chronic persistent hepatitis

Question 1

etiology

Answer 1

Alcoholic/drug induced – metronidazole, isoniazide, nitrofurane

Question 2

clinical symptoms

Answer 2

Mild or asymptomatic
- Pain in hypochondrium
- Hepatomegaly, nausea, anorexia (dyspepsia)
- Hepatic signs (spider nevi and stars on skin upper part of chest, upper extremities, face)
- Palmar erythema, strawberry tongue, gynecomastia, hair loss
- Splenomegaly, fatigue, LOA
- Ascites, jaundice
Syndromes
- Asthenic
- Dyspeptic
- Pain syndrome
- syndrome of hepatic signs
- Hepatomegaly
- Jaundice
- Cytolysis syndrome
- hepatodepression syndrome

Question 3

investigation

Answer 3

1. Liver function test
   Increase ALT, AST, hyperbilirubinemia, dysproteinemia, hyper-γ-globulinemia, hypoglobulinemia, glutamine transpeptidase, electrolytes, and alkalinephosphatase
2. Gen blood analysis:
   Leukocytosis, increase cholesterol, ↑ bleeding times
3. Blood screening – exclude viral hepatitis, hemochromatosis, carcinoma, biliary disease
4. Electrolyte tests – hypophosphatemia, hypomagnesemia, alcoholic acidosis, respiratory alkalosis
5. Immunology
   - high Ig M, A, G
   - specific cells – lupoid (LE) cells
6. U/S
   - diffused parenchyma, hyperechogenic structures without nodules
   - liver enlargement, spleen enlargement
   - Changes of tissue density (initial stage of cirrhosis)
   - Changes of bile ducts
7. gastroscopy – stomach acid
8. Liver biopsy – lymphocytes in portal tract, dystrophic changes, fibrosis, cell membrane destruction, leukocytes infiltration, necrotic changes

Question 4

treatment

Answer 4

Treatment
1. Diet No. 5 – no fatty food, spices, alcohol. high-protein, vit & mineral diet
2. Antiviral drugs, interferon (reaferon) drugs (↑ level of immune syst)
3. Hepatoprotectors – Riboxin, acid glutaminic acid, Vipamic; colchicine, asensal, catechin
4. Immunodepression drugs – Prednisolone
5. Vitamins; Myolytics; Cholinergic
6. Liver transplantation