Vegetable storage
Hepatitis d develops. Viral hepatitis D: what it is and how to avoid it

Hepatitis d develops. Viral hepatitis D: what it is and how to avoid it

Hepatitis D is an acute or chronic infectious lesion of the liver with a parenteral mechanism of infection caused by the hepatitis D virus (HDV).

A specific feature of the disease is its secondary nature. Infection with HDV is possible only against the background of prior infection with the hepatitis B virus (HBV). About 5% (according to other sources - up to 10%) of HBV carriers are simultaneously infected with HDV. Chronic viral hepatitis caused by exposure to HBV and HDD has now been confirmed in approximately 15–30 million people, according to information provided by the World Health Organization.

Liver damage in hepatitis D

For the first time, HDV was obtained in 1977 by a group of Italian scientists from liver cell biopsies of patients suffering from viral hepatitis B. An erroneous assumption was made that a fundamentally new HBV marker was isolated, however, further studies showed that the detected particles are independent pathogens, defective viruses ( viroids). Later, a fundamentally new type of hepatitis caused by these viruses was classified, called viral hepatitis D.

The prevalence of the disease in different regions varies significantly: from isolated cases to the defeat of 20–25% of those infected with the hepatitis B virus.

According to the spread of viral hepatitis D, all regions are conditionally divided as follows:

highly endemic - the frequency of HDV infection exceeds 60%;
regions of medium endemicity - the incidence rate is 30–60%;
low-endemic - HD is fixed in 10-30% of cases;
regions of very low endemicity - the frequency of detection of antibodies to HDV is not higher than 10%.

The Russian Federation belongs to the zones of low endemia, although some researchers attribute such positive statistics to the absence of mandatory diagnostics of anti-HDV antibodies in patients with HBV.

Synonyms: hepatitis delta, viral hepatitis D, HDV infection, HDV infection.

Causes and risk factors

Currently, 8 HDD genotypes have been identified, which have a specific distribution and differ in clinical and laboratory manifestations (for example, the 1st genotype is common in Europe, the 2nd in East Asia, the 3rd occurs mainly in Africa, tropical Asia , in the Amazon basin, etc.).

The main route of infection is blood contact (transmission through the blood):

at medical and diagnostic manipulations (including stomatologic);
for cosmetic and aesthetic procedures (tattoo, manicure, piercing);
with blood transfusions;
when using injecting drugs.

Less common are the vertical route of transmission of the virus (from mother to child during pregnancy) and the sexual route. Infection within the same family is possible with close household contact (the formation of family foci of chronic hepatitis D is often observed in highly endemic regions).

Forms of the disease

In combination with viral hepatitis B, there are:

co-infection (parallel infection);
superinfection (attached against the background of existing chronic hepatitis B).

Depending on the severity of the process:

acute hepatitis D;
chronic hepatitis D.

Acute hepatitis-delta is stopped, as a rule, within 1.5–3 months, the chronicity of the disease occurs no more than in 5% of cases.

Both acute and chronic disease can occur in a manifest form with a detailed clinical and laboratory picture or in the form of latent (latent) HDD infection, when the only sign of hepatitis is a change in laboratory parameters (active symptoms are absent in this case).

In accordance with the severity, the following forms of hepatitis D are distinguished:

easy;
moderate;
heavy;
fulminant (malignant, rapid).

Stages of the disease

There are following stages of hepatitis D:

incubation (from 3 to 10 weeks);
preicteric (on average - about 5 days);
icteric (several weeks);
convalescence.

Symptoms

During the incubation period, there are no symptoms of the disease; despite this, the patient is a virus shedder.

The preicteric period debuts acutely:

intoxication symptoms - headache, fatigue, decreased tolerance to habitual physical activity, drowsiness, muscle and joint pain;
dyspeptic phenomena - loss of appetite up to anorexia, nausea, vomiting, bitterness in the mouth, bloating, pain and a feeling of fullness in the right hypochondrium;
an increase in body temperature up to 38 ºС and above (noted in approximately 30% of patients).

Symptoms of the icteric period:

characteristic staining of the skin and mucous membranes, scleral icterus;
enlargement and soreness of the liver;
subfebrile body temperature;
weakness, loss of appetite;
urticarial rashes like urticaria on the skin;
discoloration of feces, dark shade of urine.

