Symptoms of chronic hepatitis

Hepatitis is a common liver disease, and it is highly contagious. If someone in a family has hepatitis and timely preventive measures are not taken, other people are likely to develop hepatitis as well. Hepatitis has many effects on us, including nausea and loss of appetite. Chronic hepatitis should also be taken seriously, and we should understand the symptoms of chronic hepatitis.

The symptoms of chronic hepatitis manifest themselves in many aspects, but some patients with chronic hepatitis do not show obvious symptoms, and some people have almost no symptoms. This is not conducive to the detection and treatment of the disease. Everyone should know more about some common knowledge about hepatitis.

Clinical manifestations of chronic hepatitis:

1. Clinical symptoms

Many people with chronic hepatitis have no symptoms at all.

The symptoms of mild chronic hepatitis are relatively mild, including fatigue, loss of appetite, aversion to oil, dull pain and discomfort in the liver area, which may be accompanied by abdominal distension, nausea, diarrhea, etc. The liver is normal in size or slightly enlarged, soft in texture with mild tenderness, and the spleen is usually not enlarged.

The symptoms of moderate and severe chronic hepatitis are more severe, most of which are accompanied by moderate jaundice, fatigue, poor appetite, nausea, vomiting, aversion to oil, abdominal distension, and dull pain in the liver area; jaundice, spider nevi, liver palms, male breast development, subcutaneous hemorrhage, enlarged liver with medium texture, tenderness and percussion pain, most of which have splenomegaly, and some patients have ascites. In severe cases, lower limb edema, bleeding tendency and hepatic encephalopathy may occur. It may be accompanied by extrahepatic manifestations such as fever, arthritis, pleurisy, skin lesions, glomerulonephritis, amenorrhea, etc. Systemic and extrahepatic manifestations are more common in autoimmune chronic hepatitis.

2. Physical signs

The liver is mildly to moderately enlarged, with a medium or full texture. In patients with cirrhosis, the liver is hard, nodular, and has splenomegaly. In the late stage, lower limb edema, bleeding tendency, and signs of portal hypertension may occur.

3. Extrahepatic manifestations

Common symptoms include renal changes (20%-30%) and papular acrodermatitis; other rare symptoms include hemolytic anemia, aplastic anemia, etc.

Detailed explanation of chronic hepatitis:

Hepatitis C is a common cause of chronic hepatitis. Approximately 75% of acute hepatitis C transforms into chronic hepatitis. Hepatitis B virus and hepatitis D virus can cause chronic hepatitis in rare cases, while hepatitis A and E viruses do not cause chronic hepatitis. Drugs such as methyldopa, isoniazid, nitrofurantoin, and acetaminophen can cause chronic hepatitis, especially if taken for a long time. Wilson's disease, a rare inherited disorder of copper metabolism, can cause chronic hepatitis in children and young adults.

Many patients with chronic hepatitis cannot find an obvious cause. For some of these people, it seems that an excessive immune response in the body causes chronic hepatitis. This condition is called autoimmune hepatitis and is more common in women than in men.

Chronic hepatitis is most commonly caused by hepatitis B virus (HBV) infection, followed by hepatitis C and D (HCV and HDV). Chronic hepatitis B infection accounts for 5% of the world's population, the positive rate in Western countries is only 0.2% of the total population, while in Southeast Asia, Africa and the Middle East countries it is as high as 20%, and 10% of HBsAg carriers in my country. Since the 1980s, due to the widespread vaccination of hepatitis B vaccine, the incidence of hepatitis B in cities has been significantly reduced. However, due to the limitations of vaccination in rural areas and the influence of the social environment, chronic hepatitis is still not uncommon in clinical practice. The prolonged course of some diseases has seriously affected the health of children and should be taken seriously.

Pathogenesis:

The pathogenesis of hepatitis B is relatively complex and has not yet been fully elucidated. Studies have shown that liver damage in hepatitis B patients is not a direct result of HBV reproduction in liver cells. The body's immune response is an important cause of liver cell damage. The main assumptions are as follows.

1. Cell-mediated immunity

It is believed that the cytotoxic effect of T cells on hepatocytes is an important factor in clearing HBV-infected hepatocytes and causing hepatocyte damage; the cytotoxic effect of non-T cells on hepatocytes is an ADCC (antibody-dependent cellular cytotoxicity) reaction mediated by anti-LSP (anti-hepatocyte membrane-specific lipoprotein). This is a common pathway of liver cell damage in patients with hepatitis B and autoimmune hepatitis. It can cause damage to both HBV-infected liver cells and uninfected liver cells.

2. Immunomodulation

(1) Regulatory effect on cellular immune response: Cellular immune response is controlled by the body's immune regulatory system, mainly involving Ts (suppressor T cells), HLA (human leukocyte antigen), interferon, IL-2 (interleukin-2), etc. Chronic hepatitis B patients may suffer from persistent liver cell damage due to immune regulation dysfunction.

(2) Regulatory effect on humoral immune response: The humoral immune response to HBV envelope antigen plays an important role in the process of clearing the virus. In patients with chronic hepatitis B, due to immune regulatory dysfunction, anti-pre-S and anti-HBs cannot be detected in the serum, and the virus cannot be completely cleared, resulting in prolonged disease.

Although the incidence of hepatitis is not as high as in previous years, it still occurs frequently and there is a high chance of transmission. We must be able to carry out scientific prevention and treatment in a timely manner. If it becomes chronic hepatitis, our health will be more seriously endangered. Therefore, it is very necessary to understand the symptoms of chronic hepatitis.