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KMID : 0365819660060010281
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Journal of Pusan Medical College
1966 Volume.6 No. 1 p.281 ~ p.296
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Clinical Studies on Acute Viral Hepatitis
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Abstract
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Clinical observation is made on 42 cases of the acute viral hepatitis seen in Department of Internal Medicine, Pusan National University Medical College from May 1960 to Nov. 1965. The result of the study:
1. In-this series, male is affected more frequently than -female with a -ratio of 7 to 3. The onset of the viral-hepatitis is -either abrupt or insidious with increased -frequency of :the former. Age of the patients in this series f ganged from 17 to 68 with peak incidence between 21 and 30. The disease is most common in autumn. The course of the disease during hospitalization is usually good. The condition of -the patients on discharge from, the hospital is either healed completely or improved markedly. It is suggested -that close relationship existed between chronic heavy alcohol intake and the course and prognosis of -the disease.
In 23 of the 28 cases in which the accurate history is obtained, the preicteric duration of the disease is within one week.
2. Symptoms can be classified into 3 major categories: gastrointestinal, nervous and miscellaneous.
a) Gastrointestinal symptoms, in order of frequency are: abdominal discomfort and pain(85%), anorexia(75%), indigestion(71 %), constipation(55%), diarrhea(4o%), vomiting(33%) and nausea(30%). Generally these symptoms are prominent in the earlier stage.
b) The major nervous symptoms are fatigability (66%), cigarette distaste(65%), headache(38%), chest .discomfort(31 %), pruritus(24%), insomnia(21 %) and drowsiness (14%). The fatigability lasted for long time to convalescent period.
c) The major miscellaneous symptoms, in order of frequency are: fever(78%), chill(43%), weight as (35%) and symptoms attributable to tipper respiratory infections in preicteric phase(33%).
The major signs, in order of frequency are: jaundice(81 %), hepatornegaly(70%), liver tenderness (57%), dark urine(79%) and spider angioma(10%).
3. The results of the liver function tests are as following;
a) The average value of total serum blirubin is 10.87mg. % and in one case it reached to 32.60mg%. The elevation of direct-reacting bilirubin is noted in the first 2 weeks, -while indirect-reacting one is
increased thereafter.
b) The maximal activity of serum transaminase is revealed in the first week of the disease. The average value of S. G. P. T. activity is 270 units with maximum being 560 units. The average value of S. G. 0. T. activity is 368 units with maximum being 780 units.
c) The mean value of the total serum protein is within normal limit. Serum albumin, however, is - decreased in all cases whereas serum globulin is increased slightly to moderately. The value of albumin is lowest in the earlier phase of the disease with tendency to increase in convalescent stage.
d) The peak abnormality of C. C. F. is seen in the first week after appearance of jaundice in 75% of the group. The value of C.C.F. is more increased in cases with the low serum albumin.
e) The peak abnormality of T. T. T. is noted also in the first week of the jaundice in 83% of the series. Convalescent rate of the T. T. T. is muchh lower than that of the C. C. F. . In patients with low albumin and low A/G ratio, the value of T. T. T. is more increased. There is a parallel between the rise of T. T. T. and the degree of C. C. F.
f) The B. S. P. test reveals abnormal retenion although other liver function tests are normal. It is suggested, therefore, that B. S. P. test is better guide in determining the degree of damage of the liver parenchymal cells. .
g) The serum cholesterol is normal. In a few patients hypercholesterolemia is seen during convalescent stage. The ratio of cholesterol esters to total cholesterol is decreased in the earlier stage but increased in the convalescent stage.
h) In general, the serum alkaline phosphatase activity is slightly increased in 36% of thep group-and normal in the remainder. In cases with increased serum alkaline phosphatase activity; both level of the T. T. T. and serum bilirubin are increased.
i) The serum Takata reaction is positive in 76% of the cases and has a trend to parallel with T. T. T. 4. The result of the miscellaneous tests are as following;
a) About 63% of the group have -some feature of anemia with decreased RBC, hemoglodin concentration and hematocrit. In considerable number of the patients, there are neutrophilic leukocytosis and lymphocytosis, Eosinophilia without monocytosis is seen in 4 cases.
b) In other half of the group with acute viral hepatitis, urinalysis reveals bilirubinuria in the earlier stage. Urobilinogenuria is noted thereafter throughout the hospitalization. Hematuria is noted in adout 3% of the series. Proteinriria in 22 cases and pyuria in adout 17% of the series.
c) Stool examination reveals clonorchis ova in 16% of the cases.
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