More than half of the patients have a two-wave course: after 2–4 weeks from the onset of the icteric stage of the disease, against the background of the subsiding of the symptoms of the disease, general well-being and laboratory parameters deteriorate sharply.

Acute hepatitis-delta is stopped, as a rule, within 1.5–3 months, the chronicity of the disease occurs no more than in 5% of cases.

Acute superinfection is more severe than co-infection, it is characterized by a violation of the protein-synthetic function of the liver, the outcomes of the disease are usually unfavorable:

death (with a fulminant form that develops in 5–25% of patients, or in a severe form with the formation of subacute liver dystrophy);
the formation of chronic viral hepatitis B + D (approximately 80%) with a high activity of the process and rapid transformation into cirrhosis of the liver.

Diagnostics

Main method laboratory diagnostics, allowing to confirm the presence of HDV infection, is testing HBsAg-positive patients (persons who have detected antigens of the hepatitis B virus) for the presence of antibodies to HDV in the blood serum.

Methods for diagnosing viral hepatitis D:

analysis of data on previous contact with possibly infected blood, medical and other manipulations;
characteristic clinical manifestations with icteric form of the disease;
determination of IgM and IgG to HD in HBsAg-positive patients;
detection of HDV RNA (HDV-RNA) by polymerase chain reaction;
specific changes in the biochemical blood test (increased levels of AST and ALT liver enzymes, a positive thymol test, hyperbilirubinemia, a possible decrease in sublimate test and prothrombin index).

A specific feature of the disease is its secondary nature. Infection with HDV is possible only against the background of prior infection with the hepatitis B virus (HBV).

Treatment

Joint therapy of hepatitis D + B is carried out, during which the following are prescribed:

interferons (including PEG-interferon);
antiviral drugs (specific medicines targeting the hepatitis D virus does not exist);
immunomodulators;
hepatoprotectors;
detoxification therapy;
desensitizing agents;
vitamin therapy;
enzyme preparations.

The duration of antiviral therapy is not defined, the question of its termination is decided depending on the patient's condition. (May take a year or more.)

For patients with fulminant hepatitis and advanced cirrhosis, liver transplantation is considered.

Possible complications and consequences

Complications of hepatitis D can be:

cirrhosis of the liver;
hepatocellular carcinoma;
acute liver failure;
hepatic encephalopathy;
bleeding from varicose veins of the esophagus;
hepatic coma, death.

Forecast

The prognosis for the acute course of HDV-co-infection is favorable: most patients are cured, the disease acquires a chronic form in 1–5% of cases.

Superinfection is prognostically unfavorable: chronic hepatitis is noted in 75–80% of patients, cirrhosis develops rapidly, often with subsequent malignancy.

The prevalence of the disease in different regions varies significantly: from isolated cases to the defeat of 20–25% of those infected with the hepatitis B virus.

Prevention

Basic preventive measures:

observance of safety precautions when working with blood;
refusal of casual unprotected sexual contacts;
refusal to take drugs;
receiving medical, cosmetology services in official licensed institutions;
implementation of systematic medical examinations in case of professional contact with blood.

Video from YouTube on the topic of the article:

Hepatitis D (Hepatitis Delta) is an infection caused by the hepatitis D virus, manifested by symptoms of liver damage and intoxication. More often than other viral hepatitis, it is severe and quickly leads to the development of cirrhosis of the liver.

However, the multiplication of the delta virus is possible only in the presence of hepatitis B.

Types

Three different genotypes of the hepatitis D virus are known:

Genotype I. Found in all countries of the world. More common in the West.
Genotype II. Found in Japan.
Genotype III. Mostly found in South America.

At-risk groups

The source of infection is a person infected with the hepatitis D virus. Infection occurs parenterally:

with intravenous injections with a reusable syringe (intravenous drug addicts)
transfusions of blood and its components
when performing endoscopic procedures, invasive procedures
during surgical operations, transplantation of organs and tissues
during dental procedures
patients on hemodialysis
with promiscuity without the use of barrier contraception
through personal hygiene items (shaving and manicure accessories, combs, toothbrushes, washcloths)
during acupuncture, piercing, tattoos
possible transmission from mother to fetus.

