HEPATITA VIRALA ACUTA

I .DIAGNOSTIC PARACLINIC

1.DIAGNOSTIC NESPECIFIC (INVESTIGATII UZUALE)

*citoliza hepatica-TGP,TGO

*retentie biliara-BT,BD,FA,δGT;

*pigmenti biliari prezenti in urina (urobilinogen↑,BC+)

*sdr.hepatopriv-albumina,colinesteraza,factorii de coagulare -Fibrinogen;

-IQ-Activitatea de protrombina;

*sdr. de hiperactivitate mezenchimala-electroforeza proteinelor serice; *uree,creatinina,RA,amoniemie,ionograma-in formele severe

2.DIAGNOSTIC ETIOLOGIC-MARKERI VIRALI SEROLOGICI

*Hepatita virala acuta cu virus A-IgM anti HAV

*Hepatita virala acuta cu virus B-IgM anti HBc

-AgHBs

-AgHBe

*Hepatita virala acuta cu virus B+D-coinfectie-IgM anti HVD

-AgHVD

-IgM anti HBc

-AgHBs

-suprainfectie-IgM anti HVD

-Ac anti HVD totali

-AgHVD

-AgHBs

* Hepatita virala acuta cu virus C-Ac anti HCV (totali )-apar dupa 7-31 sapt. de la infectare; -IgM anti HCV-indisponibili

3.EXPLORARI IMAGISTICE

*ecografie abdominala

*CT(computer tomograf) abdominal-in formele severe

II.TRATAMENT

1.IGIENO-DIETETIC-repaus la pat;

-regim alimentar de protectie hepatica(H-L-Z-initial,ulterior carne de pasare,vita) -regim hiposoat in corticoterapie

2.SIMPTOMATIC-antiemetice,antispastice,antialgice;calmante ale pruritului (anti H1,colestiramina,alcool mentolat)

3.PATOGENIC

-in forme comune-PEV cu Glucoza 5%sau 10% (aport energetic),vitamine B1,B6,C

-hepatoprotectoare-PEV cu Aspatofort,Arginina

-silimarina,LIV52,fosfolipide

esentiale,farcovit,metaspar,hepaton,sargenor ,acid orotic;

-vitamina K-in formele cu IQ↓,hemoragice;

-coleretice-colebil,bilichol,metoclopramid;

-anti H2 -arnetin,quamatel(inj./po)

-in formele colestatice-ursofalk,fenobarbital,bilichol,colestiramina; antispastice(no-spa),ampicilina-inj.; -corticoterapie scurta-prednison 1mg/kg.c/zi-5-7zile

Corticoterapie

-in formele severe -fulminanta-HHC 10-20 mg/kg.c/zi 3-4 prize 5-7 zile

-Dexametazona 0,3-0,5 mg/kg.c/zi

-colestatice-Prednison

TRATAMENT HEPATITA FULMINANTA - FORMA SEVERA-COMATOASA

1.Suprimarea proteinelor din dieta

2.Sustinere metabolica,energetica-PEV-Glucoza,vitamine B1,B6,C

3.Sustinere volemica,H-E,A-B:Ringer,Ser fiziologic,bicarbonat de sodiu

4.Amoniofixatoare-Arginina-Sorbitol,Ornitina,Multiglutin,Aspatofort

5.Antibiotice neresorbabile (posau sonda)-inhiba flora proteolitica,↓productia de NH3:neomicina2g/zi la 6h,streptomicina 2g/zi la 6h,colimicina 3000000 u/zi la 6h,normix 300mg la 6h

6.Hemostatice(profilaxia hemoragiei)-etamsilat,adrenostazin,vitamina K,calciu gluconic,vitamina C,venostat

7.Prevenirea HDS:-anti H2-inj.-arnetin,axid,quamatel;IPP-omeprazol,pantoprazol

8.Sange,plasma-aport de factori de coagulare si anticorpi

9.Sedative-haloperidol,fenobarbital,romergan,clordelazin

10.Corticoterapie-HHC-10-20mg/kg/zi la 6h in edem cerebral

11.Antiedematoase cerebrale-in encefalopatia hepatica-Glucoza10%,Manitol20% 1-2g/kg/zi,Furosemid 1-2 g/kg/zi,1f la 12 h,HHC 400-600mg/zi la 6h

12.Imunoglobuline specifice umane

13.Interferon α 10 Mux3/sapt-3 luni;lamivudina 100mg/zi 3 luni

III. Durata medie de spitalizare-10 zile(in formele severe:21zile)