Therapy of Infectious Hepatitis and Other Liver Disorders
Prof. Gupta, S., F.R.C.P., M.R.C.P., D.C.H., Head of the Department of Paediatrics, Gastroenterology Unit, Maulana Azad Medical College, New Delhi-1. Khatri, R.L., D.C.H., Resident Medical Officer, Paediatrics. Srivastava, G., M.D., Paediatrician.
INFECTIOUS HEPATITIS - 36 CASES
Infectious hepatitis is a systemic disease caused by a virus or viruses. It is characterised by evidence of liver injury and constitutional and gastrointestinal signs and symptoms. it occurs predominantly in childhood, sporadically in epidemics. Jaundice, the most distinctive symptom, does not always occur in a minority of patients.
The main pathologic changes are in the liver which have been observed both by liver biopsies at the various stages of the disease and at necropsy. The size of the liver may be larger than normal and in subacute and fulminating cases may be reduced. The clinical picture shows great variation. The disease may be inapparent or evanescent and in children its course is generally mild. The course of the disease may be separated into pre-icteric and icteric, although frequently jaundice may be the presenting symptom. The onset may be sudden or gradual with anorexia, fever, headache, irritability, lassitude and sometimes nausea, vomiting and abdominal pain. Mental depression and bradycardia are commonly observed symptoms in adults which are uncommon in children. The liver is enlarged and tender, the stools may be clay-coloured but this is not a constant finding. The icteric phase persists from a few days to as long as a month or even longer, the average duration being about eight to eleven days in children in contrast to three to four weeks in adults. As jaundice fades, the appetite returns and the patient gradually feels better.
There is no specific test to predict the patient’s response to the infection with this agent. Liver function tests and routine blood examination are helpful. The rise in serum bilirubin usually precedes jaundice and bile may be detected in the urine before the level of serum bilirubin rises. Serum transminase assay is one of the useful non-specific tests available for the diagnosis of infectious hepatitis. Clinical and epidemiological grounds aided by laboratory tests help in the diagnosis of hepatitis in the absence of specific urologic tests. There is no specific treatment and symptomatic therapy consists of bed rest and adequate diet. The diet is best regulated by the patient’s appetite.
Thirty six patients of infectious hepatitis varying in age from infancy to twelve years were studied out of which twenty seven were treated with the drug and the rest served as control as shown in Table I.
Symptomatology as observed in 36 cases is shown in the accompanying tablet.
The jaundice was mild, moderate or severe in degree, reached its peak within 12 to 16 days and gradually receded in the majority of cases.
The liver was palpable in all cases but the size and the degree of tenderness varied in different cases. Spleen was palpable in 17 cases.
Liver function tests were performed in all cases. These included total serum protein estimation, albumin/globulin ratio studies, serum bilirubin estimation, serum alkaline phosphatase studies, serum transaminase assessment and prothrombin time. Liver biopsy studies were done in ten cases in the early and receding phases of the disease.
OBSERVATIONS
Liv.52 was tried with the hope that it would cut short the acute phase or lessen the severity of the disease and prevent post-hepatitis complaints. No other drugs were administered to the drug treated group. Observations show that fever, anorexia, vomiting and jaundice improved considerably on Liv.52 therapy than in cases in the control group. Appetite improved in 72 percent of cases and this improvement continued for a prolonged period. A much higher percentage of children, 72 percent, were symptom-free earlier and the liver size and tenderness, returned to nearer normal.
Careful observations clearly demonstrate that Liv.52 therapy improves appetite, reduces the intensity and duration of jaundice and markedly cuts short the course of the attack and probably reduces the incidence of subacute hepatitis by protecting the liver.
Laboratory studies also show that total serum protein readings were not effectively affected; the albumin/globulin ratio reverting to normal limits: Serum bilirubin levels which were raised in the earlier stages returned to nearer normal earlier, thus showing regression in clinical jaundice. Serum alkaline phosphatase and prothrombin time values were not affected effectively in the treated cases. SGOT and SGPT levels which were initially higher returned to normal within 10 to 14 days. Liver biopsy studies were done in 10 cases. Seven of these were treated with Liv.52. Biopsies clearly showed receding phase of infectious hepatitis in the group treated with Liv.52 tablets.
This therapeutic study of the clinical course of the disease, the changes in the liver function tests and the histopathological studies of the affected liver clearly indicate a remarkable degree of earlier improvement in the cases treated with Liv.52. The clinical, laboratory and histopathological response was significant in the treated group as it cut short the duration and course and severity of the attack and showed remarkable improvement toward normal values. Increased appetite was noted in a large number of cases on trial in this series. No toxic effects were observed in any of the treated cases.
Infectious hepatitis is a systemic disease caused by a virus or viruses. It is characterised by evidence of liver injury and constitutional and gastrointestinal signs and symptoms. it occurs predominantly in childhood, sporadically in epidemics. Jaundice, the most distinctive symptom, does not always occur in a minority of patients.
