Hepatitis A treatment

Treatment of hepatitis A is currently carried out in an infectious hospital environment, but given that hepatitis A in most cases is mild and there are almost no malignant forms or chronic hepatitis, treatment can be done at home. In epidemiological terms, patients at the time of hospitalization are no longer dangerous to others, since they are usually hospitalized when jaundice occurs, when the concentration of viral antigen in feces sharply decreases 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. Practically in all hepatology centers, the principle of restrained therapy prevailed, presupposing protection of the diseased liver, its full protection from additional energy costs, as well as protection from medicaments with dubious or unproven efficacy.

Optimal treatment is considered to be the appointment of the so-called basic treatment of hepatitis A, including a rational motor system, therapeutic nutrition, choleretic preparations, mineral oxy, multivitamins.

Motor Regimen for Hepatitis A

Patients with hepatitis A should maintain a sparing regimen throughout the disease. The degree of limitations in the motor regime should depend on the severity of the symptoms of intoxication, the patient's well-being and the severity of the disease. With erased, jaundiced, and in most cases - mild forms, the regimen can be semi-bedded from the first days of icteric period. Patients are allowed to eat at a common table, use a wash basin, a toilet. With moderate and especially severe forms, bed rest is prescribed during the entire period of intoxication - usually during the first 3-5 days of icteric period. With the decrease in intoxication of patients, the bed rest is put on the floor. The criteria for the expansion of the regime are improving the state of health and appetite, reducing jaundice. It is important to emphasize that too strict restriction of active movements of the acute phase of the disease can adversely affect the emotional and muscle tone and does not contribute to recovery. At the same time, it is known that in the horizontal position blood supply to the liver is substantially increased, and also more favorable conditions are created for its regeneration. We can assume that the motor activity in hepatitis A should be determined by the patient himself, depending on the state of health, the degree of intoxication.

The increase in physical activity should be individualized and correspond to the nature of the pathological process, the degree of functional restoration of the liver, the presence of residual phenomena, 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 prescribe any medications. Gentle motor conditions, therapeutic nutrition, optimal hospitalization conditions, which exclude the possibility of superinfection, especially other viral hepatitis, provide a smooth course of the disease and complete clinical recovery. Not shown for hepatitis A and glucocorticosteroid hormones.

Currently, it is generally accepted that it is necessary to prescribe medications for viral hepatitis with great care, since their utilization and excretion in conditions of the affected liver is very difficult, their hepagotoxic effect may be manifested, especially with the simultaneous use of several drugs without compatibility

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

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

Phosphoglivin appoint: children under 3 years - 0.5 capsules, from 3 to 7 years - 1 capsule, from 7 to 10 years - 1.5 capsules, over 10 years and adults - 2 capsules 2-3 times a day day.

In the acute period of hepatitis A, drugs with predominantly cholekinetic action (magnesium sulfate, flamin, berberine, etc.) can be used, and in the period of convalescence it can be choleretic (allochol, cholenzym, etc.). Usually at the height of clinical manifestations they give inside 5% solution of magnesium sulfate, which possesses not only choleretic, but also a laxative effect, or appoint a decoction of immortelle, corn stigmas, tablets of immortelle - flamin. In the period of convalescence, especially in the case of lesion of the bile ducts, in addition to these preparations, allochol, cholenzym, etc. Can be prescribed.

Pathogenetically justified for hepatitis A and the appointment of a complex of vitamins. The latter, as is known, are coenzymes of all metabolic transformations, providing a normal course of metabolic processes in the body. Usually, vitamins of troupe B (B1, B2, B6) are prescribed. And also C and RR inside in the generally accepted age-related dosing regimen. It is possible to include in this complex vitamin A (retinol) and E (tocopherol), as well as rutin. Treatment of hepatitis A with vitamins is not more than 10-15 days, while it is not recommended to resort to parenteral administration of vitamins, and give them only per os.

