Chronic hepatitises at children Definition The Chronic Hepatitis

Chronic hepatitises at children

Definition • The Chronic Hepatitis (CH) - a diffusion inflammation of tissue of a liver lasting more than 6 months.

Functions of organelles of a cage • Membrane (cover) of a cage. The main functions – protective, transport, providing a homeostasis, division, work of proteins and the receptors located on it and B'day; • Mitokhodry – providing a cage with energy; • Goldzhi's complex – secretary function, and also neutralization of toxic products; • Endoplasmic – protein synthesis, • Kernel – storage of genetic information, division and cage regeneration.

The virologic factors influencing synchronization of process • Hepatitis virus (the greatest frequency of synchronization HCV causes) • Genotype of a virus of hepatitis • Degree of variability of a virus • Virus loading (quantity of a virus in blood unit of volume)

Virus hepatitis D • HBs. Ag is necessary for development of virus hepatitis D • Two types of a combination of VGV and VGD: • Superinfection • To - an infection

Current and VHD forecast • • Easy current – 10% The medium-weight – 20% Heavy – 45% Fulminate hepatitis – 25% Recovery comes extremely seldom Deadly outcomes – to 30% Formation of chronic mikst-hepatitis in 70% with fast transition to cirrhosis

Main pathological syndromes of diseases of a liver • Syndrome cytolysis • Syndrome inside - and extra hepatic holestasis • Syndrome of toxic defeat Syndrome of insufficiency of synthetic processes in heparcells • Inflammation syndrome

• Cirrhosis

CLASSIFICATION of CHRONIC HEPATITIS taking into account recommendations of the international group of experts (Los-Andjeles, 1994) • • • On an etiology: Virus (HVHV, HHGS, HVHD) Autoimmune (Type I, III) Drugs induced The cryptogene

• • • On activity degree: The minimum The low The moderate The expressed

• • • On fibrinotic degree: Isn't present fibroses Ill-defined fibroses Moderated fibroses Expressed fibroses Cirrhosis

• Clinical manifestations of chronic virus hepatitis's not always can be criteria of diagnostics and a weight assessment as aren't specific, aren't constant and are characterized by the general symptoms of intoxication, depend on degree of activity of hepatitis.

Features of a clinical course of chronic virus hepatitises • Long long-term current without clinical manifestations of an illness • Disease demonstration at late stages, including their complications • Possibility of development of various extra hepatic changes, including ways and pancreas, dysbiosis intestines

The objective clinical signs demanding an exception of HVG Pallor with a yellow shade of skin Palmarny erythem Telengoektazy Increase and consolidation liver Increase in a spleen

Ascyt “Caput Meduza”

Diagnostics of chronic hepatitis • At suspicion on existence sick chronic hepatitis at the doctor always has a number of problems most important of which is the following: • establishment of an etiologic factor; • specification of a clinic-morphological form of an illness; • identification of complications and accompanying diseases;

Etiologicall diagnostics • It is based on application of immunochemical and molecular and biological methods of research • The main immunochemical method - IFA • The main molecular biological method RPR

Definition of degree of activity of HVG • By results of functional tests of a liver • By results of histological research

Definition of degree of expressiveness (hepatitis stage) • Morphologically - according to a biopsy of a liver - "the gold standard" • According to ultrasonography • According to a dopplerografiya

Principles of therapy of chronic hepatitises • In treatment of chronic virus hepatitises B, D and S isn't present alternative recombinant interferon (Roferon, Pegintron, Pegasis and B'day) • Recombinant (Roferon, Pegintron, Pegasis and B'day) undoubtedly suppress replication of HBV and HCV and reduce activity of pathological process in a liver

Indications to appointment antiviral therapy at chronic virus hepatitises • 1. Ascertaining of chronic hepatitis B, C • or D (course of disease more than 6 months) • 2. Increase of activity of ALAT and ASAT. • 3. Detection of markers of replication of a virus of hepatitis B (DNA of HBV, HBs. Ag), hepatitis C • (HCV RNA), hepatitis D (HDV)

Criteria of efficiency of antiviral therapy • 1. Biochemical • Activity of ALAT. Researches are carried out monthly during treatment and within 6 months after the end of therapy; then each 6 months for 36 months. • 2. Virologic • (RNA of HCV and HBV DNA) - qualitative and quantitative methods • 3. Histological • (Positive dynamics according to a liver biopsy with use of an index of histological activity remission, incomplete remission, lack of remission)

Efficiency of standard antiviral therapy • Therapy by interferon is effective at 40 -60% of patients with virus hepatitis • At cirrhosis development - only at 20% • At 50 -60% of patients with hepatitis C standard therapy by interferon either doesn't yield results or is impossible because of high risk of development of side effects (especially at children) • At hepatitis treatment In a positive effect of therapy by interferon it is noted only at 33% of patients from which at 13% repeated reactivation of a virus after the end of treatment was observed

Basic, pathogenetic, symptomatic therapy • Diet (No. 5 on Pevznera) • Spazmolitic preparations (but-shpa, and B'day) • Hepatoprotektors (derivatives of ursodesoksikhol acid - Ursosan, Ursofalk and B'day) • In heavy cases - hormonal therapy (GKS), plasmotransfusiation, albumine, proteinaceous preparations, haemo statics, etc.

Diet: • • To exclude: Fat grades of meat, rich meat soups To limit: Fresh bread, pies with cream, smoked products, bean, chocolate, coffee, a pickles

Indications to anti-virus therapy of HVGV • Existence of active replication – HBV DNA, HBs. Ag (a "wild" strain of a virus) • High virus loading; 105 th cop/ml) • Degree fibrosis II-III.

Preparations of anti-virus therapy of HVGV at children • • • Interferon preparations: - Viferon - Roferon-A - Intron-A - Realdiron - PEG-IFN: Peg Intron, Pegasis

Choice preparation in etiotropy therapy of chronic hepatitises at children • Viferon – on 1 candle rectal each 12 hours (2 times per day) – the first 10 days. • Further – on 1 candle rectal each 12 hours (2 times per day) through

Preparations of anti-virus therapy of HVHS at children • • • Interferon preparations: - Viferon - Roferon-A - Intron-A - Realdiron - PEG-IFN: Peg Intron, Pegasis

Viferon's age dosages at treatment of chronic virus hepatitises • Newborns – children till 3 years – Viferon 1 (150. 000 ME IFN) • Children from 3 to 7 years – Viferon-2 (500. 000 ME IFN) • Children from 7 to 10 years – Viferon-3 (1. 000 ME IFN) • Children are more senior than 10 years – Viferon-4 (3. 000 ME IFN)

Medical examination at chronic hepatitises • It isn't regulated • It is carried out in policlinics in a residence, if necessary with the direction to the hepatologic, diagnostic centers, infectious diseases hospitals for profound inspection • Frequency of survey - each 6 months