Gastroenterologist, Gastroenterology Journal

Question: I have chronic hepatitis for about 10 years. biochemistry for 10 years in the normal range. Uzi pcheni only diffuse changes. HCV RNA rented 2 times both times negative. please tell me if I can take to maintain the liver is now widely advertised gepatosan? thanks for the reply.

Answer: Can. But there is a significant difference between "can" and "need."

Question: Dear doctor! It is clear that giving advice in absentia – is extremely difficult to treat – it is impossible, and the amount set out for part-time consulting big. Given your professionalism Gastroenterology – Hepatology, thank you in advance for any your answer to me. I learned about the possibility of consulting the site http://www. doktor. ru / qa / gastro, so my questions to you with some cuts and placement as on the website. Dear doctor, is it possible to understand what causes the disease, to determine what it is and assign treatment? Son, 23 years old. Do not drink, does not smoke, not prickly. In February-March 2007, after twice endured influenza (?) Escalated mycoplasmal bronchitis (interstitial pneumonia) (anti-Myc. Pneumonia, Ig G titer silnopolozh, anti-Chl. Pneumonia, Ig G, Ig M-put. " experience "- about 2 years old), and while taking summameda fever (37,8), sallow face, urine acquired shade beer, cloudy, chair-light. Weakness, fatigue, irritability, no appetite, lost weight, body skin – pale, with yellowish tinge, dryish skin. Antibiotics were canceled. Results of Biochemistry and wedge an. blood revealed the increase in the amount of bilirubin, ALT, AST, GGTT, monocytes, leukocytes, reduction of lymphocytes, neutrophils, low ESR (see table).. Blood tests for autoimmune hepatitis (25. 04. 07 and 24. 10. 07) – autoantibodies were detected (Technition medico-genetic. RSMU technology). An blood for hepatitis viruses A, B, C, D, E, TTV of 21. 04. 2007. (By ELISA and PCR) were found. An blood for hepatitis viruses B, C, TTV of 24. 10. 2007. (By ELISA and PCR) – TTV DNA detected by PCR, Qual. analysis. * PCR, HepB C (1999, RNA C, qty. – Is found) Repeated analysis – PCR and ELISA – hepatitis C virus and antibodies to it is not detected and cut-t 1999 ". was regarded as a false positive. Thyroid gland – in the norm. Biochim. Al. Blood: Ultrasound 28. 04. 07 Ultrasound 17. 12. 07 07. 04. 07 21. 04. 2007 08. 06. 07 04. 10. 2007 13. 12. 2007 Referee rdg. ALT 41 66 47 28 21 <41 U / l 40 AST 57 89 40 25 25 <37 U / l 39 Bil Society. 27 28.9 47.7 39.6 35.2 3. 4-17. 1 mmol / l 45 Beal Ave 9 12 12.2 13.9 12.8 <7. 9 mmol / l 9,7 Gamma-GT 222 219 95 87 62 <49 U / l F. Schel 168 237 154 137 117 40-150 U / l Iron – - 21.1 20 21.93 11,64-31, 3 mmol / l 14,4 Lat zhelezosvyaz Choco-Th – - 43.8 46.4 51 20-62 mmol / L Transferrin – - 3,09 2,75 2,83 2,00-4,00 g / l. Ferritin – - 36.9 60.9 – 20-250 mg / l transferrin saturation% – - 27.2 28.9 30.8 15-50% C-REACT protein – 5.0 18.1 1.9 0.0 -5.0 mg / l cholesterol 3.46 3.64 2.77 3.53 3.94 3,16-5,59 mmol / l Albumin 44.1 45 41 46 45 35-50 Alpha-1-Globe 2 , 4 2,8 2,6 2,5 1,8 1,0-3,0 g / l. Alpha-2-Globe 7.3 6.4 7.3 8.4 7.1 6,0-10,0 g / l beta-Globe 8.7 8.3 7.8 8.1 8.4 7,0-1,001 g / l Gamma-Globe 11.5 12.3 15.8 11.2 11.4 8.0 — 16,0 g / l Creatinine 110 110 88 99 85 62-115 mmol / l Glucose 5.2 5 4.6 5.3 4.8 3,89-5,83 mmol / L Total protein 74 75 74 76 74 64 — 83g / l. Homocysteine 16,27 3,70-13,90 mmol / l IgE 338. 3 0-150 kIU / L Antibodies to tireperroksidaze 18 0-40 IU / ml Klin. Al. blood Ultrasound 28. 04. . 07 Ultrasound 17. 12. 07Parametry 07. 04. 07 21. 04. 2007 08. 06. 07 04. 10. 2007 13. 12. 2007 Referee rdg. Hematocrit 45.7 44.7 47.5 47.1 47.6 39-49% Hemoglobin 16.2 15.4 16.4 16.3 16.9 13,2-17,3 g / dL RBC 5.78 5 , 57 5,87 5,98 5,93 4,3-5,87 million / microL MCV (Wed volume er) 79 80 81 79 80.3 80-99fl MCN (Wed previous article Hb in Riyadh) 28 27,6 27 9 27.3 28.5 27-34g/dl MCHC (Wed conc. Hb in er) 35.4 34.5 34.5 34.5 35.5 32-37 g / dL Platelets 275 236 324 297 292 150 — 400tys/mkl Leukocytes 4.95 7.90 6.80 9.55 8.49 4,5-11 thousand / mcl Neutrophils 42 20 34.2 58.1 42.2 48-78% Lymphocytes 35 62 49.1 31 1 41,2 19-37% Monocytes 14 21 13.5 10.3 9.2 3-11% Eozinofily 2 2 2.9 2.3 6.9 1-5% basophils 0 1.1 0.3 0 , 2 0,5 ESR less than 1% (by Vestergrenu) 1 – 1 2 1 menee15mm / h ultrasonography (17. 12. 