Syphilitic hepatitis symptoms. Syphilis is hepatitis. Early syphilitic jaundice

On the contrary, since I witnessed a typical arthropathy in severe liver syphilis. Once I saw a complication of liver syphilis with tuberculosis of the peritoneum, which is extremely interesting from the point of view of a similar combination with the tubercle of the peritoneum.

Diagnosis

The diagnosis of liver syphilis is not always easy and certain. Usually, on the basis of the symptoms of the disease (objective changes in the liver, abdominal dropsy, enlargement of the spleen), it is possible to recognize the suffering of the liver, but its nature is often questioned.

First of all, it goes without saying, attention should be paid to the etiological moment. If we are dealing with an undoubted drunkard, then first of all we should assume an ordinary form of cirrhosis.

On the contrary, if the anamnesis indicates syphilis and it is possible to prove the existence of other signs of this disease (damage to the bones, scars in the pharynx, Wasserman's reaction, etc.), then it is undoubtedly more likely to assume syphilitic suffering of the liver. Of the individual signs for syphilis of the liver, rough irregularities on the surface of the organ are characteristic.

In contrast to fine granularity in common cirrhosis and sometimes also severe pain in the area of ​​the latter. In addition, it is necessary to take into account that the course of liver syphilis is much longer than the course of normal hepatic cirrhosis.

Treatment

Syphilis of the liver and other internal organs is often found in practice, but, unfortunately, is rarely diagnosed.

We can safely say that no organ spares this fairly common infection, especially the liver, which reacts very subtly to almost all types of acute and chronic infections. According to statistics, syphilis accounts for 7.2% of all liver diseases, which, of course, indicates a relatively high frequency of this disease.

Liver syphilis can be congenital, acquired. Both types can have an acute and chronic course of the disease. An acute course occurs with syphilitic hepatitis, and chronic forms are expressed in the form of syphilitic gums or in the form of the so-called syphilitic lobular liver, which is a consequence of syphilitic cirrhosis.

The defeat of the liver tissue with acquired syphilis can be observed in all three periods of syphilitic infection, but more often it occurs in the secondary and tertiary periods of the pathological process. Certain pathological changes in the liver tissue, characteristic of a specific syphilitic infection, occur mainly on the basis of the penetration and stay for a long time of pale spirochetes in the liver tissue; the possibility of syphilitic intoxication on the hepatic tissue is also not denied.

In the acute period of syphilitic lesion, the process proceeds in the form of vulgar infectious hepatitis, when small-cell infiltration of the hepatic parenchyma, vasodilation, exudation occurs.

Usually in such cases, the liver enlarges, its tissue becomes painful, soft-elastic consistency. In the later stages, due to chronic irritation of the liver tissue with syphilitic poison, the connective tissue grows, which subsequently leads to cirrhotic changes in the organ. Specific is also the formation of single or multiple gummas, which, disintegrating, dissolving, are replaced by connective tissue, which leads to severe deformation of the liver, a decrease in its volume, the formation of a lobular liver with large constrictions, and sometimes the detachment of parts of the liver, which is characteristic of syphilis of this organ. Of course, the described morphological changes, the gradual replacement of its tissue with connective tissue cannot but affect the overall functional capacity of this organ. With sharp violations of hepatic functions, significant changes occur in the body of patients, which is reflected in the clinical picture of the disease.

Clinical picture

And the symptomatology of liver syphilis is rather confusing and does not have the characteristic symptoms characteristic only of syphilis. In the initial, acute, period of lesion, with the so-called syphilitic hepatitis, there are all the clinical signs of acute infectious hepatitis that usually have to be observed: a feeling of heaviness, colic, pain in the right hypochondrium, low-grade fever, an increase in liver size, soreness, slight leukocytosis and other morphological and biochemical changes in the blood picture. In such cases, the true etiology of hepatitis is determined only by a carefully collected anamnesis. In the presence of anamnestic indications of syphilis disease, especially with poor and unsystematic treatment, the question becomes clear. And in general, with all types of hepatic syphilis, since there are no pathognomonic clinical signs and the disease can be confused with many other liver diseases, a carefully collected history indicating the disease with this disease makes the diagnosis of hepatic syphilis most likely.

If you suspect liver syphilis, you should put the Wasserman reaction, other serological reactions. In such cases, positive reactions fully confirm the presence of liver syphilis, and negative reactions do not yet indicate the absence of such.