Symptoms of Hepatitis D

hepatitis D virus can cause both acute and chronic infection. With the development of the latter, clinical manifestations may be absent for a long time, or they may be nonspecific. Patients may complain about:

weakness
fatigue
loss of appetite
weight loss
nausea, vomiting
heaviness in the right hypochondrium
muscle and joint pain
there may be an increase in body temperature.

With such complaints, the patient can be observed for a long time by various specialists, until symptoms appear that indicate a significant decrease in liver function: ascites (an increase in the volume of the abdomen due to fluid accumulating in the abdominal cavity), jaundice (skin, sclera, mucous become icteric), edema lower extremities, the appearance of bruises on the skin, nosebleeds, bleeding gums.

The natural course of chronic D+B infection is characterized by an undulating pattern with alternating periods of exacerbation and remission.

Diagnosis of hepatitis D

The hepatitis D virus enters the liver with blood flow, penetrates into its cells (hepatocytes) and begins to multiply, thereby causing their death. Since hepatitis D causes infection only in the presence of hepatitis B, there are 2 possible infections:

simultaneous infection with hepatitis B and D virus (HDV / HBV - coinfection)
introduction of the D virus into hepatitis B-infected liver cells (HDV/HBV - superinfection).

To exclude coinfection in all patients with newly diagnosed hepatitis D, it is necessary to exclude hepatitis delta. Superinfection can be suspected in intravenous drug addicts, with severe viral hepatitis, frequent exacerbations, rapid progression with the development of liver cirrhosis.

Case management chronic viral hepatitis D+B is carried out by a hepatologist who prescribes the necessary examination on the basis of which he determines the course of therapy and controls its effectiveness.

Diagnosis of hepatitis D consists in a complex laboratory and instrumental examination, including clinical, biochemical blood tests, assessment of fibrosis using fibrotests, elastography and elastometry, a detailed virological examination for hepatitis B and D viruses, ultrasound of the abdominal organs, FGDS, etc.

It must be remembered that timely diagnosis and timely treatment can slow down the progression of the disease, increase life expectancy and improve its quality.

Forecast

The course of coinfection and superinfection is different. In the case of co-infection, acute hepatitis develops and in most cases ends in recovery, and the frequency of transition to chronic hepatitis is about 10%. Superinfection is manifested by an exacerbation of chronic hepatitis B followed by a transition to chronic D+B infection.

Without treatment chronic hepatitis B+D leads to cirrhosis of the liver within 3-5 years, however, the patient's condition in most cases remains quite stable until decompensation occurs (on average, about 10 years after infection).

Doctors who treat the disease

Clinical Cases

Hepatitis B+D and the impossibility of therapy

Vadim turned to the gastro-hepatocenter EXPERT in connection with changes in the clinical analysis of blood in the form of a decrease in the number of platelets and leukocytes, which was detected during a preventive examination. When collecting an anamnesis, it was possible to establish that in childhood he had “some kind of hepatitis”, but he has no more accurate information. bad habits does not have. An objective examination drew attention to the presence of spider veins on the body, enlargement of the liver and spleen.

Cirrhosis in mixed hepatitis (B+D)

Konstantin applied to the gastro-hepatocenter EXPERT with complaints of slight weakness. The reason for the appeal was changes in the biochemical analysis of blood (an increase in the activity of liver enzymes by 2 times, a decrease in platelets by 3 times from the lower limit of the norm). During the initial collection of an anamnesis of the disease, it was found that the patient had been diagnosed with chronic viral hepatitis B since childhood, but he did not receive treatment and was not regularly observed by an infectious disease specialist.

Hepatitis D is a viral anthroponotic infection that causes damage to the liver. A prerequisite for the development of the disease is the presence of a concomitant virus - hepatitis B. Due to this factor, the process of replication of the delta infection occurs. The hepatitis D virus does not have its own membrane, so it needs a cell coating of the B virus. Such coinfection causes serious infections.

The human body is highly susceptible to the hepatitis D virus. You can protect yourself by vaccination. The vaccine provides protection against both hepatitis D and B.

Causes of hepatitis D

The cause of hepatitis D is the causative agent of infection - RNA containing a viral particle. The RNA molecule carries the genetic information of the virus, protected by a protein coat. It contains an antigen that was also found in the hepatitis B virus. This fact allowed specialists to find out that the reproduction of hepatitis D viral particles is impossible without hepatitis B pathogens.

