Viral Hepatitis in Children
Sudhakar Rao, V., Reddi, Y.R. and Rohini, K. Institute of Child Health, Niloufer Hospital, Hyderabad, India. (Paper read at the XII National Conference of Indian Academy of Paediatrics, Manipal, Karnataka)
Table IV: Complaints on admission |
||
Complaint |
No. of cases |
Percentage |
Lack of appetite |
120 |
100 |
Fever |
106 |
88 |
Yellow urine |
103 |
86 |
Jaundice |
84 |
70 |
Clay coloured stools |
66 |
55 |
Nausea or vomiting |
60 |
50 |
Pain in abdomen |
36 |
30 |
Pruritus |
7 |
6 |
Insomnia |
7 |
6 |
Chills and rigors |
5 |
4 |
Altered sensorium |
2 |
1.7 |
Bleeding tendencies |
2 |
1.7 |
Results of treatment: Table 5 shows the comparison of the four groups with respect to age, sex, duration of symptoms and mean serum bilirubin level, and Table 6 shows the results of treatment in these groups.
Table 5: Age, sex, duration of symptoms and serum bilirubin level prior to treatment |
||||
Groups |
Mean age |
Sex ratio Male/female |
Duration of symptoms, mean period in days |
Mean serum bilirubin mg/100 ml |
A |
4 years |
18/12 |
10 |
8 |
B |
3 years 10 months |
16/14 |
11 |
7 |
C |
4 years 2 months |
15/15 |
9 |
7.4 |
D |
3½ years |
16/14 |
12 |
11.2 |
Table 6: Results of treatment (mean period in days) |
|||||||||||||||||||||||
Groups |
Group A |
Group B |
Group C |
Group D |
|||||||||||||||||||
1. |
Return of appetite |
4 |
10 |
5 |
14 |
||||||||||||||||||
2. |
Liver size reduction |
10 |
18 |
14 |
28 |
||||||||||||||||||
3. |
Clearance of jaundice |
12 |
17 |
11 |
14 |
||||||||||||||||||
4. |
Normalisation of |
Serum bilirubin |
10 |
18 |
12 |
26 |
|||||||||||||||||
Thymol turbidity |
14 |
21 |
13 |
30 |
|||||||||||||||||||
SGOT & SGPT |
18 |
26 |
21 |
34 |
|||||||||||||||||||
Alkaline phosphatase |
16 |
23 |
16 |
30 |
|||||||||||||||||||
5. |
Histopathologic recovery |
35 |
70 |
36 |
98 |
||||||||||||||||||
The clinical, biochemical and histopathologic recovery was earliest in Group A. Appetite returned to normal earliest in Group A (mean period - 4 days), followed by Group C (mean period - 5 days). A general sense of well being was present in Groups A and C. Jaundice disappeared clinically in a mean period of 12 days in Group A, while in Groups B and D, the mean period for disappearance of jaundice was 17 and 14 days, respectively. The cases in Group C took 11 days for clearance of jaundice. Biochemical remission in terms of serum bilirubin, thymol turbidity, SGOT and SGPT values was also earliest in Groups A and C.
Histopathologic recovery, in terms of complete regeneration of liver cells decrease or disappearance of mononuclear infiltration of portal tracts, absence of vacuolation of hepatocytes and normalisation of their glycogen content in sections stained with Periodic acid Schiff, etc., was noticed in all groups. However, complete histopathologic recovery was seen in a mean period of 5 weeks in Groups A and C. Groups B and D took 10 and 14 weeks, respectively, for completing histopathologic recovery.
Side effects of prednisone therapy, such as mooning of face, etc., were seen in all cases of Groups B and C.
DISCUSSION
Viral hepatitis is often a self-limiting disease, but can have high mortality and morbidity during epidemics4, particularly where malnutrition is endemic. Therapy with inexpensive and efficient drugs is, therefore, welcome.
Peak incidence was in pre-school age group, an observation made by other workers5 also. The higher frequency noted in our study during the summer months also agrees with the observations of other workers6. Lack of appetite with irritability and fever should alert the physician for the development of jaundice, in a few days, and urine examination for bile salts, bile pigments and urobilinogen should be a routine in such cases. Early detection is of importance, to avoid administration of hepatotoxic drugs, such as chlorpromazine, etc., for vomiting or drugs, such as cyproheptadine hydrochloride for appetite.
Abdominal pain was noticed in 30 per cent, which is in agreement with the observations of Sule et al.7. It is attributed to perihepatitis, distension of Glisson's capsule, phlegmonous enteritis or sudden shrinkage of liver in acute hepatic necrosis8.
Majority of our cases belonged to the poor socio-economic group, and obvious signs of malnutrition were found in 28 per cent cases. Seventeen per cent were clearly malnourished in another study9.
Corticosteroids did produce clinical and biochemical remission as observed by Duccy10 although Sule et al7 did not find much change in the histologic lesions. In our study, Group B experienced clinical remission much later than the Groups A and C and the histopathologic improvement also took much longer time than Groups A and C. Our study has also revealed that addition of corticosteroids to Liv.52 does not seem to have any extra advantage in treatment and routine management of cases. All cases on corticosteroids developed mooning of the face and oedema of feet as observed by Libov11.
The efficacy of Liv.52 was observed by several other workers2,3,5,7,8,9. The drug is a herbal preparation with anabolic, aperient, diuretic, stomachic and protective and has regenerative action on the liver. It is also relatively inexpensive and has no toxic side effects. Patients in our study (Groups A and C) experienced improvement in symptomatology earliest, and this is also corroborated by the biochemical and histopathologic improvement. The absence of untoward side effects with even prolonged administration makes this drug safe and effective in the management of viral hepatitis.
REFERENCES
1. Davidson, S. (ed.): In The Principles and Practice of Medicine, 9th ed. The English Language Book Society and E & S Livingstone Ltd., Great Britain, 1968, pp. 1009 and 1052.
2. Arora, J.K.: Role of various types of treatment in infective hepatitis. Armed Forces Med. J. 3: 3621, 1961.
3. Ramalingam, V., Sundaravalli, N. and Raju, V.B.: Liv.52 studies in acute hepatitis. Indian Pediatr. 8: 839, 1971.
4. Melnick, J.L.: In Waterborne Urban Hepatitis (Delhi Epidemic): Hepatitis Frontier, Little Brown, Boston, 1957, p. 241.
5. Dave, D.S., Rajput, V.J. and Gupta, N.R.: Clinicobiochemical study of infective hepatitis. Probe 911: 214, 1972.
6. Viswanathan, R.: Epidemiology of infective hepatitis. Probe 45: 101, 1957.
7. Sule, C.R., Puri, V.R., Damania, R.F. and Joshi, V.S.: Sutides with Liv.52 therapy in infective hepatitis. J. Indian Med. Prof. 12: 6391, 1968.
8. Litchman, S.S.: In Diseases of Liver and Gall Bladder, 3rd ed. Lea & Febiger, Philadelphia, 1953.
9. Deshpande, R.S. and Sheth, S.C.: Infective hepatitis: Study of 100 cases. Probe 11: 105, 1972.
10. Ducci, H. and Alesondro, H.: Treatment of acute hepatitis with cortisone. J. Clin. Invest. 9: 1370, 1957.
11. Libov, B.L: Chloroquin in viral hepatitis: Adverse effects of steroid therapy. Indian J. Pediatr. 33: 255, 1966.
Refference: http://www.himalayahealthcare.com/pdf_files/liv227.pdf
Copyrights © 2009 healthyliver.co.uk