What Is the Relationship Between Hepatitis and Jaundice?

Jaundice hepatitis

About jaundice hepatitis

Synonym: Jaundice Hepatitis

English name: Icterohepatitis

Classification: TC26.065.010.015

Definition: Including hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, etc., yellow staining of the sclera and skin, and jaundice as the main symptoms.

Index note: It belongs to hepatobiliary disease; pay attention to the difference between various types of hepatitis from MeSH, only in the literature can not distinguish what kind of hepatitis, and those with jaundice as the main symptoms use this word.

Symptoms of jaundice hepatitis

1. Yellow urine such as tea: patients with jaundice hepatitis have symptoms of yellow urine. At the beginning, the urine color is yellow, and it deepens day by day, and is thick like tea or soybean oil. Then the skin and sclera are yellow. The reason for the deepening of urine color is due to the destruction of liver cells caused by the hepatitis virus, which affects the metabolism of bilirubin and causes bilirubin to increase into the blood.

2. Pain in the liver area: It is called jaundice hepatitis, which will definitely damage the liver. The pain was in the right upper quadrant. The symptoms of jaundice hepatitis, which are pain in the liver area, are caused by liver enlargement caused by the hepatitis virus, which increases the tension of the liver capsule and the inflammation spreads to the liver ligament and its surrounding knitting.

3. Fever: When fever symptoms occur in patients with jaundice hepatitis, many people will be misdiagnosed as having a cold and fever, which will delay the timely treatment of the condition. Fever is caused by hepatocyte necrosis, liver dysfunction, reduced detoxification and excretion, or viremia.

Clinical manifestations of jaundice hepatitis

Pre-jaundice

At this stage, it is easy to be misdiagnosed due to individual differences and complex and diverse patient performance. Special attention should be paid to patients with upper respiratory tract inflammation, similar to a cold. Some patients may be mistaken for rheumatism with joint soreness. There are also a few people who have severe abdominal pain and mistake it for acute abdomen. There are a few people who can wait for measles. At the end of this period, physical examination revealed hepatic throbbing pain and tenderness. More than half of the patients could touch the liver under the costal margin, serum alanine aminotransferase (ALT) was significantly increased, and urine bilirubin was positive. Hepatitis B surface antigen was positive and hepatitis B core antibody immunoglobulin M (anti-HBcIgM) was positive. Patients at this stage contain a large amount of hepatitis virus in their blood, urine, and vomit, so they are highly contagious.

Jaundice hepatitis

Jaundice occurs after fever regression, and the common sclera is first yellow-stained, and then the whole body is yellow, reaching a peak within a few days to 2 to 3 weeks. Most are mild to moderate jaundice. At this time, the symptoms of the digestive tract were aggravated, the liver was enlarged, and there were tenderness and throbbing pain; a few spleens were enlarged and can be touched with help. Some patients have itchy skin, bradycardia, abdominal pain and rash. After a few days of rest, the patient reduced nausea, disappeared vomiting, and gradually improved his appetite. The blood white blood cell count is generally normal or slightly lower, the differential count of lymphocytes is high, and a few abnormal lymphocytes may appear. Urinary bilirubin and urobilinogen are positive (for those with deep jaundice and grayish-white stool, urobilinogen may be temporarily negative). Serum ALT activity increased significantly, often above 400u, and this period lasted 2 to 6 weeks or longer.

Recovery period of jaundice hepatitis

Jaundice receded, hepatomegaly, and various other symptoms gradually subsided during this period. Appetite returned to normal, but mild liver pain was still felt. This period lasts for an average of one month. A few cases are marked with jaundice, which persists for several months, fatigue, liver pain and gastrointestinal symptoms are not obvious, liver function shows obstructive jaundice, and ALT only rises mildly or moderately, which is called cholestatic hepatitis. Complications: A few cases can be complicated by myocarditis, pericarditis, miliary viral pneumonia, pancreatic necrosis, diabetes, meningoencephalitis, acute polyradiculitis, acute hemolytic anemia, pancytopenia, aplastic anemia, thrombotic Phlebitis, nephritis, orchitis, papular dermatitis, multiple arthritis, etc. are several kinds of salty.

