Toxic hepatitis is caused by chemical poisons (such as phosphorus, arseniccarbon tetrachlorideHepatitis or liver disease caused by drugs or biological toxins.It is mainly the result of cytotoxicity.
TCM disease name
Toxic hepatitis
Common location
liver
common symptom
Loss of appetite, nausea, vomiting, abdominal pain, hepatomegaly, and increased serum transaminase
Toxic hepatitis can be divided into the following four categories according to the wave pattern in the ultrasonic pattern:
1. Severe acute poisoning
In the case of poisoning with a large dose, serious damage, coma and other symptoms, the wave pattern is dense microwave, mixed with sparse wavelets, which is somewhat similar to the second wave pattern of viral hepatitis, but more wavelets.If there is no continuous contact, the above acute inflammatory wave pattern will disappear within 30-40 hours after poisoning, and one of the following two or three wave patterns may be caused by liver edema orSteatosisCaused by.
2. Mild acute poisoning
Within 24 hours, the liver swelled, and the outgoing wave shifted significantly to the right. There was a flat segment between the wave bands entering the liver and exiting the liver. Occasionally, there were one or two microwave waves between them, which opened and enlarged the basin, but they were still flat segments. There was no obvious wave amplitude rise, which may be caused by liver edema.Generally, the wave pattern recovers within 10 days, and the microwave gradually increases between the flat segments. The recovery of hepatomegaly is often later than the wave pattern.
3. Chronic poisoning
Generally, it is occupational, and the liver is swollen. There is no obvious amplitude in the wave pattern in and out of the wave band, which may be caused by fatty changes in the liver.
4. Repeated chronic poisoning
Sometimes the hepatomegaly is not obvious, and the liver wave is+++, and the wave pattern is mainly dense microwave plus even wavelet, and sometimes the interface changes actively.It may be caused by the dimensional change of liver.
Basic information
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Toxic hepatitis
With the development of modern chemical industry, this disease is increasing.Animal experiments have proved that industrial toxic hepatitis has the following common points:
① There are definite pathological changes similar to hepatitis;
② The severity of the lesion was related to the dose received;
③ People are generally susceptible, and the lesions are similar;
④ It is easy to replicate animal models.The diagnosis mainly depends on clinical manifestations, such as jaundiceHepatomegaly, tenderness and gastrointestinal symptoms, combined with personal contact with the natural environment.Avoid the toxicants in contact as soon as possible and treat them symptomatically,Good prognosis, only a few lead toChronic liver diseaseThe mortality rate is very low.Some died in a short timehepatic failure。
category
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ToxicityhepatitisAccording to the time and amount of exposure to toxic substances, it can be divided into acute and chronic toxic hepatitis, and chronic hepatitis is more common.Acute toxic hepatitis has an acute onset, often without prodromal symptoms, and usually occurs within 24 to 48 hours of poisoning.
symptom
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Appetite, nausea, vomiting, abdominal pain, hepatomegaly, serum transaminase increased, and acute liver necrosis occurred in severe cases.Chronic toxic hepatitis, with insidious onset and no obvious symptoms, is similar to chronic viral hepatitis.
Infectious toxic hepatitis
Toxic liver lesions secondary to bacterial infection.Severe infections such as septicemia, typhoid fever and fulminant meningitis can cause toxic hepatitis.The onset is more common in younger infants, most of whom have obvious pre infection or concurrent infection. TTT test is slightly positive, and SGPT value generally does not exceed 200~300U.
Chronic toxic hepatitis
Poisoning reaction caused by toxic substances after long-term acceptance of antimony, arsenic, sulfonamide, antituberculosis, sedative and hypnotic drugs (such as chlorpromazine, phenobarbital), etc.It is mainly manifested in fatigueTolerance, nausea, vomiting, abdominal distensionHepatic pain, jaundice, etc.In case of toxic reaction, the drug should be stopped immediately to protect the liver, promote gallbladder function, and give high calorie and high protein diet.
Clinical significance
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Ultrasound has two completely different echo patterns for toxic hepatitis and viral hepatitis. Although similar viral wave patterns also appear in the acute phase of severe poisoning, they generally disappear within 30-40 hours and become edema wave patterns, which has certain value in the differential diagnosis of joint trauma. Repeated exploration can further understand the process of liver recovery.The wave pattern of chronic poisoning, which is dominated by fatty changes, and the wave pattern of return poisoning, which is dominated by dimensional changes, are helpful for differential diagnosis, early treatment and prevention.In addition, ultrasound can play a certain role in the regular examination of workers who may have occupational poisoning, as well as the liver examination of new workers before employment.