Infection can occur in the following ways:

through blood transfusion. According to statistics, 2% of all donors are carriers of viral hepatitis. In this regard, a thorough blood test is carried out, but this does not exclude the possibility of infection. The risk of transfusion of blood containing the hepatitis D virus is especially high for patients with multiple repetitions of the procedure.

sexually. Thus, the hepatitis B virus most often enters the human body. If there is already a hepatitis D virus in the blood, this will cause it to multiply and develop the disease.

repeated use of the same needle in non-sterile conditions. It is no coincidence that the percentage of patients with hepatitis D among drug addicts is so high. In most cases, the cause of the disease is the use of the same needle by different people. Infection is possible during procedures such as acupuncture, piercing, tattoos. Due to the ingress of the hepatitis D virus into the body while non-compliance with sterile conditions.

infection of children in the womb. This way of appearance of hepatitis D virus in the body is known as vertical. Women with acute hepatitis are most likely to be infected. later dates. The risk of the disease increases significantly if it also has. Hepatitis D is transmitted from mother to child only in some cases. For example, the possibility of infection with milk is excluded.

These are the main ways the infection spreads. In many cases, the cause of infection and how the hepatitis D virus enters the human body remains unknown.

Symptoms of hepatitis D

Symptoms of hepatitis D are similar to other types of this disease. Usually, this virus causes a complication in the presence of hepatitis B. The development of coinfection in this case takes from 3 to 5 days, and superinfection - from several weeks to 2 months. The preicteric period is characterized by weakness in patients, lack of appetite, nausea, turning into. There may be pain in the knee joints and liver, fever.

In the icteric period, actively progressive and severe intoxication is observed. With superinfection, edematous-ascitic syndrome appears early. It is very difficult to distinguish it from hepatitis B due to similar symptoms. Superinfection is difficult. Recovery takes much longer than with hepatitis B. In addition, hepatitis D causes complications that negatively affect liver cells. It, like the spleen, increases in size. On the skin, these complications appear in the form of spider veins. Hepatic edema and ascites are also common in hepatitis D.

Based on the fact that the hepatitis D virus is closely related to the causative agent of hepatitis B, the following types of infection are distinguished:

coinfection. It involves the simultaneous entry of hepatitis D and B viruses into the body. Most often in this case, the infection proceeds passively, and the outcome is favorable. Hepatitis does not require treatment and goes away after a while without medical attention. However, sometimes viruses cause an acute form of the disease, which leads to serious consequences. The liver suffers the most.

Superinfection. The hepatitis D virus appears after the B virus enters the body. This form is more severe than co-infection, so in most cases, patients need qualified medical care. The percentage of spontaneous elimination of the virus is very low.

Diagnosis and treatment of hepatitis D

Diagnosis of hepatitis D involves a biochemical blood test, as a result of which specific antibodies are usually found in the blood. Since this virus affects the liver cells, an ultrasound scan of this organ, rheohepatography is performed. In some cases, they resort to the help of a puncture biopsy. At the diagnostic stage, it is important to confirm the presence of the hepatitis D virus and to distinguish it from other types.

The main method of treatment of this disease - interferon therapy. This drug is considered the most effective in hepatitis. Depending on the type of disease, the dosage and frequency of taking interferon are individually prescribed. In hepatitis D, treatment with this drug continues until a normal level of serum transaminases in the blood is reached. interferon is taken either daily or several times a week. Depending on this, the dose is determined.

Medical treatment allows you to prevent the development, stop the reproduction of the hepatitis D virus. In most patients, during the first few months of taking interferon, the clinical symptoms of the disease disappear, inflammation decreases. After hepatitis D, it takes a long period of time to restore the normal functioning of the liver. To avoid the development of the disease and the complications it causes, such as cirrhosis or hepatic coma, regular vaccination is necessary.

Education: Diploma in the specialty "Medicine" received at the Military Medical Academy. S. M. Kirova (2007). Voronezh Medical Academy named after N. N. Burdenko graduated from residency in the specialty "Hepatologist" (2012).

