Hepatology: diseases — симптомы, диагностика и лечение

Viral hepatitis B and C are chronic infections that affect the liver and remain asymptomatic for years. This is their main danger: a person feels healthy until cirrhosis or liver cancer develops. However, the situation with their treatment has changed radically over the past decade. Hepatitis C today can be cured in the vast majority of cases with a course of tablets lasting 8-12 weeks. Hepatitis B cannot yet be completely cured, but it can be reliably controlled, and most importantly, there is a vaccine against it.

Cirrhosis is the outcome of long-term liver damage, in which the working tissue is replaced by scar tissue, and the structure of the organ is irreversibly rebuilt. The liver has a huge reserve of strength and takes a long time to compensate for losses, so the disease goes on without symptoms for years, and the first obvious signs often appear already at the stage of complications. It is important to understand the difference: the scar itself does not disappear, but if you eliminate the cause - cure hepatitis C, stop drinking alcohol, lose weight in case of fatty disease - the progression stops, and the condition of the liver can significantly improve. Therefore, the diagnosis of “cirrhosis” is not a death sentence, but requires active action.

Autoimmune hepatitis is a chronic inflammation of the liver in which the immune system mistakenly attacks its own liver cells. Viruses, alcohol and drugs have nothing to do with it, although sometimes the disease starts after an infection or taking a drug. Women are more often affected, and the disease can begin at any age. Its insidiousness is that for a long time it proceeds hidden: a person is only bothered by fatigue and heaviness in the right hypochondrium, and sometimes the disease is first detected already at the stage of cirrhosis. At the same time, autoimmune hepatitis responds well to treatment, and early initiation of therapy allows saving the liver.

Hepatitis A is an acute viral inflammation of the liver that is transmitted through contaminated water, food and dirty hands. The virus is excreted in the stool of a sick person and spreads especially easily where hygiene and water supply rules are violated. The disease is known as jaundice or Botkin's disease, although in young children it often occurs without any yellowing of the skin at all. An important difference from hepatitis B and C: hepatitis A never becomes chronic and does not lead to cirrhosis. After an infection, lifelong immunity remains, and vaccination allows you to reliably protect yourself in advance.

Hepatitis D is caused by an unusual virus: it is defective and cannot reproduce on its own, so it exists only in the presence of the hepatitis B virus, using its shell. You can become infected with delta infection either simultaneously with hepatitis B, or later, already having chronic hepatitis B. The second option is more dangerous: it often leads to a sharp exacerbation and rapid progression of the disease. Of all viral hepatitis, the combination of B and D is considered the most severe - cirrhosis and liver failure develop faster. The good news is that the hepatitis B vaccine also protects against hepatitis D, because without the B virus, the delta virus does not take root.

Hepatitis E is an acute viral inflammation of the liver, which is transmitted mainly through contaminated water, as well as through insufficiently heat-treated pig and game meat. The disease is common in regions with water supply problems and often causes outbreaks after floods and water supply accidents. In most people, hepatitis E proceeds like ordinary jaundice: weakness, nausea, dark urine, yellowing of the skin, and ends with complete recovery in a few weeks without becoming chronic. However, in pregnant women, especially in the third trimester, the disease can be extremely severe, so they need special vigilance and mandatory medical supervision.

The liver neutralizes almost everything that enters the body, which is why it is the first to suffer from drugs, herbal remedies and dietary supplements. The damage can be predictable and dose-dependent, as with an overdose of antipyretics with paracetamol, or individual and unpredictable, in which case it develops in individual people on normal doses. Manifestations are varied: from asymptomatic increases in liver enzymes in tests to jaundice, skin itching and severe liver failure. The main thing in treatment is to recognize the connection with the drug in time and stop taking it in consultation with the doctor. Most cases result in complete recovery.

Primary biliary cholangitis is a chronic autoimmune disease in which the immune system gradually destroys the small bile ducts inside the liver. Bile stagnates, damages liver cells, and over time, fibrosis develops, and without treatment, cirrhosis. The former name “primary biliary cirrhosis” was changed precisely because most patients today are diagnosed long before cirrhosis. Mostly middle-aged women are affected. The first manifestations are nonspecific: severe fatigue and skin itching, which is not explained by a skin disease. Often the disease is discovered accidentally by elevated alkaline phosphatase in a biochemical blood test.

Hepatic encephalopathy is a brain disorder that develops when a diseased liver stops neutralizing toxic metabolic products, primarily ammonia. In cirrhosis, blood from the intestines partially bypasses the liver through dilated veins and carries these substances directly to the brain. Sleep, attention, behavior and handwriting change, characteristic large tremors of the hands appear, and in severe cases, confusion and coma. Almost every episode is triggered by a trigger: bleeding from the esophageal veins, infection, constipation, dehydration, excess diuretics or alcohol. It is important to understand the main thing: the condition is reversible, with timely help consciousness is restored, so the first changes in behavior cannot be attributed to fatigue or age.

Chronic hepatitis is an inflammation of the liver that lasts longer than six months. Its main feature is that for many years it gives almost no symptoms: the liver has no pain endings inside the tissue, so a person feels healthy while the working cells are gradually replaced by connective tissue. The result of an untreated process is fibrosis, cirrhosis and the risk of liver cancer. The main causes are hepatitis B, C and D viruses, alcohol, accumulation of fat in the liver due to metabolic disorders, autoimmune damage and medications. There is two good news: the disease can be detected by simple blood tests, and viral hepatitis C is curable today.