2007): Liver – increased size of the Upper-Lower right lobe of the right cp / clavicular line-13-smVerhne Lower size the left lobe of the right parasternal line-8 cm ECHO-structure of the parenchyma-grained, moderately heterogeneous. ECHO-gennost parenchyma-reduced. Focal amended. – NetVnutripechenochnye vessels-N, intrahepatic bile ducts-N. Choledochitis-0, 5 cm, portal Vienna 1, 2, see Gall bladder, 7×2, 5 cm, the walls thickened to 0, 5 cm, compressed, content-NPodzheludochnaya iron-NSelezenka-raised, S-70 cm, the edges are rounded. Conclusion: Diffuse changes in the liver. Chr. beskamenny cholecystitis (cholesterosis?). The increase in the spleen. Ultrasound (28. 04. 2007) Liver – not increased the size of the Upper-lower right lobe of the right cp / clavicular line-10, 5 smVerhne-lower size of the left lobe of the right parasternal line-5, 5 cm ECHO-structure of the parenchyma-N ECHO-gennost parenchyma-N focal amended. – NetVnutripechenochnye vessels-N, intrahepatic bile ducts-N. Choledochitis-0 4 cm, portal Vienna 1, 1, see Gall bladder-8 x 3 cm, the walls are not changed, the content-anehogennoPodzheludochnaya iron-NSelezenka is not increased, S-60 cm Conclusion: The signs of colitis. Immunogram (25. 04. 2007) – Lack of T-suppressor level. High levels of NK-cells in perifiricheskoy blood. Expressed lack of IgG in serum. Reduced levels of neutrophil phagocytosis. Received treatment (all prescribed by a doctor, April-December): w / vitamins, in / in miksidol, w / medical ozone, Roncoleukin n / a, laser nadvenno, geptral, ursofalk. Geptral (2 tables) and ursofalk (2 Caps at Night) takes now. Following a course of treatment over the next 5 months (April-October) is very slow improvement in some indices of blood. A better feel (cough, which lasted about 2 years old – stopped in the lungs – without pathology) December 2007 – well-being has worsened again, on the face yellowish skin, even thinner. No appetite, weakness, fatigue, irritability. Works, is raising her daughter. In terms of the survey (until 28 December): – ultrasound to determine the function of the gall bladder and be retested for hepatitis viruses (PCR and ELISA). Previously: (main): Resection of small intestine (at the age of 1, 5 days). Chr. cholecystitis. Gastroduodenitis. Polyvalent allergy (hay fever from April – October, allergies, fungal, bacterial). Recurrent urticaria. Secondary immune deficiency (?). In 1994, hospital. Cervical cholecystitis. Jet pancreatitis. Toxic-allergic hepatitis (?). (Och. high values of alkaline phosphatase (until 2200), GGT, ALT, AST. The true cause and the diagnosis is not reliably determined). Tests Used x blood for the period 1998-2006, the city, except almost always slightly elevated values of alkaline phosphatase, bilirubin, frontier values, or some elevated ALT and AST, and without a sharp deterioration in other indicators, but is constantly "on the verge" , or just "beyond", except in periods of acute illness. Wellbeing in the period 2002-2006. – the fairly decent, given the "tail" of disease. All the main discharge (hospital) in 1984 – on his hands. What happened? 1. 1. "Drug" hepatitis? -Almost a year since the acute onset of disease, cure has not come. 2. Because of the weak immune response (judging by the cut-m tests, the work of the immune system and disorganized) – tests for detection of viral infection provide a negative reaction. But he himself viral hepatitis caused by hepatitis B virus itself, or epshteny bar (povyshen. titles in 2002.), Or herpes (obnar. types VI, II) or other viruses, does its work? 3. Reasons number 1 and number 2, together give a picture. Do not understand where the cause and where the investigation. 4. As a result of long-term preservation of cholestasis, and came suddenly such changes, as identified by ultrasound 17. 12. 2007 and is not detected at ultrasound in April, May and October 2007. earlier? 5. Or newly acquired TTV? (read that this virus is almost "home", does not cause liver damage. I doubt it). 6. Alarmed that in the wake of and ongoing therapy, despite improvements in some indices of blood and a transient improvement in well-being, in general – unstable dynamics or nonpositive dynamics. Ultrasound showed changes in the liver, gallbladder, enlargement of the spleen. This feeling also create indices of lymphocytes, monocytes, neutrophils, leukocytes in blood analyzes perifiricheskoy extremely slow decrease in GGT, "jumped" reactive protein and does not reduce the bilirubin level, cut-you ultrasonography (17. 12. 2007.) After and against the backdrop of the ongoing therapy. 6. By Gastroenterology (Hepatology) for the period April-December approached. And if only very briefly – this was not yet. What, how and with what to treat? Gall with its bend in the bottom third? Hepatitis? Would you take up this puzzle? Or can recommend a qualified specialist? Thank you for your attention, with respect, Nadezhda. 21. 12. 2007.