Viral hepatitis D(delta hepatitis) is an infectious lesion of the liver, coinfection or superinfection of viral hepatitis B, which significantly worsens its course and prognosis. Viral hepatitis D belongs to the group of transfusion hepatitis, prerequisite infection with hepatitis D is the presence of an active form of hepatitis B. The detection of hepatitis D virus is carried out by PCR. A study of the liver is mandatory: biochemical tests, ultrasound, MRI, rheohepatography. The treatment of viral hepatitis D is similar to the treatment of hepatitis B, but requires larger doses of drugs and a longer duration of treatment. In most cases, chronic disease is observed with subsequent outcome in cirrhosis of the liver.

General information

Exciter characteristic

Hepatitis D is caused by an RNA-containing virus, which is the only currently known representative of the “wandering” genus Deltavirus, which is distinguished by its inability to independently form a protein for replication and uses a protein produced by the hepatitis B virus for this. Thus, the causative agent of hepatitis D is a satellite virus and occurs only in combination with the hepatitis B virus.

The hepatitis D virus is extremely stable in the external environment. Heating, freezing and thawing, exposure to acids, nucleases and glycosidases do not significantly affect its activity. The reservoir and source of infection are patients with a combined form of hepatitis B and D. Contagiousness is especially pronounced in the acute phase of the disease, but patients pose an epidemic danger throughout the entire period of circulation of the virus in the blood.

The mechanism of transmission of viral hepatitis D is parenteral, a prerequisite for the transmission of the virus is the presence of an active hepatitis B virus. The hepatitis D virus integrates into its genome and enhances the ability to replicate. The disease can be a co-infection, when the hepatitis D virus is transmitted simultaneously with hepatitis B, or a superinfection, when the pathogen enters the body already infected with the hepatitis B virus. The most significant risk of infection during blood transfusion from infected donors, surgical interventions, traumatic medical manipulation (for example, in dentistry).

The hepatitis D virus is able to overcome the placental barrier, can be sexually transmitted (the spread of this infection among persons prone to promiscuity, homosexuals is high), which in some cases has a familial spread of the virus suggests the possibility of its transmission through household contact. Patients with viral hepatitis B, as well as carriers of the virus, are susceptible to viral hepatitis D. In particular, the susceptibility of persons who are chronic carriers of HBsAg is high.

Symptoms of viral hepatitis D

Viral hepatitis D complements and aggravates the course of hepatitis B. The incubation period of coinfection is significantly reduced, 4-5 days. Superinfection incubation lasts 3-7 weeks. The preicteric period of hepatitis B proceeds similarly to that of hepatitis B, but has a shorter duration and a more rapid course. Superinfection can be characterized early development edematous-ascitic syndrome. The icteric period proceeds in the same way as in hepatitis B, but bilirubinemia is more pronounced, signs of hemorrhage often appear. Intoxication in the icteric period of hepatitis D is significant, prone to progression.

Co-infection proceeds in two phases, the interval between the peaks of clinical symptoms of which is 15-32 days. Superinfection is often difficult to differential diagnosis, since its course is similar to that of hepatitis B. A characteristic difference is the rate of development of the clinical picture, the rapid chronization of the process, hepatosplenomegaly, a disorder of protein synthesis in the liver. Recovery takes much longer than in the case of hepatitis B, residual asthenia may persist for several months.

Diagnosis of viral hepatitis D

In the acute phase of the disease, specific IgM antibodies are noted in the blood, over the next few months only IgG are detected. In wide practice, diagnosis is carried out using the PCR method, which makes it possible to isolate and identify the RNA virus.

To study the state of the liver in viral hepatitis D, ultrasound of the liver, rheohepatography, MRI of the liver and biliary tract are performed. In some cases, to clarify the diagnosis, a puncture biopsy of the liver can be performed. Nonspecific diagnostic measures are similar to those for hepatitis of a different etiology and are aimed at dynamic control of the functional state of the liver.

Treatment of viral hepatitis D

Treatment of hepatitis D is carried out by a gastroenterologist according to the same principles as the treatment of viral hepatitis B. Since the hepatitis D virus is more resistant to interferon, the basic antiviral therapy is adjusted towards increasing dosages, and the duration of the course is 3 months. If there is no effect, the dosages are doubled, the course is extended to 12 months. Since the hepatitis D virus has a direct cytopathic effect, drugs of the corticosteroid hormone group are contraindicated in this infection.