The main pathologic changes are in the liver which have been observed both by liver biopsies at the various stages of the disease and at necropsy. The size of the liver may be larger than normal and in subacute and fulminating cases may be reduced. The clinical picture shows great variation. The disease may be inapparent or evanescent and in children its course is generally mild. The course of the disease may be separated into pre-icteric and icteric, although frequently jaundice may be the presenting symptom. The onset may be sudden or gradual with anorexia, fever, headache, irritability, lassitude and sometimes nausea, vomiting and abdominal pain. Mental depression and bradycardia are commonly observed symptoms in adults which are uncommon in children. The liver is enlarged and tender, the stools may be clay-coloured but this is not a constant finding. The icteric phase persists from a few days to as long as a month or even longer, the average duration being about eight to eleven days in children in contrast to three to four weeks in adults. As jaundice fades, the appetite returns and the patient gradually feels better.
There is no specific test to predict the patient’s response to the infection with this agent. Liver function tests and routine blood examination are helpful. The rise in serum bilirubin usually precedes jaundice and bile may be detected in the urine before the level of serum bilirubin rises. Serum transminase assay is one of the useful non-specific tests available for the diagnosis of infectious hepatitis. Clinical and epidemiological grounds aided by laboratory tests help in the diagnosis of hepatitis in the absence of specific urologic tests. There is no specific treatment and symptomatic therapy consists of bed rest and adequate diet. The diet is best regulated by the patient’s appetite.
Thirty six patients of infectious hepatitis varying in age from infancy to twelve years were studied out of which twenty seven were treated with the drug and the rest served as control as shown in Table I.
Table I: Age in years - 36 cases |
|||
Age in years |
No. of cases on Liv.52 |
Control |
Total |
Birth to 2 years |
5 |
2 |
7 |
3 - 5 years |
12 |
4 |
16 |
6 - 9 years |
6 |
2 |
8 |
10 - 12 years |
4 |
1 |
5 |
Total |
27 |
9 |
36 |
Table II |
|||
|
On Liv.52 |
Control |
Total |
Fever |
23 |
5 |
28 |
Jaundice |
27 |
8 |
35 |
Anorexia |
22 |
8 |
30 |
Nausea and/or vomiting |
15 |
5 |
20 |
Pain in abdomen |
12 |
4 |
16 |
Distention of abdomen |
12 |
4 |
16 |
Pallor |
14 |
5 |
19 |
Yellow urine |
27 |
8 |
35 |
Clay-coloured stool |
9 |
3 |
12 |
Oedema |
2 |
1 |
3 |
Bleeding tendency |
1 |
— |
1 |
Table III: Size of Liver - 36 cases |
|||
Palpable in mid-clavicular line in cm. |
No. of cases |
Control |
Total |
Upto 2 cm |
5 |
2 |
7 |
3-5 cm |
18 |
6 |
24 |
6-10 cm |
4 |
1 |
5 |
Symptomatology as observed in 36 cases is shown in the accompanying tablet.
The jaundice was mild, moderate or severe in degree, reached its peak within 12 to 16 days and gradually receded in the majority of cases.
The liver was palpable in all cases but the size and the degree of tenderness varied in different cases. Spleen was palpable in 17 cases.
Liver function tests were performed in all cases. These included total serum protein estimation, albumin/globulin ratio studies, serum bilirubin estimation, serum alkaline phosphatase studies, serum transaminase assessment and prothrombin time. Liver biopsy studies were done in ten cases in the early and receding phases of the disease.
OBSERVATIONS
Liv.52 was tried with the hope that it would cut short the acute phase or lessen the severity of the disease and prevent post-hepatitis complaints. No other drugs were administered to the drug treated group. Observations show that fever, anorexia, vomiting and jaundice improved considerably on Liv.52 therapy than in cases in the control group. Appetite improved in 72 percent of cases and this improvement continued for a prolonged period. A much higher percentage of children, 72 percent, were symptom-free earlier and the liver size and tenderness, returned to nearer normal.
Careful observations clearly demonstrate that Liv.52 therapy improves appetite, reduces the intensity and duration of jaundice and markedly cuts short the course of the attack and probably reduces the incidence of subacute hepatitis by protecting the liver.
Laboratory studies also show that total serum protein readings were not effectively affected; the albumin/globulin ratio reverting to normal limits: Serum bilirubin levels which were raised in the earlier stages returned to nearer normal earlier, thus showing regression in clinical jaundice. Serum alkaline phosphatase and prothrombin time values were not affected effectively in the treated cases. SGOT and SGPT levels which were initially higher returned to normal within 10 to 14 days. Liver biopsy studies were done in 10 cases. Seven of these were treated with Liv.52. Biopsies clearly showed receding phase of infectious hepatitis in the group treated with Liv.52 tablets.
This therapeutic study of the clinical course of the disease, the changes in the liver function tests and the histopathological studies of the affected liver clearly indicate a remarkable degree of earlier improvement in the cases treated with Liv.52. The clinical, laboratory and histopathological response was significant in the treated group as it cut short the duration and course and severity of the attack and showed remarkable improvement toward normal values. Increased appetite was noted in a large number of cases on trial in this series. No toxic effects were observed in any of the treated cases.
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