Answer: At the site of the request has been received. With a weak immune response, the number of viruses in the blood is growing and they are found (another thing – antibodies). What prevents to make tagging a liver biopsy?

Question: When esophagogastroduodenoscopy revealed swelling of the pancreas. with further revealed obsledovanpii carrier HCV, analysis of Biochemistry 108,9 ALT, ALP 152, AST 42.9. The doctor's diagnosis: chronic viral hepatitis C with minimal activity transominaz. I have appointed a medicine or Fosfolyugliv Essliver forte and they all said. it is not scary and I will live to 90 years, although I feel. that the liver is increased during ultrasound found that the liver is increased in size LD 79h89 mm. , PD 178 mm. Echogenicity is normal, ehostruktura heterogeneous diffusely intrahepatic ducts are not dilated, choledochitis not expanded gate Vienna is not extended 12 mm. Dimensions are not changed, the thickness of the norm, the lumen is homogeneous, the pancreas visualized fragmentary head of 34 mm. Body 18mm, tail. not vitzualiziruetsya irregular contour, size change, increased Gorlovka, increased echogenicity, heterogeneous ehostruktura cone spleen were normal 112h28 mm. , NE 6mm. , UZ-pr diffuser changes of the liver, rasps. Ipatomelaliya. What do I need to do, what medications to take, the doctor said. that all is well and the special treatment I do not need? Perhaps administration of drugs on the job and at home? if yes then help me.

Answer: treatment strategy depends on the amount of virus in the blood.

Question: Dear experts! greatly worries me a question that has not given any specialist dnonachnogo answer. I am 38 weeks pregnant, I had hepatitis B. I do not suffer any nedomogariyami, but this virus, they say, can be transmitted to baby through breastfeeding. Say it's too late, dangerous to breastfeed and how to prevent infection of the child? "Sincerely, John Kloster

Answer: No need to exaggerate so much of our incompetence. newborn have been vaccinated against hepatitis B in hospital.

Question: dear Doctor! Two years ago, handing the donated blood, I have discovered hepatitis B. What led to infection and can not be assumed. Immediately appealed to the infectious disease in their clinic. Every six months I hand analysis. Overall condition is good, as before. Tests conform to the norm. Cure not appointed. But now appeared dynamics: cholesterol 6,8; bilirubin 26,6; iron 35; potassium 5,5; ultrasound liver and spleen were not enlarged, diffuse changes in the liver and pancreas. Doctor's recommendation remained the same, diet and dietary supplements lowering cholesterol. My constant weight of 70 kg with an increase in 173. And suddenly it is the first bell of serious liver damage? "These are the thoughts began to go to my head. I am 52 years old, still have to marry two sons and I would like to wait for grandchildren.