Noting the positive effect of vitamins on metabolic processes, it should be emphasized that the question of their undoubted effectiveness in hepatitis A can not be considered definitively resolved. In recent years, it is widely believed that vitamins in liver diseases are at least ineffective and even contraindicated. In any case, excessive administration of vitamins and especially a single vitamin can not be considered justified, since this can lead to a disruption of the dynamic equilibrium of the cellular metabolism and the exclusion of other components from the liver cells that are also necessary for their functioning. That is why it is necessary to warn against excessive consumption of vitamins, but in physiological doses they are still shown.

In the period of convalescence and especially with prolonged current of hepatitis A, doctors recommend prescribing phosphoglue 2 capsules 3 times a day during meals for 2-4 weeks. According to our clinic, in patients treated with phosphoglyme, the functional state of the liver is restored faster than in the control group.

The accumulated clinical experience makes it possible to consider that patients with hepatitis A do not need infusion therapy directed, as is known, to detoxification, restoration of homeostasis and, in part, to providing parenteral nutrition. However, with hepatitis A, the symptoms of intoxication are usually short-lived and moderately expressed, changes in homeostasis are unimportant, and eating disorders are uncharacteristic. Only with severe forms and in individual patients with a moderate form of hepatitis A it is possible to resort to infusion therapy. In these cases, rheopolyglucose, 5% glucose solution, polyionic buffer solutions are injected intravenously.

[1], [2], [3], [4],

Extract from the hospital

Extract from the hospital is made as recovery. Criteria for discharge are: a satisfactory general condition, the disappearance of jaundice, a reduction in liver size to a normal or close to normal level, normalization of bilirubin in the blood serum, a decrease in the activity of hepatic cell 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. Regulated by the order of the Ministry of Health of the Russian Federation, calendar terms and discharge criteria should be understood only as conditional. Terms of discharge must be determined individually! Taking into account the premorbid state, home conditions, the level of polyclinic services, etc. For mild forms of hepatitis A, the discharge should be performed on the 15-20th day of the disease, and if appropriate conditions, treatment can be carried out at home. The accumulated experience of an early discharge from the hospital (15-20 days of the disease) shows that in these cases the functional state of the liver is restored more quickly, less residual phenomena occur and the recovery period ends sooner.

With prolonged course of hepatitis A, patients are discharged as the pathological process stabilizes and the trend towards improvement is identified. In this case, the liver can protrude from under the edge of the costal arch by 2-3 cm, the level of hyperfermentemia exceeds the normative values by 2-4 times, phenomena of considerable disproteinemia, changes in sediment samples, etc., are possible.

[5], [6], [7], [8], [9], [10]

Dispensary supervision

After discharge from the hospital, all reconvalescents are subject to compulsory dispensary observation. It is better to conduct medical examination in a special office organized at the hospital. If it is impossible to organize such an office, the infectious disease specialist should conduct the prophylactic examination.

The first examination and examination are carried out 15-30 days after discharge from the hospital, repeated - after 3 months. In the absence of residual clinical phenomena and complete normalization of hepatic samples, the convalescents are removed from the register, in the same cases when there are any residual phenomena, the dispensary observation is carried out until complete recovery.

Clinical examination of convalescents living in rural areas is carried out at infectious divisions of central district hospitals and in polyclinics.

[11], [12]

Rehabilitation of convalescent

In the process of dispensary observation, it is necessary to solve a set of tasks related to the rehabilitation of the reconstructive celiac. After discharge from the hospital, drug therapy is usually not required. In some cases, convalescents can receive choleretic preparations, multivitamins, tuffages with mineral water, etc. The issue of expanding physical activity, as well as removing restrictions in medical nutrition, should be decided strictly individually and in full accordance with the general state and rate of restoration of functions liver.

The suggestion of some authors to carry out the treatment of convalescent hepatitis A in rehabilitation departments or specialized sanatoriums requires additional study. In any case, the best results on the rehabilitation of convalescent hepatitis A can not be achieved in the departments for healing, where it is difficult to avoid additional infection, and at home in the organization of individual care and treatment of hepatitis A.