Hepatitis B

Hepatitis B

Hepatitis B, also known as serum hepatitis, is an infectious pathology of acute or chronic nature, where the liver is affected by a specific type of virus. This condition is considered extremely dangerous as it can lead to the development of cirrhosis and other serious complications, posing a direct threat to the patient’s health and life. Acute and chronic viral hepatitis B is treated by hepatologists, with the involvement, if necessary, of specialists from other fields (endocrinologists, allergists, infectious disease specialists, etc.).

General Information
The disease is caused by the DNA-containing hepatitis B virus, which is transmitted from person to person only through biological fluids (blood, semen, etc.). Specialists report a total of nine known genotypes of this infectious agent, which is capable of mutation and integration into human DNA.
Upon entering the liver, the hepatitis virus accumulates in the glandular cells of the organ (hepatocytes) and begins to actively replicate, causing autoimmune changes in the tissues. The pathology progresses in various clinical variants, ranging from asymptomatic carrier state to severe forms of intoxication.
The main danger of the pathology is its widespread prevalence: according to the World Health Organization as of 2019, the number of primary infected individuals worldwide exceeded 1.5 million. The highest number of detected cases is found in African countries and regions of the eastern Mediterranean.

Classification
First and foremost, specialists distinguish between acute and chronic forms of hepatitis B, with acute cases further categorized into acute prolonged and acute resolved types.
The chronic variant of the pathology is characterized by a prolonged course (more than 6 months) and manifests multiple changes in liver tissues of varying severity with mild symptoms.
The acute form (up to 4–6 months) is accompanied by a prominent clinical picture, with obvious signs of intoxication. Outcomes of this type of hepatitis B vary from complete recovery, observed in nearly 90% of cases, to liver cirrhosis, cancer, chronic progression, and other complications.
Clinically, hepatitis B can manifest as either subclinical, meaning asymptomatic, or overt clinical pathology, where the patient exhibits clear signs typical of this type of disease.
Based on severity, viral hepatitis B can be classified into mild, moderate, and severe forms, as well as being in the stage of development or remission.

Causes

The main cause of disease spread is the transmission of the hepatitis B virus from person to person. There are several possible modes of transmission:
During intrauterine development, when hepatitis B is transmitted from a pregnant woman to her unborn child through the uteroplacental blood flow.
Through blood transfusion from an infected patient.
During various medical and diagnostic invasive procedures if non-sterile instruments are used or aseptic precautions are not followed.
Through unprotected sexual contact.
During injections, for example, for intravenous administration of narcotic substances to multiple individuals using the same syringe, etc.
In some cases, infection occurs through household contact, when biological fluids such as blood or semen come into contact with injured areas of another person’s skin (abrasions, scratches, cuts). Fortunately, such a mode of virus transmission is extremely rare.

Symptoms of Hepatitis B

The incubation period of the disease lasts from 42 to 180 days. The development occurs gradually, and the first symptoms of hepatitis B in men and women during the prodromal stage include:

• Joint pain, mainly occurring at night.
• Rashes on various parts of the body resembling hives.
• Increased nervousness, irritability.
• Decreased appetite.
• Increased fatigue.
• Persistent feelings of weakness, fatigue, even after prolonged sleep and rest.

Some patients experience mild gastrointestinal disturbances, manifested by bloating, brief episodes of diarrhea, and occasional bouts of nausea. Others complain of darkening of urine and lightening of stools. Occasionally, Gianotti-Crosti syndrome occurs, characterized by the appearance of symmetrical, bright red rashes with large spots on the hands, feet, or other parts of the body.

The next stage of hepatitis B development is the jaundice period, characterized by changes in the color of the skin and sclera of the eyes. This phase usually lasts about one month. Against the background of skin and mucous membrane yellowing, general symptoms of intoxication intensify, and the patient feels progressively worse, becoming fatigued more quickly. Additionally, at this stage, other unpleasant symptoms of hepatitis B may occur, including:

• Heaviness, acute pain in the right hypochondrium.
• Bitter taste in the mouth.
• Severe itching of the skin, which cannot be relieved even by special gels and medications.
• Facial, neck, and limb swelling.
• Weight loss.
• Severe nausea, especially after eating and in the morning.
• Decreased pulse rate.
• Elevated body temperature to subfebrile values.
• Muscle pains and spasms.
• Decreased blood pressure.

