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Chronic hepatitis — an inflammatory disease of a liver of various etiology which lasts more than half a year. On morphological features chronic hepatitis represents diffusion inflammatory and dystrophic damage of a liver at preservation of lobular structure of a liver.
Classification of chronic hepatitis
On an etiology:
• chronic viral hepatitis of B, C, D, etc.;
• chronic not certain viral hepatitis;
• chronic cryptogenic hepatitis;
• chronic autoimmune hepatitis;
• chronic medicinal hepatitis;
• primary biliary cirrhosis;
• primary sclerosing cholangitis;
• Wilson's illness — Konovalova;
• insufficiency and - antitrypsin.
On a degree of activity:
• active (poorly expressed, moderately expressed, expressed degree of activity).
On process stages:
0 — without fibrosis;
1 — the portal fibrosis which is poorly expressed a feather;
2 — moderate fibrosis with portoportalny septa;
3 — the expressed fibrosis with portotsentralny septa;
4 — cirrhosis.
At a viral hepatitis also two phases are allocated: And — a replication phase; B — an integration phase.
According to classification of chronic diffusion diseases of the liver accepted in 1994 on the World congress on gastroenterology in Los Angeles.
The alcoholic etiology of damage of a liver as now the alcoholic liver disease which enter is separately allocated did not enter this classification:
• alcoholic fatty dystrophy of a liver;
• alcoholic hepatitis (acute and chronic);
• alcoholic cirrhosis.
Etiology of chronic hepatitis
The most often chronic hepatitis is caused by hepatotropic viruses B, C, D and others (classification of viruses of hepatitis).
Infection with a virus of hepatitis B occurs mainly parenteral, more rare sexually. Chronic hepatitis at an acute viral hepatitis In develops at 8 — 10% of patients.
For hepatitis C with a parenteral way of infection the high frequency of transition to a chronic form is inherent (in 30 — 70%).
The virus of hepatitis D is a virus satellite, its replication happens only in the presence of a hepatitis B virus. Existence of a virus of hepatitis D makes heavier the course of hepatitis B and often leads to development of chronic hepatitis. Infection with a virus of hepatitis D can occur along with infection with hepatitis B, but also superinfection is possible.
Other etiological factors of chronic hepatitis are alcohol, hepatotoxic poisons (tetrachloride carbon, phosphorus, chloroform, benzene, lead, mercury, arsenic, etc.), drugs (Methyldopa, streptocides, tetracycline, a methotrexate, an isoniazid, etc.), poison of a death angel. However the possibility of development of chronic inflammatory process in a liver at influence of toxic substances is acknowledged not by all.
The most often chronic hepatitis is caused by a combination of two reasons in the form of infection with viruses of hepatitis B, C or D and an alcohol abuse. At mikst-hepatitis (In + With, In + D and other combinations of viruses) superinfection, as a rule, takes place, is more rare — coinfection with consecutive or simultaneous activity of several hepatotropic viruses.
An important role in developing of chronic hepatitis is played by genetic predisposition.
The pathogeny of chronic hepatitis has common features: damage of hepatic fabric by various etiological factors (viruses, alcohol, drugs), then an immune response — cellular and humoral, turning on of mechanisms of autoimmune aggression which support and promote progressing of a chronic inflammation in hepatic fabric, creating chronic active hepatitis with transformation in cirrhosis, with some features of a pathogeny depending on an etiology.
Clinical syndromes at chronic hepatitis
The Astenovegetativny syndrome is characterized by the expressed weakness, fatigue, the decrease in working capacity, a sleep disorder, irritability suppressed by mood, headaches that is caused by disturbance of all types of a metabolism, pechenochnokletochny insufficiency.
The Dispepsichesky syndrome is shown by loss of appetite, nausea, sometimes vomiting, weight in epigastric area, an eructation, bitter taste in a mouth, abdominal distention, intolerance of greasy food, an unstable chair.
Pain in right hypochondrium has the constant, aching character, amplifies after an exercise stress or errors in food. At part of patients with chronic hepatitis of pain are absent or they are disturbed by weight in epigastric area without communication with meal.
Fervescence to subfebrile figures is characteristic of an exacerbation of chronic hepatitis.
At objective research the following syndromes come to light.
Palmarny erythema — reddening of the tenor and a hypothenar.
Teleangiectasias (vascular asterisks) are located on a neck, a face, shoulders, an upper half of a trunk.
Hepatomegalia. Less often in the period of an exacerbation of chronic hepatitis the moderate splenomegaly is defined.
The hemorrhagic syndrome is shown by formation of petechias, bruises on skin, is more often than the lower extremities; nasal bleedings, uterine bleedings at women.