With gummy hepatitis, much in the clinical picture depends on the size and number of gummy granulomas in the liver, on the presence of their decay or the presence of already connective tissue degeneration.

Surgical treatment of liver syphilis

Liver syphilis in all its types is not of great interest for, since in most cases it is not subject to surgical treatment. With the marginal location of the deformed, detached parts of the liver, with the marginal gummas, one can resort to excision (resection) of the parts of the liver, although such resections are unsafe for patients. The more accepted is a conservative-specific method of treatment, which is especially appropriate for acute and chronic syphilitic hepatitis, as well as for liver gums. Ineffective, almost useless is the use of conservative treatment when the process is over, when the formed lobular fibrous growths have already led to a complete deformation of the liver. Nevertheless, when a diagnosis of liver syphilis is made, systematic anti-syphilitic treatment is started.

Etiology. In the early period of the disease, syphilitic infection can cause acute parenchymal hepatitis, which, however, often arises from an accidentally introduced virus of Botkin's disease ("syringe" infection ", see Botkin's disease). With syphilis of the liver, a gummy process is more often observed in the tertiary period, with a dense, lumpy liver. When disintegrating, gums are replaced by connective tissue with the formation of scars that disfigure the liver (syphilitic lobular liver - hepar lobularis). Late congenital syphilis of the liver is usually characterized by diffuse hepatitis in combination with gummy lesions in the form of numerous small gummas.

Symptoms and course. Acute parenchymal syphilitic hepatitis occurs with the symptoms of ordinary hepatitis: jaundice, an enlarged and painful liver. The course of this disease is usually longer than that of Botkin's disease; there is an accelerated ROE, the number of leukocytes is normal or increased, fever of a prolonged remitting nature. With diffuse hepatitis with a small-gummy process, a dense, small-lumpy painful liver and an enlarged spleen are palpated. In the presence of a lobular liver, its surface is hard, uneven. The disease, with improper and insufficient treatment, progresses, but proceeds relatively benign. The general condition of patients remains satisfactory for a long time, liver function is slightly impaired. In the final stage of the disease, jaundice and ascites develop from compression of the bile ducts and portal vein by the scar tissue.

Diagnosis. Acute syphilitic hepatitis is differentiated from hepatitis of a different etiology; hummoanic and cirrhotic process - with liver cancer and cirrhosis of another origin. Anamnesis data, a positive Wasserman reaction, clinical features of the course of liver disease and other manifestations of syphilitic infection in a patient may indicate syphilitic hepatitis.

Treatment. Specific treatment: penicillin, mercury preparations, biloquinol, iodine; with the use of novarsenol, you need to be careful, especially in the presence of jaundice, since novarsenol itself can cause toxic hepatitis (see Hepatitis salvarsan acute). General regimen, diet and nonspecific drug treatment, as in acute parenchymal hepatitis (see)

Prevention. Vigorous anti-syphilitic treatment in the initial stages of the disease, as well as prevention, common with chronic hepatitis (see) and salvarsan hepatitis (see). With exacerbations of the disease, fever, jaundice, the patient is temporarily disabled; during remission, with good health, compensated liver function - limited working capacity: the patient should not overwork and perform heavy physical work (see Chronic hepatitis).

Many diseases, both viral and bacterial, are fatal to humans.

Some of them appear almost immediately, and some, on the contrary, do not manifest themselves for a long time. This can lead to the fact that the patient learns about the terrible diagnosis when it is too late to do anything. Therefore, there is an opportunity to conduct a preventive anonymous examination to check your health status, in particular, to be tested for HIV and hepatitis.

• HIV testing
• How to decipher the results?
• How long is the result valid?
• Methods for detecting hepatitis
• ELISA method
• PCR analysis

HIV testing

The human immunodeficiency virus was discovered at the end of the last century. It is dangerous in that it hardly manifests itself in any way, often until the patient's death. An HIV test is mandatory in the following cases:

• pregnancy (to avoid the vertical path of the spread of the virus);
• donation (to avoid infection through the blood of other people);
• before carrying out operations.

How is the analysis carried out, where is the blood taken from and is preparation needed? Blood is taken from the cubital vein on an empty stomach.

In newborns, blood is taken from the umbilical cord vein. Within 2-10 days, an analysis is made for the content of antibodies, after which a diagnosis is made about the presence or absence of a virus in the body.