Causes of jaundice hepatitis

Jaundice hepatitis is caused by the destruction of liver cells, liver tissue reconstruction, and bile duct obstruction caused by the hepatitis virus, resulting in an increase in both blood conjugated bilirubin and non-conjugated bilirubin. Yellowing symptoms. Usually, when the blood bilirubin concentration is higher than 2-3mg / dL, these parts will appear to the naked eye.

This type of jaundice occurs in viral hepatitis, mainly because the hepatitis virus invades the liver and replicates in liver cells. Under the action of the body's immune response, hepatocytes are damaged together, resulting in edema of the hepatocytes, destruction of the liver tissues, inflammatory infiltration, hyperemia, edema, exudation, degeneration and necrosis of the liver cells. This affects the normal state and structure of liver tissue, damages various functions of bilirubin metabolism in the liver, prevents bilirubin from being excreted from the biliary system and enters the blood, and bilirubin runs with the blood to various organs in the body. Organs, each organ can be dyed yellow. This bilirubin is a yellow pigment that binds the tissues of elastin hardest. Therefore, the sclera and skin that are rich in elastin are most likely to show yellow, and the yellow stain subsides more slowly than other tissues.

The most common of these is acute jaundice hepatitis, which is a type of acute viral hepatitis and an acute gastrointestinal infectious disease caused by the hepatitis virus.

Alcohol is one of the causes of jaundice hepatitis . Human liver can metabolize about 1 gram of alcohol per kilogram of body weight per day. A person weighing 60 kg should be allowed to consume less than 60 grams of alcohol per day. Those who weigh less than 60 kg should be reduced accordingly, preferably at about 45 grams. If people drink too much alcohol, they will directly cause liver damage. Later, the body will gradually become tired and jaundiced, and jaundice will appear on the skin, and jaundice hepatitis will eventually form.

Jaundice hepatitis diagnostic criteria

First, the total number of white blood cells in the blood is normal or slightly lower, the lymphocytes are relatively increased, and occasionally abnormal lymphocytes appear. Platelets can be reduced in some patients with chronic hepatitis.

2. Jaundice index and bilirubin quantitative test were all significantly increased. Urine tests showed a significant increase in bilirubin, urobilinogen, and urobilin.

Three, serum enzyme determination

Transaminase alanine aminotransferase (ALT) and aspartate aminotransferase (AST) can be increased during the incubation period of hepatitis, the initial stage of onset, and the occult infection, so it helps early diagnosis.

Other enzymes -glutamyl transpeptidase (-GT) can be slightly increased.

Fourth, cholesterol, cholesterol ester, cholinesterase measurement Cholesterol, cholesterol ester, cholinesterase can be significantly reduced in patients with severe hepatitis, suggesting a poor prognosis.

Five, serum immunological examination

Determination of anti-HAV-IgM in hepatitis A has early diagnostic value for hepatitis A.

Hepatitis B HBV markers (HBsAg, HBeAg, HBcAg and anti-HBs, anti-HBe, anti-HBc) are of great significance in determining the presence or absence of hepatitis B infection. HBV-DNA, DNA-P, and PHSA receptor assays are of great value in determining the presence or absence of HBV replication in patients with hepatitis B. High-titer anti-HBc-IgM positive is helpful for the diagnosis of acute hepatitis B. Some people use genetic engineering methods to obtain the pre-S1 (Pre-S1) and pre-S2 genes of HBsAg. Histochemistry and solid-phase radioimmunoassay can be used to study the localization of pre-S antigen in hepatocytes in patients with acute and chronic hepatitis B. Pre-Sl and pre-S2 of HBsAg are often contained in liver tissues with HBV replication. Anti-pre-S1 and anti-pre-S2 can be determined in serum, the former appearing during the incubation period, and the latter appearing before the termination of virus replication. Therefore, anti-pre-Sl positive can be used as an early diagnostic indicator of acute hepatitis B, and anti-pre-S2 can be an indicator of hepatitis recovery.

