Clinical symptomatology and for

Chronic hepatitis (true diffuse) often develops as a continuation of clinically expressed acute epidemic of hepatitis (Botkin's disease), and with increasing severity of the latter increases the probability of an outcome in chronic. At the same time, chronic hepatitis can occur after subclinical or Busselton flowing acute hepatitis. Then the signs of chronic liver disease are identified, often without indications of previous acute stage of the disease. Wepler (1960) found in 20% 3,000 fine-needle biopsy of the liver morphological signs of chronic hepatitis, and only 41 % of cases latter evolved after the epidemic of hepatitis occurring with jaundice. Clinical manifestations of the disease in the latent the development of chronic hepatitis often identified already in the presence of the expressed morphological changes and often without special morphological studies are signs of acute hepatitis.
X. X. Mansurov (1962), based on a large number of observations, pays special attention to the fact that in chronic hepatitis "is not always celebrated sufficient correlation of clinical and morphological signs of activity, as expressed histopathological changes in the liver can be even when clinically mild cases".
Manifestations of chronic hepatitis can be combined in a variety of options, depending on the stage and activity of the pathological process. The consequence of this is extremely diverse clinical picture of the disease. And yet there are a number of fairly regular clinical features which allow to diagnose chronic active hepatitis.
Most often, patients with active chronic hepatitis complain of pain in the right upper quadrant or epigastric pain associated with eating or exercise stress, sometimes colicky. Such pain is often erroneously interpreted as a sign of cholecystitis or gallstones. The appearance of pain in chronic hepatitis due, perhaps, stretching liver capsules and the emergence of perihepatitis. Frequent dyspeptic symptoms: bad taste in the mouth, nausea, anorexia, bloating, irregular bowel movements, intolerance fats. Typical low capacity for work, muscle weakness until full adinamii. There are neurological disorders: irritability, sleep disorders, signs of violations of vegetative innervation. Sometimes these changes are reaching a degree of psychopathy. Often nosebleeds; allergic reactions: skin itching, urticaria, arthralgia. Sometimes develops rapidly emaciation, characterizing the acute phase of the disease. The liver is almost always increased, sealed, with a characteristic sharp edge, often painful. The degree of increase in the liver and is mainly density it depends on the stage of the disease.
Splenomegaly is found only in some patients. The skin is often dry, with grey-yellowish tint. Often appear Palmar erythema, star telangiectasias, hemorrhagic manifestations. In the active phase may experience fever.
Jaundice is not related to permanent signs of chronic active hepatitis. It is not present in one third of patients with acute illness occurring with a significant other violation of the liver, and not always in the latent the progression of chronic hepatitis.
Of the many biochemical studies greatest value for detecting clinically unexpressed chronic hepatitis is the establishment in the blood increase the transaminaz, alkaline phosphatase, organ-specific enzyme, 5-th fraction LDH, decrease of activity of cholinesterase, and the increase and in-globulin fractions and complex proteins. In the active phase of the disease often elevated level of bilirubin in blood serum, mainly due to the conjugated fraction. This fraction is in high and normal content of bilirubin (N. M. Konchalovsky, 1958; 3. D. Schwarzmann, 1963). Changes bromsulfaleinovy sample.
As a rule, increases the allocation of urobilin with urine. In most cases with the active hepatitis fall positive samples with turbulence and occulation thymol, reaction Takata - Ara. Other functional tests are less positive. So, the sample of Quick-Pytel we found positive in 67%, change "sugar curve" - 83%, decreased prothrombin index - in 81 % of cases of clinically significant exacerbations of chronic hepatitis.
In inactive phase (stabilization) chronic hepatitis subjective symptoms are absent or poorly expressed. Liver function maintained or slightly disturbed. The size and consistency of the liver depends on the stage at which slowed the progression of the disease.