Forecast and prevention of viral hepatitis D

Prognosis for mild and medium degree severity is more favorable, since a complete cure is noted much more often than with superinfection. However, co-infection with hepatitis B and D viruses often proceeds in a severe form with the development of life-threatening complications. Chronic coinfection develops in 1-3% of cases, while superinfection develops into a chronic form in 70-80% of patients. Chronic viral hepatitis D leads to the development of cirrhosis. Recovery from superinfection is extremely rare.

Prevention of viral hepatitis D is similar to that of viral hepatitis B. Preventive measures are of particular importance for people with hepatitis B who are positive for the presence of the HBsAg antigen. Specific vaccination against viral hepatitis B effectively protects against delta hepatitis.

Viral hepatitis D is an acute viral liver disease that occurs as a result of infection of the body with a defective RNA-containing virus from the Deltovirus family, characterized by the development of persistent inflammation in the liver, which subsequently leads to liver failure, cirrhosis or cancer.

It is possible to become infected with viral hematitis D only if the hepatitis B virus is present in the body. It is impossible for a healthy person to become infected with hepatitis D, since the virus is defective and multiplies by introducing the hepatitis B virus antigen into HBs.

According to WHO (World Health Organization) observations, about 5% of people who are ill or are carriers of the hepatitis B virus become ill with viral hepatitis D.

Hepatitis D is common throughout the world, but the incidence of the disease in different countries varies.

Countries with a high prevalence of infection:

Colombia;
Venezuela;
northern part of Brazil;
Romania;
Moldova;
Central African Republic;
Tanzania.

Countries with an average prevalence of infection:

Russia;
Belarus;
Ukraine;
Kazakhstan;
Pakistan;
Icarus;
Iran;
Saudi Arabia;
Türkiye;
Tunisia;
Nigeria;
Zambia;
Botswana.

Countries with a low prevalence of infection:

Canada;
Argentina;
Chile;
Great Britain;
Ireland;
France;
Portugal;
Spain;
Switzerland;
Italy;
Norway;
Sweden;
Finland;
Australia and Oceania.

In the countries of the former CIS, the incidence rate of hepatitis D is steadily growing; over 10 years, the rate of infected people has increased 3 times.

Viral hepatitis D affects mainly young and middle-aged people (from 18 to 40 years), the infection occurs with the same frequency among men and women.

The prognosis of the disease is unfavorable and in 10-15 years leads to death. The cause of death is the development of hepatic coma, which leads to liver failure.

Causes

The cause of the disease is an RNA-containing virus from the Deltovirus family.

This virus is isolated only in patients with viral hepatitis B in the presence of HBs antigen in the blood serum, since this antigen is the basis for the start of reproduction of the hepatitis D virus. Getting into the blood of a healthy person or infected with hepatitis A or C, hepatitis D does not develop, because the virus can not normally exist and multiply.

The source of infection is a sick person or a virus carrier (there are no symptoms of infection, and the hepatitis D virus is detected in the blood). Infection occurs parenterally (when the blood of an infected person interacts with a healthy one).

This way of transmission of hepatitis D is realized through:

surgical interventions with contaminated or poorly disinfected instruments;
a blood transfusion from a donor who has hepatitis D;
sexual intercourse not protected by a condom;
placenta, in case of infection of the mother, to the fetus;
reusable or non-sterile instruments used in beauty and dentistry salons.

They also distinguish a risk group for those individuals who are predisposed to infection with viral hepatitis D due to their profession or certain diseases:

doctors;
nurses;
orderlies;
patients with viral hepatitis B;
HIV-infected;
AIDS patients;
sick diabetes or hypothyroidism.

Classification

According to the type of infection with the hepatitis D virus, there are:

coinfection - this happens when the body is simultaneously infected with viral hepatitis B and D;
superinfection - with hepatitis B, a few years later the patient becomes infected with viral hepatitis D.

According to the duration of the disease, there are:

protracted viral hepatitis D - up to 6 months;
chronic hepatitis D - more than 6 months.

Symptoms of viral hepatitis D

The period of initial manifestations

increase in body temperature;
headache;
noise in ears;
dizziness;
general weakness;
increased fatigue;
slight nausea;
decreased appetite.

