Hepatitis is the inflammation and damage of liver particularly invol¬ving the hepatocytes. It is usually due to various infective and toxic substances.
Infective agents :
These are mainly viruses like, Type A and Type B, non-A, non-B, Delta agent, yellow fever, Epstein-Barr virus, cytomegalo virus (CMV), Herpes simplex, Rubella, Marburg agent and others like Leptospiraicterohaemorrhagiae. Leptospiracanteola, Toxo-plasma gondii, Borreliarecurrentis etc.
Toxic agents :
Chlorpromazine and other phenothiazine derivatives, Mono-amine oxidase inhibitors (MAO-inhibitors), erythromycin, tetra-cycline, INH, rifampicin, methyl dopa, chlorpropamide, phenylbu-tazone, .indomethacin, paracetamol, thiouracil, acetaminophen, halo-then, alcohol, carbon tetrachloride etc.
Viral hepatitis is usually caused by four types of agencies.
1. Type A virus (MSi, HAV) :
It causes acute type A viral hepatitis which is the commo¬nest variety. This virus has been identified in human stools as 27 nm particles and in the cytoplasm of the liver cells. This is acid and ether resistant RNA virus which is inactivated by ultraviolet light, heat (100°C for 5 minutes), by formalin (1 : 4000) and chlorine. Stored blood of patients having type A viral hepatitis may show this virus even after 10 years.
Faeco-oral route is the possible mode of transmission of this disease. Thus this virus is responsible for epide-mics. The virus particles disappear from the stool when the serum transaminase level attains its peak. So the patient becomes noninfective when the disease becomes obvious. It is very difficult to culture this virus.
2. Type B virus (MS2, HBV, SH virus)
It causes acute type B viral hepatitis which is somewhat rare. It is transmitted through injections, transfusions etc. and rarely after bite of infected bed-bugs, or sexual contact. Hence it is found in the blood and not usually found in the stool. Hepatitis B virus is pleomorphic having spherical and tubular forms of various sizes. It is repre¬sented by Dane particles 42 nm composed of the following :
(i) A core of 27 nm is found in the nucleus of the infected hepatocyte, (ii) double celled surface particles seen in the cytoplasm of the hepatocytes. The surface antigen can be measured in the blood and is called HBs-Ag previously known as Australia Antigen. The antibody to this antigen is called HBs-Ag. The core antigen is called HBc-Ag and its antibody is called HBc-Ab. The antigens are also found in various body fluids, secretions and excre¬tions.
3. Type Non A Non B Virus
It also causes hepatitis. This is very important in re¬lation to post transfusion hepatitis. The clinical pattern of this is similar to that of Hepatitis B virus. There are two types of non A non B agent. These two have been identified from clotting factors II, VII, Vm, IX and X concentrates.
4. Delta agent
This has worldwide distribution having two epidemio-logical patterns. Severe outbreak of hepatitis by this agent has also been reported.
1. Acute icteric hepatitis.
This is the common type described above.
Here jaundice is not frank and symptoms are few, Liver is enlarged and tender.
3. Fulminant hepatitis.
Hepatic necrosis is massive and it develops in a short time. This is described below.
4. Relapsing hepatitis.
The disease relapses with some of the original features.
5. Cholestatic hepatitis.
Here jaundice is prolonged due to intrahepatic biliary cholestasis and hepatomegaly also persists. It may conti¬nue for many months but the prognosis is good.
6. Rare types.
Chronic persistent hepatitis, chronic active hepatitis may rarely develop.
1. The onset is gradual and there may be marked anorexia, continous nausea and vomiting, constipa¬tion and headaches for a few days before Jaundice develops.
2. Epigastic discomfort, pain in right hypochondrium and even colics may occur.
3. Slow fever is present for 3-4 days or more but as soon as Jaundice develops, fever and symptoms are quickly abated.
4. In severe cases, high fever, rigor, generalised pains, prostration and excruciating headache may be pres¬ent.
5. Very mild cases,may be asymptomatic with only slight jaundice and in others there may be no overt Jaundice.
6. Weakness, wasting, dehydration due to vomiting and in severe hepatic necroses mania, delirium, coma and convulsions may occur.
7. The signs are yellowish tinge of the conjunctivae and enlarged soft tender liver.
8. The colour of the urine is yellow and the stool becomes pale and may be white associated with itching in the later stage.
9. The mortality rate is 0.2%. Death may be due to hepatic coma.
(a) Raised serum bilirubin.
(b) Alkaline phosphatase (not more than 30 K.A. units).
(c) Level of S.G.P.T. is always high.
(d) Prothrombin time may be altered.
(e) Presence of bilirubin and urobilinogen in Urine. 10. Relapse may occur in 2-8%.
The object of therapy is two fold: —
(a) Hepatic cell damage to be minimised.
(b) Progress of the disease teJje arrested. Hence the following measures are taken-
(1) Bed rest til the activity of the disease ceases,
(2) Nourshing diet, as tolerated.
(3) Vitamin B complex and Vit. C.
(4) With drawn of alcohol.
(5) Homoeopathic Medicines like cholidonium, Nat sulph etc.
i) Chelidonium—Spasmodic pain in the liver and under inferior angle of the Rt. Scapula or shoulder blade. Stool, urine, tongue, skin, nail, eyes, and everything yellow; cannot eat nor drink anything but hot.
ii) Lycopodium—Jaundice from chronic liver trouble, atrophy of the liver. Urine milky with brick dust sediment, 4 to 8 P.M. aggravations.
iii) Merc sol.—Skin constantly moist with prespiration which stains the linen yellow, but perspiration does not relieve; worse at night; itching; clay coloured stool; salivation; tongue moist and mapped.
iv) China.—Brought on by loss of animal fuids, by sexual excesses. Skin and Sclerotice (whites of eye) yellowish.Liver swollen, hard and sensitive to touch. Abdomen feels full and tight as if stuffed. Jaundice from gall stones.
v) Bryonia.—With obstinate constipation, stool dry and hard. Lips parched, dry and cracked.Pains esp. stitching in liver, on being touched or coughing.
vi) Hydrastis can, Carduuas M, Nat Sulf, Kali mur also may be useful according to symptoms.
vii) Magnetic therapy as per therapeutic hints.