The further course of events depends on how promptly hepatitis B treatment was initiated, the overall health status of the patient, and several other factors. If therapy is conducted properly and in a timely manner, a stage of recovery begins, characterized by normalization of skin color, improvement in well-being, stabilization of stool and appetite. In cases where treatment is not carried out or is done incorrectly, and the patient refuses to follow medical prescriptions and take medication, the acute form transitions into chronic. Moreover, the risk of developing complications increases significantly, including:

• Liver cirrhosis.
• Hepatic encephalopathy.
• Hepatic coma (more often develops if hepatitis B is combined with other forms of the disease).
• Sepsis.
• Acute liver failure.
• Hepatic malignancies.

Signs of chronic hepatitis B in men and women include:

• Periodic dull pain in the right hypochondrium.
• Persistent enlargement of the liver.
• Nausea, heaviness in the abdomen after consuming fatty foods or alcohol.
• Paleness of the skin.

In most cases, the chronic form of the disease proceeds practically asymptomatic. This is the main danger of the pathology: the absence of a clear clinical picture does not diminish the destructive effect of the disease on the liver, and each exacerbation causes increasing damage to the organ tissues, which can ultimately lead to extremely serious consequences.

Diagnosis

The key tasks of examination include determining the type and cause of hepatitis B, assessing the existing symptoms, and analyzing the patient’s general condition. First and foremost, a hepatologist conducts a physical examination, during which they inspect the patient’s skin, mucous membranes, palpate the liver, and collect information about past illnesses, surgeries, etc.

Subsequently, a diagnostic complex is prescribed, which, depending on indications and necessity, may include:

• Complete blood count and urinalysis.
• Biochemical blood analysis for albumin, bilirubin, liver enzymes, and other specific indicators.
• Ultrasound examination of the abdominal cavity and liver.
• Liver biopsy.
• PCR or ELISA.

If the patient has accompanying pathologies or chronic systemic diseases, specialized specialists are involved in the examination and diagnosis, and the list of studies may be expanded.

Treatment of Hepatitis B

The treatment program for acute and chronic forms of viral hepatitis B involves a comprehensive set of measures aimed at eliminating the infection, restoring liver function, alleviating symptoms, and preventing further progression of the disease.

For acute cases of the disease, it is recommended to:

• Strict bed rest.
• Gentle nutrition based on a diet specifically tailored to the individual patient.
• Fluid balance restoration through abundant drinking.
• Avoidance of exacerbating factors (smoking, alcohol consumption, certain medications).

For mild and moderate forms of hepatitis, antiviral therapy is rarely used. In cases of severe disease and high risk of complications, as well as in chronic forms, patients are indicated for intravenous infusion of special interferon-based medications. In such situations, treatment is always conducted in a hospital setting for an extended period.

In some cases, surgical treatment may be required when complications such as ascites (accumulation of fluid in the abdominal cavity) or gastrointestinal bleeding develop against the background of acute or chronic hepatitis B.

Prevention

The primary method of preventing disease spread is vaccination, which allows maintaining durable immunity to hepatitis B for at least 15 years (after this period, revaccination is recommended). Other measures to contain the pathology include:

• Adherence to sanitary and epidemiological norms during invasive procedures, blood transfusions, and processing of reusable instruments in medical institutions.
• Abstaining from unprotected sex with unfamiliar partners.
• Use of personal hygiene items only (razors, toothbrushes, etc.).
• Avoidance of drug use.

Disseminating the necessary information to schoolchildren and high school students also plays an important role in prevention.

Rehabilitation

The prognosis depends on the form and severity of hepatitis B, the route of virus penetration, the treatment tactics, as well as the individual characteristics of the patient’s body. In cases of acute liver damage, the prognosis is generally favorable, except in cases where the patient’s body is severely depleted, rapid-onset disease is diagnosed, or type B is combined with other variants, such as C, D, E.

Regarding the chronic form of the disease, only the treating physician can provide any forecasts.