Hepatitis C is often diagnosed by excluding A, B, E, and other viruses (CMV, EBV). A serum anti-HCV-IgM positive diagnosis can be confirmed.

The diagnosis of hepatitis E depends on the serum anti-HEV-IgM positive or immunoelectron microscopy to see 30 32nm virus particles in the stool.

Serological diagnosis of hepatitis D depends on serum anti-HDV-IgM positive or HDAg or HDV cDNA hybridization positive; HDAg positive or HDV cDNA hybridization positive in liver tissue can be confirmed.

Six, serum protein and amino acid determination

Protein electrophoresis of -globulin (9-18%) Chronic active hepatitis is often> 26%, and -globulin may be> 30% in cirrhosis.

Serum protein electrophoresis prealbumin (synthesized by the liver) 83 to 92% of patients with acute hepatitis and chronic active hepatitis who have lower serum prealbumin values return to normal as their condition recovers.

If the ratio of plasma branched chain amino acid (BCAA) to aromatic amino acid (AAA) decreases or is inverted, it reflects liver parenchymal dysfunction, which is of reference significance for judging the prognosis of severe hepatitis and assessing the efficacy of branched chain amino acid.

Jaundice Hepatitis Diet Treatment

(1) To ensure sufficient heat supply, it is generally appropriate to use 8400-10500 kJ (2000-2500 kcal) per day. In the past, high-calorie therapy for hepatitis was not advisable. Although high-calorie can improve clinical symptoms, it can eventually lead to fatty liver, which will worsen the condition, so the disadvantages outweigh the benefits.

(2) Carbohydrates generally account for 60 to 70% of the total thermal energy. The high-sugar diet used in the past must also be corrected, because high-sugar diets, especially excessive glucose, fructose, and sucrose, can affect patient appetite, increase gastrointestinal flatulence, increase body fat storage, and easily lead to obesity and fatty liver. Carbohydrate supply should be mainly through staple foods.

(3) In order to promote the repair and regeneration of liver cells, the supply of protein should be increased, which should generally account for 15% of the total thermal energy. In particular, a certain amount of high-quality protein should be guaranteed, such as animal egg envelopes, soy products, etc.

(4) In general, fat intake can be left unrestricted. Because patients with hepatitis often have symptoms such as anorexia and loss of appetite, usually, the problem of excessive fat intake does not occur.

(5) Ensure vitamin supply. Vitamin B1, vitamin B2, nicotinic acid and other B vitamins, and vitamin C, have an important role in improving symptoms. In addition to choosing foods rich in these vitamins, multivitamin preparations can also be taken orally. ?

(6) Supply sufficient liquid. Appropriate drinking of fruit juice, rice soup, honey water, watermelon juice, etc. can accelerate the excretion of toxicants and ensure the normal metabolic function of the liver.

(7) Pay attention to cooking methods to improve food color, aroma, taste and shape to promote appetite. Avoid frying, frying, etc. and strongly irritating foods. Limit foods with high nitrogen extracts such as broth and chicken broth to reduce the burden on the liver.

(8) Use a small number of multiple meals.

The dangers of jaundice hepatitis

1. Damage the liver. As the hepatitis virus invades the liver, it continuously replicates in liver cells. Under the action of the body's immune response, hepatocytes are damaged together, resulting in edema of the hepatocytes, destruction of the liver tissues, inflammatory invasion, congestion, edema, exudation, degeneration and necrosis of the liver cells. This affects the normal state and structure of liver tissue, and impairs various functions of liver bilirubin metabolism.

