets, compound Muji granules, Fuzheng Huayu capsules and so on.

3 Treatment of severe hepatitis

Severe hepatitis has a mortality rate of more than 50%, and early detection and early treatment are important. Patients should be absolutely bedridden to avoid removing the inducement of hepatic encephalopathy, prevent and control infection, treat bleeding in time, prevent electrolyte disorders, and strengthen symptomatic supportive therapy. If possible, consider liver transplantation.

Prevention of Hepatitis B in Children

Comprehensive measures focusing on vaccination and cutting off transmission routes should be adopted.

1. Managing the source of infection

Comprehensive measures should be taken to improve sanitary conditions, establish a strict disinfection and isolation system, and strengthen the management of iatrogenic transmission channels. Strengthen the management of pediatric patients and HBV carriers in the catering industry, childcare personnel and childcare institutions.

2. Cut off

The focus is on preventing transmission through blood and body fluids. Strengthen the management of blood products; Prevent iatrogenic sexual transmission; Prevent infection of daily necessities; Block mother-to-child transmission.

3 Protecting vulnerable populations

(1) Active immunization: Vaccination of susceptible children with hepatitis B vaccine is a key measure for the control and prevention of hepatitis B. Generally, three vaccination sessions are given for a period of 0, 1, 6 months.

(2) Passive immunity: direct injection of hepatitis B immunoglobulin (HBIG), suitable for high-risk groups of accidental exposure, newborns whose mothers have chronic hepatitis B, etc.

Epidemic globulin (HBIG), suitable for high-risk groups of accidental exposure, newborns whose mothers have chronic hepatitis B, etc.