extrahepatic implications of chronic hepatitises.

At an infection of viruses of a hepatitis In and With the wide spectrum of a pathology is established. Clinico-morphological implications of these infections concern lesions of a liver and system (extrahepatic) implications.

Those and others can
To be observed in a combination or as independent diseases. On the basis of clinico-morphological research two basic groups of pathogenetic mechanisms of development of extrahepatic lesions at becoming infected HBV and HCV and, besides, allocate conditionally group of a pathology of system of blood. [13, 50, 183].

Role HCV is proved as the basic etiological factor: the admixed cryoglobulinemia, V-cellular nehodzhkinskoj limfomy, a monoclonal gammapathy, a late dermal porphyria, red flat depriving. Role НСV, as one of etiological factors Is supposed: an autoimmune thyroiditis, a cancer of a thyroid gland, a diabetes, syndrome SHegrena, fibrozirujushchego an alveolitis, nekrioglobulinemicheskih nephropathies, a psoriasis, a lesion of peripheric and central nervous system, a chronic polyarthritis, a pseudorheumatism, a nodous polyarteritis, polimiozita/dermatomiozita, fibromialgii, pseudosarcomas Kaposhi, cardiomyopathies, vitiligo, corneal ulcers Murena, chronic urtikarnoj eruptions [91, 113, 119]

At children of a lesion of others except a liver of organs at HGV are rare enough, and, as a rule, accompany serious variants of illness [204]. At children such extrahepatic implications as HcV-assotsiirovannaja a cryoglobulinemia, krioglobulinemicheksy a vasculitis, a late dermal porphyria [419] are not described. In connection with a rarity of an extrahepatic pathology at children, data in references are not numerous.

Lesions of hemopoietic system

The special role at becoming infected HBV and HCV is made by the third group of diseases - a pathology of system of blood. It is presented by an autoimmune hemolitic anaemia, an autoimmune thrombocytopenia, a hypoplastic anaemia, monoclonal immunoglobulinopatiej, admixed

Cryoglobulinemia, malignant limfoproliferatsiej, a partial cellular aplasia, a peripheric pancytopenia [13, 50, 113, 193, 305].

Eventually at patients with HG moderate and high activity,
Especially cirrhotic orientation, there are signs of oppression of hemopoietic system (an anaemia, a leukopenia, a thrombocytopenia), the greatest expression which it is necessary for a disease exacerbation. At HG the moderate and high activity can be enlarged by an ESR. There are indicatings on disturbance of oxidation-reduction processes and enzymatic activity of formulated elements of blood. At the same time depression of level of leucocytes, thrombocytes and an anaemia at HG the moderate and high activity can be caused disturbances of functional activity of a lien — the phenomena of a secondary hypersplenism [50, 204, 283].

Except immediate supressornogo actions HBV on blood cells and a secondary hypersplenism, the syndrome of an immune cytopenia is possible. Clinical implications of these lesions are raised krovotoyochivost and anemizatsija [50, 204,]. The thrombocytopenia at adult patients with HGS meets in 54,15 cases, and an anaemia in 9,5 % of cases [34].

Besides, at patients with HG the microcirculatory hemostasis is broken. The most expressed shifts are registered in a stage of exacerbation HG of the moderate and high activity and correlate with such symptoms, as ecchymomas and petehialnye eruptions on a trunk and extremities. This condition can be regarded as chronically proceeding syndrome disseminirovannogo intravascular coagulation of blood.

Deep inflammatory changes in a liver in a combination to the raised thromboplastic activity and a disproteinemia mainly at the expense of ascending u-globulinovoj to fraction [13, 204] promote it.

Lesions of endocrine glands. Endocrine disturbances at HG are shown by delay and an irregularity of a menses at girls, presence akne, stry on a skin of a stomach and hips, a hirsutism more often. Lesions of a thyroid gland with hypo-or that hyperfunction at 10—13 % of patients HG of the moderate and high activity which can arise much earlier become perceptible, than clinically expressed chronic hepatitis [13, 204, 217] will develop.

It is underlined possibility of development of a diabetes at patients with HG to the moderate and high activity [53, 204].

Lesion of kidneys. The wide spectrum of a lesion of kidneys, assotsiirovannogo with a HBV-infection becomes perceptible: from membranoznoj nephropathies to membranoyoproliferativnogo a glomerulonephritis and also tubulo-interstitsialnogo nefriyota. The clinical manifestation at one children is presented by a nephrotic syndrome (edemas, a hypercholesterinemia, sharply expressed proteinuria), and at other children of change from kidneys are shown by an asymptomatic proteinuria or a hematuria [204, 265, 359].

At patients with HG in 10 % of cases the urinary syndrome is taped, and more often at HG the moderate and high activity [203, 204, 459].

At patients HGS frequency of occurrence of diseases of kidneys authentically increases with augmentation of age of patients, and also duration of a becoming infected. All patients in an illness end-stage had signs of renal insufficiency. At persons with a lung and srednetjazhelym the NANOSECOND current  - infections of disease of kidneys were registered only in 4,5 % of cases [13, 25, 222]. Preventive maintenance VGV at patients with HPN is a serious problem. However there are reports on successful bacterination of the patients receiving steroids [459].

Lesions of joints. Transient arthralgias, mainly at the expense of involving of large joints of the top and bottom extremities, are observed at patients with HGV high activity.

The clinic and X-ray pattern of a lesion of joints at HGV are similar to those, at a pseudorheumatism. However for patients with HVG serious advance with formation of proof deformations and ankyloses is not characteristic. Articulate implications at HG, despite their duration and expression, disappear in due course. In sinovialnoj and tissues at patients HGV with an articulate syndrome find liquids HBsAg and anti-Hbs. [13, 50, 115, 203, 204].

Skin lesions. On a skin at HVG erythematic maculae, an urticaria, a nodulose erythema become perceptible. The big frequency (43,2 %) dermal becomes perceptible
Lesions at HG high activity among which the relapsing purpura which has been not bound to disturbance of coagulating system of blood more often becomes perceptible. Results of morphological researches testify that for serious HG the lesion of vessels of a skin in the form of productive and is productive-destructive arteriolitov and venulitov [13 is characteristic, 204].


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Scientific source Dmitriev Tatyana Gennadevna. CHRONIC VIRUS HEPATITISES At CHILDREN And TEENAGERS In REGION GIPERENDEMICHNOM. The PROGRAM of PERFECTION of RENDERING of the MEDIKO-SOCIAL HELP. The dissertation on competition of a scientific degree of the doctor of medical sciences. Yakutsk - 2014. 2014

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Other medical related information extrahepatic implications of chronic hepatitises.:

  1. the basic clinical syndromes
  2. extrahepatic implications of chronic hepatitises.
  3. diagnostics of chronic hepatitises at children and teenagers.
  4. 4.3. The Clinico-laboratory characteristic of chronic mikst-hepatitises at children and teenagers