Hepatitis A treatment

Treatment of hepatitis A is currently usually carried out in an infectious diseases hospital, but given that hepatitis A in most cases is mild and there are practically no malignant forms or chronic hepatitis, treatment can be carried out at home. In epidemiological terms, patients are no longer dangerous to others by the time of hospitalization, since they are usually hospitalized when jaundice appears, when the concentration of viral antigen in feces decreases sharply or disappears completely. It should be noted that in many foreign countries, patients with hepatitis A are almost exclusively treated at home.

The complex of therapeutic measures recommended for the treatment of hepatitis A has undergone significant changes in recent years. In almost all hepatological centers, the principle of restrained therapy has prevailed, which involves protecting the diseased liver, protecting it in every possible way from additional energy expenditure, and protecting it from medications with questionable or unproven effectiveness.

The optimal treatment is considered to be the so-called basic treatment for hepatitis A, which includes a rational exercise regimen, therapeutic nutrition, choleretic drugs, mineral waters, and multivitamins.

Physical activity for hepatitis A

Patients with hepatitis A should follow a gentle regimen throughout the disease. The degree of restrictions in the motor regimen should depend on the severity of the symptoms of intoxication, the patient's well-being and the severity of the disease. In erased, anicteric and, in most cases, mild forms, the regimen can be semi-bed rest from the first days of the icteric period. Patients are allowed to eat at the common table, use the washbasin and toilet. In moderate and especially severe forms, bed rest is prescribed for the entire period of intoxication - usually during the first 3-5 days of the icteric period. As the intoxication decreases, patients are transferred to semi-bed rest. The criteria for expanding the regimen are improved well-being and appetite, a decrease in jaundice. It is important to emphasize that too strict a restriction of active movements in the acute period of the disease can negatively affect the emotional and muscle tone and does not contribute to recovery. At the same time, it is known that in a horizontal position, the blood supply to the liver increases significantly, and more favorable conditions are created for its regeneration. It can be considered that motor activity in hepatitis A should be determined by the patient himself, depending on his well-being and the degree of intoxication.

Increased physical activity should be individualized and correspond to the nature of the pathological process, the degree of functional recovery of the liver, the presence of residual effects, the age of the patient, and his premorbid background.

Drug treatment of hepatitis A

It is believed that most patients with hepatitis A do not need to be prescribed any medications. A gentle exercise regimen, therapeutic nutrition, optimal hospitalization conditions that exclude the possibility of superinfection, especially with other viral hepatitis, ensure a smooth course of the disease and complete clinical recovery. Glucocorticosteroid hormones are also not indicated for hepatitis A.

It is now generally accepted that it is necessary to prescribe medications for viral hepatitis with great caution, since their utilization and elimination in conditions of a damaged liver are very difficult, and their hepatotoxic effect may manifest itself, especially when several drugs are used simultaneously without taking into account compatibility.

It should be emphasized, however, that a negative attitude towards polypharmacy does not exclude the possibility of selective prescription of certain medications.

In case of hepatitis A, it is advisable to prescribe phosphogliv. Phosphogliv is a combination drug containing phospholipid (phosphatidylcholine) and glycyrrhizic acid salt. Phosphatidylcholine is the main structural component of the phospholipid layer of biological membranes and acts like a "membrane glue", restoring the structure and functions of damaged hepatocyte membranes, thereby preventing the loss of enzymes and other active substances by cells, normalizing protein, lipid and fat metabolism, restoring the detoxification function of the liver, suppressing the synthesis of connective tissue in the liver, reducing the risk of fibrosis and cirrhosis of the liver. Sodium glycyrrhizinate has an anti-inflammatory effect, suppresses virus reproduction in the liver and other organs by stimulating the production of interferon-y, increasing phagocytosis, increasing the activity of natural killers, etc.

Phosphogliv is prescribed: for children under 3 years old - 0.5 capsules, from 3 to 7 years old - 1 capsule, from 7 to 10 years old - 1.5 capsules, over 10 years old and adults - 2 capsules 2-3 times a day.

In the acute period of hepatitis A, drugs with predominantly cholekinetic action (magnesium sulfate, flamin, berberine, etc.) can be used, and in the recovery period - choleretic (allochol, holenzym, etc.). Usually, at the height of clinical manifestations, a 5% solution of magnesium sulfate is given orally, which has not only a choleretic but also a laxative effect, or a decoction of immortelle, corn silk, immortelle tablets - flamin are prescribed. In the recovery period, especially in case of damage to the bile ducts, in addition to the above drugs, allochol, holenzym, etc. can be prescribed.