2. Life threatening. The substance that produces jaundice is called bilirubin. It comes in two forms: one is fat-soluble and the other is water-soluble. The former can settle on the nucleus of the brain, which accumulates more and more, affects the function of the nerve, and can cause the extremely harmful nuclear jaundice. People with mild jaundice can affect the human brain, and those with severe jaundice can be life-threatening at the time. Although the toxicity of water-soluble bilirubin is small, the liver and gallbladder disease that can cause this bilirubin increase is more harmful to the human body than its own toxicity. Therefore, bilirubin, whether fat-soluble or water-soluble, regardless of their toxicity, is a garbage that should be eliminated in the human body. It must be eliminated when it is eliminated. If it cannot be removed by itself, a doctor should be asked to help eliminate it.

3, easy to cause complications. The outcome of this disease is related to the nature of jaundice, physical strength, and treatment and care. Although the properties of Yanghuang, Yinhuang and Jihuang are different, they can be transformed into each other under certain conditions. If the patients with Yanghuang are of poor constitution, severe illness, and jaundice are getting deeper, the symptoms of rapid fever and fever can be changed to acute yellow; Yanghuang can also be caused by damage to the spleen and yang, and the dampness will change from cold to yellowish; The evil of hot and humid can also be expressed as Yanghuang; if the yellow fever is hot, the pericardium is invaded, or there is a large amount of bleeding, liver and kidney yang failure may occur; Yinhuang is not cured for a long time, and it can be turned into accumulation and bulging.

Jaundice hepatitis infectious

The period from when a patient begins to have symptoms to the appearance of jaundice ranges from a few days to 2 weeks. Patients often feel chills and fever at the onset of the disease, and their body temperature is about 38 ° C. A few patients can have high fever for several days. The more prominent symptoms are general fatigue, loss of appetite, nausea, and vomiting, especially loathing of greasy food, upper abdomen blockage and stuffiness, yellow urine like strong tea, thin stools or constipation. At this stage, it is easy to be misdiagnosed due to individual differences and complex and diverse patient performance. Special attention should be paid to patients with upper respiratory tract inflammation, similar to a cold. Some patients may be mistaken for rheumatism with joint soreness. There are also a few people who have severe abdominal pain and mistake it for acute abdomen. There are a few people who can wait for measles. At the end of this period, physical examination revealed hepatic throbbing pain and tenderness. More than half of the patients could touch the liver under the costal margin, serum alanine aminotransferase (ALT) was significantly increased, and urine bilirubin was positive. Hepatitis B surface antigen was positive and hepatitis B core antibody immunoglobulin M (anti-HBcIgM) was positive. Patients at this stage contain a large amount of hepatitis virus in their blood, urine, and vomit, so they are highly contagious.

What are the checks for jaundice in jaundice?

When jaundice occurs, the type of jaundice should be identified first, and it is first judged whether hepatocellular jaundice, obstructive jaundice, or hemolytic jaundice. Then check liver function, blood lipids, blood routine, urine routine, coagulation function and so on.

1. If the patient's routine red blood cell (RBC) and hemoglobin (Hb) values are decreased, the urine routine occult blood test is positive, the urobilinogen is increased, and the urinary bilirubin is negative, the TB is increased, and the DB is basically normal. GGT, ALB, and PT are normal. Hemolytic jaundice should be considered, and further relevant examinations that can cause hemolytic diseases should be considered. At this time, patients should go to the hematology department for further examination and treatment.

2. If the patient's liver function is normal, heparin (TB), direct bilirubin (DB), transaminase (ALT and AST), alkaline phosphatase (ALP) and -glutamyl transferase (GGT) will increase , DB / DT is between 30% and 40%, prothrombin time (PT) is prolonged, albumin (Alb) is reduced, and urine bilirubin and urobilinogen can be seen to increase in varying degrees. Can be considered as hepatic jaundice, can cause hepatic jaundice of diseases such as viral hepatitis, cirrhosis and other further examination.

