Hepatitis B What are the performance and how the diagnosis?

Based on the clinical features, epidemiological data refer to the exclusion of other related diseases, the diagnosis relying on pathogen serology. Clinical manifestations are not typical of those who should be carried out pathological examination of liver puncture. 1. Etiological diagnosis Are more a result of asymptomatic HBsAg carriers, who were then infected with A, C, D, hepatitis E virus or other hepatitis, due to HBsAg-positive often misdiagnosed as acute hepatitis B, so the diagnosis should be careful. 2. Basis for the diagnosis of acute hepatitis B ① HBsAg-positive; ② HBeAg-positive; ③ anti-HBcIgM positive, high-titer (≥ 1:1000); ④ HBV-DNA positive. HBV infection is characterized by diverse clinical manifestations, incubation period is longer (about 45 ~ 160 days, with an average of 60 ~ 90 days). 1. Acute hepatitis B than hepatitis A slow onset. (1) clinical jaundice jaundice can be divided into the early recovery period with jaundice, the entire course of 2 to 4 months. Most of them in the early jaundice with gastrointestinal symptoms, such as disgust oil, anorexia, nausea, vomiting, abdominal distension, fatigue and so on, some patients have low-grade fever, or with serum sickness-like symptoms, such as joint pain, urticaria, angioedema, rashes and so on, the more common viral hepatitis. The course of the disease progress and prognosis with the Hepatitis A similar, but a small number of patients with persistent unhealed to chronic hepatitis. (2) no clinical symptoms of jaundice or asymptomatic light, mostly in check or inspection body found in other diseases, there are single elevated ALT, easy to become chronic. 2. Cholestatic The same as with hepatitis A. Manifested as a longer-term intrahepatic obstructive jaundice, but less gastrointestinal symptoms, hepatomegaly, intrahepatic obstructive jaundice test results, sustained for several months. 3. Pathogenesis of chronic hepatitis B more than 6 months. (1) chronic persistent hepatitis (CPH) clinical symptoms of light, no jaundice or mild jaundice, mild swelling of the liver and spleen than the general touch. Light damage to liver function, polynomial expression for the single ALT fluctuations, musk muddy and plasma protein no obvious abnormalities, generally without extrahepatic manifestations. (2) chronic active hepatitis (CAH) clinical symptoms are serious, persistent or recurring signs were obvious, such as liver disease face, spider angioma, liver palm, may have varying degrees of jaundice. Enlargement of the liver, texture medium-hard, most of splenomegaly. Significant liver damage, ALT continued or repeated rise, musk muddy obvious abnormality, increased plasma globulin, A / G ratio of reduced or inverted. Some patients have extrahepatic manifestations, such as arthritis, nephritis, Sjögren's syndrome and nodular artery Yandeng. Autoantibodies such as antinuclear antibodies, anti-smooth muscle antibody and anti-mitochondrial antibody-positive. Who can also be seen without jaundice and atypical persons, although the history of short, mild symptoms, but with signs of chronic liver disease and liver function impairment; or like chronic persistent hepatitis, but after histopathological examination confirmed chronic active hepatitis. In recent years, with the HBV-DNA pre-C mutation in progress, the existing scholars advocated by HBeAg and anti-HBe chronic hepatitis B situation will be divided into two kinds: ① HBeAg-positive chronic hepatitis (typical of chronic hepatitis B) from HBV wild type strain due to infection, its course has been HBeAg-positive and anti-HBe-positive in two stages. Consistent with the views of past, HBeAg-positive HBV replication in vivo activity on behalf of serum HBV-DNA positive, liver function and have the pathological changes of liver tissue. When HBeAg seroconversion, anti-HBe turn-yang, on behalf of weakening or cessation of HBV replication, serum HBV-DNA was negative, liver function returned to normal liver tissue lesions improved. ② anti-HBe-positive chronic hepatitis (atypical chronic hepatitis B) considered by the HBV pre-C gene mutation strain caused by infection. The serum HBeAg negative, anti-HBe positive, HBV-DNA in vivo is still to copy, display the progress of serious liver disease, easily develop into severe hepatitis, liver cirrhosis and hepatocellular carcinoma. 4. Severe hepatitis B (1) acute fulminant hepatitis (fulminant hepatitis) may onset of acute jaundice hepatitis, there is a high degree of fatigue significant gastrointestinal symptoms, such as severe loss of appetite, frequent nausea, vomiting, abdominal distension, was there within 10 days after onset of hepatic encephalopathy disease. The majority of illness 3 to 5, first appeared excited, euphoric, multi-language, character abnormal behavior, excessive daytime sleepiness did not sleep at night, day and night perversion, depending on the material is unclear, unstable gait. Orientation in problems of power and computing power, the further development of exciting, manic screaming, serious illness can be manifested as increased intracranial pressure, cerebral edema Erzhi disorders, such as blood pressure, conjunctival edema, or even both sides of the pupil ranged from large, there herniation, prevention and aggressive treatment of brain edema, to prevent brain herniation, patients on the importance of saving. After the emergence of rapidly deepening jaundice, liver dullness area narrowing and significant bleeding tendency. Generally occur without ascites or late, often in the three died of brain herniation, bleeding complications. (2) subacute onset of severe hepatitis, acute jaundice hepatitis and the general the same as the 10 after the onset of illness up sicker, showed a high degree of fatigue, abdominal distension, never thinking about food, jaundice deepened day by day, obviously characterized by a tendency to bleed. To the late hepatorenal syndrome and hepatic encephalopathy. Course number of weeks to several months. This model easily develop into post-necrotic cirrhosis. There can be after the onset of hepatic encephalopathy as the first symptom, only a period of history of more than 10, the other are like acute fulminant hepatitis. (4) the majority of asymptomatic carriers of HBsAg asymptomatic, physical examination found in HBsAg-positive with normal liver function or part of a single elevated ALT. Signs less. The clinical characteristics of elderly onset of viral hepatitis more slowly, light symptoms and the severity of discrepancies. Recovery slow, easy to chronic to severe hepatitis and chronic active hepatitis have a higher prevalence, of which sub-acute and chronic severe hepatitis were more common.