The depth and incidence of morphological changes are not always proportional to the duration of the course of chronic hepatitis and the number of exacerbations of the disease. There are the so-called benign options when signs of cirrhosis are not identified and 10 years after the acute phase, in spite of having a place on 8-9 exacerbations of the disease during this period of time.
The progression of chronic hepatitis can be suspended at any stage of its development.
Stability of chronic hepatitis is not constant. After a long quiet period, you may experience a severe deterioration, leading to rapid progression of the pathological process.
60-70% of persons with chronic hepatitis, vyzdoravlivat, in 30% of cases of chronic hepatitis ends with liver cirrhosis (Markoff, Kaiser, 1962).
In the outcome of chronic hepatitis C may develop cirrhosis all three morphological types (Century, Smagin, 1961; E. N. Ter-Grigorova, 1963; E. M. Tareev, 1964). More likely to develop postnecrotic cirrhosis (38%) and mixed (33%), rarely - portal (24%) and rarely biliary cirrhosis (5%).
The diversity of the clinical picture of chronic hepatitis is aggravated by the fact that in some cases giperergicakie manifestations (arthralgia, hypergammaglobulinemia, LE-cells) or cholestasis symptoms dominate other symptoms.
The so-called chronic hepatitis with persistent hypoproteinemia and plasmozytom, or pseudoplasticity (Good, 1956), is developing gradually, as progressive portal hepatitis, current Busselton. Often show signs purpura, mainly on the lower limbs; along with this determined a marked increase in gamma globulin in the blood serum and plasmacytoma infiltration of the liver and bone marrow. Often, the disease leads to postnecrotic cirrhosis of the liver.
The so-called lupoid hepatitis, or cirrhosis of young women described Waldenstrom (1950), Mackay (1955), really occurs mostly in young women and less common in men. Beginning of the disease is similar to that of acute viral hepatitis, sometimes the disease begins without prior obvious acute hepatitis. The clinical picture at the forefront are enlarged liver and spleen, fever, abdominal pain, often associated with spider; later develops liver, hemorrhagic manifestations, periods liver failure. Often marked arthralgia and other symptoms that occurs in systemic lupus erythematosus, until the detection LE-cells. Detected pulmonary fibrosis, fingers forms of drum sticks. Young women are developing endocrine disorders: amenorrhea, hypoplasia of the genitals, sometimes cousinhood syndrome (hirsutism, obesity, striae distense). Always hyperproteinemia with a pronounced increase in gamma globulin. Rather characteristic positive reaction serum antigen cytoplasm of smooth muscles (Mackay et al., 1965, 1968).
Cholestatic option chronic hepatitis flows with years of jaundice, severe cholestasis, long-lasting not modified or malosemeyku by the liver, with hypercholesterolemia and high activity of alkaline phosphatase in the blood. Peritoneoscope the surface of the liver is not changed, in the late stages grainy, color liver green. The study of biopsies shows that the long-term progression of the process develops peridomiciliary and perilously fibrosis, developing into a biliary cirrhosis without extrahepatic blocking (Popper, Schaffner, 1957; Sherlock, 1959, and others).
Special place chronic holangiogepatit, developing friendly with inflammatory diseases of the biliary tract.
The clinical picture shows a set of symptoms of the underlying disease (cholecystographic, cholelithiasis). Fever is often absent, and in the initial stages do not always have jaundice. Persistent itching often appears before the other manifestations of the disease. The liver from the very beginning of a big, heavy, painful pressure. Characterized by the increased activity of alkaline phosphatase in the blood, often hypercholesterolemia. Peritoneoscope: the surface of the liver is not changed, sometimes on the right lobe visible scar retraction, color liver green, expressed situation of perihepatitis and pericholecystic. At puncture biopsy in early stages is determined by the round-cell productora infiltration, and in the subsequent stages - development productlares and pererabotannoe fibrosis.
In subsequent considered pathological changes often are suspended in phase productlares fibrosis, and a specified condition is stable; the progression of disease in the months or years leads in the end to the biliary cirrhosis of the liver.