Answer: Doubts can allow the definition of live virus in the blood.

Question: Good day! I wanted to raise vaccination against hepatitis B, but I have during the year kept the temperature 37,1-37,2 not decline, neither day nor night. In addition to fatigue, no worries. Only the sick was often just one – two shoots mesatsa temperature under 39. Analysis HBsAg-neg, AHBs – pos, AHH cor (tot) – neg, A. HCV – Neg. Biochemistry of blood and a general analysis of normal, only elevated bilirubin. Inoculated just before I did. A doctor even really can not say I was sick with hepatitis or not. Ordered vitamins and sent home! Everything! Do I still put vaccinated or not? Do not want to hurt. . Thank you.

Answer: If "AHBs – pos" means the presence of antibodies to the antigen of hepatitis B virus in the blood, the vaccine is no longer needed.

Question: Dear doctor, Please forgive me, but writing to you again. Half a year ago, when screening for ultrasound, I found a diffuse changes in the liver, recommended to give a PCR for hepatitis. I passed. Result – PHK HCV (kach.) – denying DNA HBV (Kutch) – denying RNA HGV – positive. The analysis of blood – almost the norm (not beyond the upper limit of Ref. Interval). Question – Please tell us whether you want me to undergo treatment? Danger Is what I get sick with hepatitis G – for my family. If so, what preventive measures? Please, if you can answer me in detail.

Answer: Carriage of the virus does not require treatment. About G virus, we know only that he is not transmitted through dirty hands and presumably belongs to the same group as the virus C. It is not known whether it is acute and / or chronic liver disease. In fact, just know that this flavivirus, along with dozens of other already known viruses and can be detected in the human body.

Question: 3dravstvuyte, doctor, I-Nagy, I live outside of Russia. If you can remove me a minute and answer my question, I shall be very glad. I am married for 8 years. We did not obtain children. The problem with my husband. Decided in the end to "test-tube baby." Was tested, but I have found in the liver geppatit B. I was shocked, so k. no signs of hepatitis I had. But the outcome is not very large, and for geppatita, and the doctor told us that in this case, drugs are not given, but can only wait and minnimum 6 months, that the organism itself pereboret it all. AST (SGOT) = 38 / / now = 33ALT (SGPT) = 80 / / now = 65GGT = 34TBIL = 1. 65 / / now = 0. 6DBIL = 0. 71 / / now = 0. 4HBsAg now = 19. 40Anti-HBs now = <5Anti-HBc now = negatifV general has already passed the 9 months, was tested again yesterday, but alas, th me really happy. Let's go back to the doctor. But then again he would say, wait?? The way, sometimes stalopokalyvat liver. . . I decided to consult with our doctors, no matter how much medicine as we developed. What you can seem a etmu about? Thank you in advance. From SW. Nadia.

Answer: Physician rights. Such deviations, by the way, there are at taking certain medications.

Question: My husband 37 years, 5 years ago, he was discovered hepatitis C. In 2007, he was treated with interferon plus ribavirin, but treatment did not give positive results, performance deteriorated more than that of ALT and AST (126 and 38 respectively), although prior to treatment, all indices were normal and ultrasonography showed no abnormalities. His physician insists on the puncture of the liver and the continuation of treatment, but her husband no longer believes in the successful treatment, and it cost them dear. What could puncture the liver and whether the procedure is safe? Deciding Whether to continue treatment, if already treated with 8 months of no positive results? What is a liver biopsy? How many high risk household – we'd been married 5 years, the son of 4,5 years (he was conceived when her husband was already ill, but we do not yet know), the son was born healthy, but he had a prolonged jaundice at birth (approximately 3 months), my tests are negative. Son and I have been vaccinated against hepatitis B, whether this vaccine can protect us from gepatitaS? My husband and I want to have a second child on how high the risk of future child? Does prevention of the disease? Does smoking on the course of the disease? Thank you in advance for your reply!

Answer: Doctor operates as it should be. Medications must now be provided free of charge. Issues of hygiene, etc., please visit http://hepatit-c. narod. ru – Russia's community of patients with hepatitis C.

Question: At http://www. hcv. communityhost. ru describes the practical experience of attempting to maintain a treatment for hepatitis C (with concomitant pancreatitis) Roncoleukin. Actually there is a treatment? Not hurt right?

Answer: I'm sorry, but can answer specific questions about the state of health. Ask your question on the above site (the author, if the material is signed).