3. When the patient's TB is increased, DB is significantly increased, DB / DT is greater than 50%, ALP and GGT are significantly increased, and urine urinary bilirubin is also significantly increased, but urobilinogen is reduced or disappeared, and obstructive should be considered. The possibility of jaundice may be confirmed by B-ultrasound CT, MRI, ERCP, and liver biopsy to determine intrahepatic cholestasis or liver obstruction.

Is jaundice hepatitis?

The so-called jaundice means that the serum bilirubin content exceeds the normal range, which causes yellowing of the sclera and other tissues. In the process of bilirubin metabolism, two types of bilirubin are produced, indirect bilirubin and direct bilirubin. No matter what kind of bilirubin is elevated, it can cause jaundice. The most common parts of jaundice are sclera, mucosa, blood vessels, and skin. Because these tissues are rich in elastin, the latter has a strong affinity for bilirubin. If only the serum bilirubin exceeds the normal standard and the patient does not show yellow staining of the sclera and skin, it is called recessive jaundice; if only the skin and other parts are yellow, and the serum bilirubin does not rise, it is called pseudojaundice.

As we mentioned earlier, the liver is the largest "chemical plant" in the body. After indirect bilirubin production, it must be transported to the liver for transformation and excretion. If there is inflammation or other pathological changes in the liver, obstacles in the process of transformation and excretion of bilirubin will cause simultaneous elevation of serum indirect bilirubin and direct bilirubin, and patients will rapidly develop deep urine color, yellowing of the sclera, and skin. Nausea, vomiting, loss of appetite and other gastrointestinal symptoms before and after jaundice are known as jaundice hepatitis. This type of jaundice is also called hepatocellular jaundice. Therefore, the presence or absence of jaundice is an important sign of liver involvement or lesions, but those who develop jaundice are not necessarily hepatitis. Clinically, the jaundice that occurs due to excessive or excessive destruction of red blood cells caused by indirect bilirubin elevation is called hemolytic jaundice, also called prehepatic jaundice. Sometimes bilirubin excretion can be caused by diseases of the gallbladder or bile ducts, such as stones, tumors, inflammation, and other diseases, which can cause direct serum bilirubin elevation and jaundice. It is called obstructive jaundice, which is also called after liver cells. Sexual jaundice. It can be seen that there are many causes and types of jaundice caused by temple beds, and it cannot be generalized that they are caused by viral hepatitis. ^[1]

What to pay attention to after jaundice hepatitis treatment

First, from the severity of jaundice hepatitis, explain what patients with jaundice hepatitis should pay attention to after treatment. If jaundice-type hepatitis is severe and can be life-threatening, a substance that produces jaundice is called bilirubin. Fat-soluble bilirubin can settle on the brain's nerve nucleus, affect the function of nerves, and can cause extremely harmful nuclear jaundice. People with mild jaundice can affect the human brain, and those with severe jaundice can be life-threatening at the time. Although the toxicity of water-soluble bilirubin is small, the liver and gallbladder disease that can cause this bilirubin increase is more harmful to the human body than its own toxicity.

Secondly, from the etiology of jaundice hepatitis to patients, the prognosis of jaundice hepatitis is explained. Hepatitis A and E only cause acute hepatitis, and a few develop severe hepatitis without becoming chronic, and comorbidities are rare. Acute hepatitis B, C, and D can develop into chronic hepatitis for more than half a year due to pathogens and body immunity. Among them, about 10% of acute hepatitis B and about 50% of acute hepatitis C become chronic.

In addition to the above contents, patients with jaundice hepatitis should also pay attention to dietary problems after treatment. Food should be fresh and delicious, light, digestible, hot and cold suitable, non-irritating, moderate, nutritious liquid, semi-liquid, soft. Only by doing these things can patients gradually recover their bodies.