How long can a blood sample be stored? At room temperature, the shelf life is no more than 12 hours. If you store raw materials in a special refrigerator at a temperature of no more than 8 ° C, the period increases to 24 hours. After the specified time, the ongoing processes of hemolysis may affect the results obtained. Also, the study can use blood serum, which is obtained by centrifugation. The serum is able to retain its properties for up to 7 days at temperatures from 4 to 8 ° C.

How to decipher the results?

The time after infection, in which reliable results can be obtained, is of key importance. During the study, the presence of antibodies to the Ag p24 protein, which is part of the wall of the virus envelope, is checked. They begin to appear in the blood as early as 2-4 weeks after infection.

Normally, Ig M Ag p24 and Ig G Ag p24 are absent in the blood. Ig M Ag p24 can be produced for several months after infection, but disappears within a year from the moment of infection. Ig G Ag p24 is produced in the body for years.

How long is the result valid?

The shelf life of an HIV test is 6 months. This is due to the fact that it is possible to accurately determine the virus only 3 months after infection.

The results are valid only during this period, after which you need to re-take the analysis. This period of validity is not relevant during pregnancy - during this period, the analysis is carried out monthly.

So, to be sure that there is no disease, it is required to conduct a new study every 6 months to check for the presence of antibodies in the body.

Methods for detecting hepatitis

The routes of transmission of hepatitis B and C are similar to the routes of transmission of HIV: sexual and parenteral. These diseases are diagnosed with an analysis that requires a blood donation.

How is hepatitis tested? To conduct a study for hepatitis, blood is taken from the cubital vein on an empty stomach. It is also recommended to refrain from smoking and drinking alcohol for at least 8 hours before donating blood.

The study includes a complete blood count and a detailed biochemical analysis, which allows you to detect the presence of antibodies and markers of hepatitis in the blood.

The term for receiving the analysis results takes up to 7 days. In paid institutions, the term is usually no more than 2-3 days.

The analysis for hepatitis is done in two stages: ELISA and PCR. The second analysis is carried out in the event that the ELISA gave a positive result - both the first time and when repeated.

ELISA method

An enzyme-linked immunosorbent assay shows the presence of the hepatitis virus in the body with a probability of up to 95%. The risk of a false positive or false negative reaction is not excluded.

A false positive result is possible with a reaction that occurs in the absence of infection. A false negative result is more often observed - in the presence of an infection, there is no reaction of the body.

Statistics show that obtaining a false negative result is possible in 8% of cases. It is possible in the following cases:

• malignant neoplasms;
• autoimmune pathologies;
• syphilis;
• short period from the moment of infection.

PCR analysis

The polymerase chain reaction is carried out if the enzyme immunoassay is positive. This diagnostic method has been used for more than 15 years and is considered the most reliable.

It is carried out in qualitative and quantitative directions. The qualitative direction implies the determination of viral RNA fragments in the blood (HCV RNA). Quantitative analysis determines the viral load on the body. In this case, the amount of the virus in the blood is determined, which is an important indicator.

A low viral load reduces the risk of transmitting the virus to others and implies higher treatment efficacy. A high viral load, on the other hand, increases the risk of infection and indicates a lower effectiveness of treatment.

How to decipher the result? The decoding of the PCR result for the quantitative indicator of the virus is expressed in IU / ml (international units per milliliter of volume). This indicator is accepted all over the world for standardization purposes. Depending on how many units are detected, the level of the virus is determined.

If the indicator is more than 800 IU / ml, this indicates a high viral load. A value of less than 800 IU / ml, on the contrary, indicates a low viral load on the body.

What is the shelf life of a hepatitis test? By itself, a biochemical blood test has a shelf life of up to 14 days. However, the test result for hepatitis is reliable within 6 months from the date of the study. This is due to the "window" period during which the virus cannot be detected after infection. For people who are at risk, the study must be carried out without fail once every six months. If the expiration date of the analysis has expired, a new one is required, since the previous one will no longer be valid.

Prevention and regular examinations help, if not prevent, then determine the pathology in the early stages, when the treatment will be more effective and simpler.

Syphilitic hepatitis of the liver (liver syphilis) is one of the most frequent manifestations of visceral syphilis, second only in frequency to syphilitic aortitis and syphilis of the central nervous system. Syphilitic lesions of the liver of a chronic type are found on the section in one third of all corpses of patients with syphilis. During life, they are recognized only in half of all cases.