Pathogenetically justified in case of hepatitis A and prescription of a vitamin complex. The latter, as is known, are coenzymes of all exchange transformations, ensuring the normal course of metabolic processes in the body, Usually vitamins of the B group (B1, B2, B6) are prescribed, as well as C and PP orally in the generally accepted age-related dosage regimen. It is possible to include vitamin A (retinol) and E (tocopherol), as well as rutin in the specified complex. Treatment of hepatitis A with vitamins is carried out for no more than 10-15 days, while it is not recommended to resort to parenteral administration of vitamins, but to give them only per os.

Noting the positive effect of vitamins on metabolic processes, it should be emphasized that the question of their indisputable effectiveness in hepatitis A cannot be considered finally resolved. In recent years, the opinion has been quite widespread that vitamins are at least ineffective and even contraindicated in liver diseases. In any case, excessive administration of vitamins and especially of a single vitamin cannot be considered justified, since this can lead to a violation of the dynamic balance of cellular metabolism and the displacement of other components from liver cells, which are also necessary for their functioning. This is why one should warn against excessive use of vitamins, but they are still indicated in physiological doses.

During the recovery period and especially during protracted hepatitis A, doctors recommend prescribing phosphogliv 2 capsules 3 times a day during meals for 2-4 weeks. According to our clinic, patients treated with phosphogliv recover their liver function faster than those in the control group.

The accumulated clinical experience allows us to consider that patients with hepatitis A do not need infusion therapy, which is known to be aimed at detoxification, restoration of homeostasis and, in part, at providing parenteral nutrition. However, with hepatitis A, the symptoms of intoxication are usually short-term and moderately expressed, changes in homeostasis are insignificant, and nutritional disorders are uncharacteristic. Only in severe forms and in individual patients with moderate hepatitis A can we resort to infusion therapy. In these cases, rheopolyglucin, 5% glucose solution, and polyionic buffer solutions are administered intravenously by drip.

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Discharge from hospital

Discharge from the hospital is carried out as recovery progresses. The criteria for discharge are: satisfactory general condition, disappearance of jaundice, reduction of liver size to normal or close to normal levels, normalization of bilirubin content in the blood serum, decrease in the activity of hepatocellular enzymes to normal or close to normal values. It is important to emphasize that these criteria should be considered indicative. The patient can be discharged with residual hepatomegaly, hyperfermentemia, dysproteinemia, and even in the absence of complete normalization of pigment metabolism. The calendar dates and criteria for discharge regulated by the order of the Ministry of Health of the Russian Federation should be understood only as conditional. The discharge dates should be determined individually! Taking into account the premorbid condition, home conditions, the level of outpatient care, etc. In mild forms of hepatitis A, discharge should be made on the 15-20th day of the disease, and if appropriate conditions are available, treatment can be carried out at home. Our accumulated experience of early discharge from hospital (15-20 days of illness) shows that in these cases the functional state of the liver is restored more quickly, residual effects are less common and the recovery period ends more quickly.

In the case of protracted hepatitis A, patients are discharged as the pathological process stabilizes and a tendency for improvement is identified. In this case, the liver may protrude from under the edge of the costal arch by 2-3 cm, the level of hyperfermentemia may exceed the standard values by 2-4 times, significant dysproteinemia, changes in sediment samples, etc. are possible.

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Outpatient observation

After discharge from the hospital, all convalescents are subject to mandatory dispensary observation. It is better to conduct dispensary observation in a special room organized at the hospital. If it is impossible to organize such a room, dispensary observation should be carried out by an infectious disease specialist.

The first examination and survey are carried out 15-30 days after discharge from the hospital, repeated - after 3 months. In the absence of residual clinical effects and complete normalization of liver tests, convalescents are removed from the register, but in cases where there are any residual effects, dispensary observation is carried out until complete recovery.

Medical examination of convalescents living in rural areas is carried out in infectious disease departments of central district hospitals and in polyclinics.

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Rehabilitation of convalescents

During the dispensary observation, it is necessary to solve a set of problems related to the rehabilitation of the convalescent. After discharge from the hospital, drug therapy is usually not required. In some cases, convalescents can receive choleretic drugs, multivitamins, mineral water tubages, etc. The issue of expanding physical activity, as well as lifting restrictions in therapeutic nutrition, should be decided strictly individually and in full accordance with the general condition and rate of recovery of liver function.

The proposal of some authors to conduct follow-up treatment of hepatitis A convalescents in rehabilitation departments or specialized sanatoriums requires additional study. In any case, the best results in the rehabilitation of hepatitis A convalescents are achieved not in follow-up departments, where it is difficult to avoid additional infection, but at home with the organization of individual care and treatment of hepatitis A.