The period of a detailed symptomatic picture

frequent nausea;
vomiting of intestinal contents;
jaundice (yellowing of the skin and mucous membranes);
dark urine;
discoloration of feces.

The chronic period of the disease

pallor of the skin;
lowering blood pressure;
increased heart rate;
bleeding gums;
the appearance of hemorrhages on the skin;
vomiting blood or "coffee grounds" - occurs when bleeding from the upper intestines, stomach or esophagus;
"tarry" stool - occurs when bleeding from the intestines;
dark red blood in the stool - occurs when bleeding from hemorrhoidal veins;
an increase in the volume of the abdomen (occurs in the presence of ascites - free fluid in the abdominal cavity);
swelling of the lower extremities.

Terminal period of the disease (initial manifestations of hepatic coma)

hepatic encephalopathy, dementia (patients are not critical of themselves, do not orient themselves in space and time, do not recognize loved ones, “fall into childhood”);
the appearance of arrhythmia;
the appearance of shallow breathing;
anasarca (swelling of the whole body);
prolonged bleeding from the veins of the digestive system;
frequent loss of consciousness.

Diagnostics

Laboratory research methods

The very first diagnostic tests that the doctor you contact refer to are general analysis blood and urine:

a general blood test, in which there will be an increase in leukocytes, a shift in the leukocyte formula to the left and an increase in ESR (erythrocyte sedimentation rate);
general urinalysis, in which there will be an increase in leukocytes and squamous epithelium in the posture of vision.

Changes in these analyzes indicate an inflammatory reaction in the body, in order to clarify in which organ the pathological process occurs, additional laboratory examination methods are prescribed.

Liver tests:

Index	Normal value	Significance in hepatitis D
total protein		55 g/l and below
total bilirubin	8.6 - 20.5 µmol/l	28.5 - 100.0 µm/l and above
direct bilirubin	8.6 µmol/l	20.0 - 300.0 µmol/l and above
ALT (alanine aminotransferase)	5 – 30 IU/l	30 - 180 IU/l and above
AST (aspartate aminotransferase)	7 – 40 IU/l	40 - 140 IU/l and above
Alkaline phosphatase	50 – 120 IU/l	120 - 160 IU / l and above
LDH (lactate dehydrogenase)	0.8 – 4.0 pyruvite/ml-h	4.0 pyruvate/ml-h and above
Albumen		34 g/l and below
Thymol test		4 units and more

Coagulogram (blood clotting):

Lipidogram (cholesterol analysis):

Serological research methods

Analyzes that can directly determine the marker of viral hepatitis D in the blood serum of a sick person and thereby make a final, accurate diagnosis. Among the methods of examination are:

ELISA (enzymatic immunoassay).
XRF (X-ray fluorescence analysis).
RIA (radioimmune analysis).
RSK (complement fixation reaction).
PCR (polymerase chain reaction) is the most sensitive and expensive method.

Interpretation of results:

Instrumental research methods

Ultrasound of the liver, in which it is possible to determine the consequences of viral hepatitis D or its complications (fibrosis or cirrhosis).
Liver biopsy - taking with a needle, under the control of ultrasound of the liver tissue, followed by examination under a microscope. The method allows you to establish an accurate diagnosis and the presence of complications, but is invasive (penetrating) and therefore has not become widely used in viral hepatitis D.

Treatment of viral hepatitis D

Medical treatment

The duration of treatment, the frequency of taking drugs and the dosage is selected individually for each patient by the attending physician.

Surgery

Surgical treatment is used to alleviate the patient's condition with the development of complications from viral hepatitis D. These include:

Alternative treatment

Treatment with alternative medicine should only be carried out in combination with medications and with the permission of your doctor.

Most effective methods folk treatment with viral hepatitis D are:

A diet that alleviates the course of the disease

Viral hepatitis D requires a strict diet.

Allowed the use of cereals, pasta, boiled vegetables, non-fatty meats, poultry and fish, not fatty fermented milk products, compotes and fruit drinks.
It is forbidden to consume legumes, smoked, salty, fatty, spicy foods, canned food, coffee, carbonated water, juices in tetra packs, alcohol, pastry and chocolate.

Complication

tense ascites;
bleeding from the gastrointestinal tract;
hepatic coma;
hepatic encephalopathy;
anemia (anemia).