Liver syphilis is diverse. The most typical form of chronic syphilitic hepatitis of the liver is gummy hepatitis. This form is specific for syphilis, moreover, such as is characteristic of all sorts of other localizations of syphilis. But there are other forms of chronic syphilitic liver damage. Gummy hepatitis is a type of syphilitic interstitial (mesenchymal) hepatitis. He needs to oppose syphilitic parenchymal (epithelial) hepatitis and associated with it.

Syphilitic chronic epithelial hepatitis

The disease is based on the defeat of the liver cells of a dystrophic-degenerative nature with a secondary reaction from the mesenchyme.

Syphilotoxic hepatitis can be compared with syphilitic nephrosis or amyloidosis. There, too, we are talking about deep dystrophic processes caused by some kind of toxic effects of syphilitic origin, but not directly by spirochetes.

Syphilis can lead to chronic epithelial hepatitis in three ways:

1) as a result of acute hepatitis ("syphilitic jaundice");

2) as a result of "chronically" acting syphilitic intoxication;

3) as a complication of interstitial-gummy hepatitis.

Epithelial hepatitis occurs at any age. At a young age, it is either the result of dystrophic disorders accompanying other manifestations of congenital syphilis (as in lipoid nephrosis), or is combined with congenital interstitial hepatitis. In people aged 20-30 years, chronic epithelial hepatitis is usually the outcome of acute hepatitis (jaundice). At a later age, it develops either as a result of prolonged syphilitic intoxication, or joining gummy hepatitis.

With regard to the pathological picture of this form, it should be emphasized:

1) the intensity of dystrophic changes in the liver cells;

2) the severity of the reaction from the reticuloendothelial system (both Kupffer's cells and the corresponding elements in the spleen and other organs);

3) a relatively high frequency of cases with mixed extra- and intralobular reproduction of connective tissue (the latter often predominates - the insular type);

4) a relatively weak tendency of the connective tissue of the liver to wrinkle.

In connection with these features, it is clear that with syphilotoxic hepatitis, the liver retains an increased size longer than with alcoholic cirrhosis.

The specific origin of this kind of forms is evidenced by individual findings of characteristic manifestations of syphilis in various organs in the form of endarteritis, periarteritis, single gummas, etc., found during postmortem examination.

Clinically, most cases of syphilotoxic hepatitis are rather severe suffering, relatively rapidly progressive, previously described as "syphilitic cirrhosis". In the first stage, general malaise, heaviness in the hypochondria, sometimes itching, poor appetite, and increased nervousness are usually noted. The liver is enlarged, usually smooth, almost painless. Jaundice starts early and fluctuates in intensity. Functional disorders of the liver are more pronounced than with alcoholic hepatitis. The spleen usually enlarges, sometimes even earlier than the liver. It is known that other, extrahepatic, localizations of late syphilis are sometimes accompanied by an enlargement of the spleen.

In the second stage, the liver becomes denser and somewhat smaller, but usually it retains an increased size and a flat surface for a long time. Collaterals are rare and poorly expressed. Despite this, ascites appears only in the very late period of the disease and does not reach the degrees that are expressed in portal cirrhosis. These features are due to the low tendency of the fibrous tissue of the liver to wrinkle.

The bleeding that sometimes appears are not mechanical, but mostly dyscratic in nature and are rarely profuse. Anemia is common and is often macrocytic in nature. Leukopenia is common. Monocytosis is often severe. Lesions of the cardiovascular system, nervous system and kidneys are often observed as parallel manifestations of syphilis.

The course of the disease in comparison with other forms of liver syphilis is the least favorable. The disease usually progresses and the duration of the disease varies between 2 and 5 years. Death most often occurs from liver failure.

Syphilitic chronic mesenchymal (interstitial) hepatitis

At the heart of the disease is the introduction into the liver of the pale spirochetes themselves and the development of productive-infiltrative changes there. Spirochetes enter the liver most often through the hepatic artery, as this refers to acquired syphilis. This is understandable, since it generally spreads mainly hematogenously and since the primary foci that create spirochetemia in acquired syphilis are usually located in the general circulation, outside the portal vein system. The second route - through the portal vein - plays a major role in congenital syphilis (spirochetes enter through the placenta and umbilical vein). With acquired syphilis, this pathway is of relatively little importance and only with syphilitic foci in the abdominal cavity, primary syphilis of the stomach or spleen, etc., although, of course, the possibility of spirochetes entering the portal blood from the arterial system under any conditions is not excluded. The lymphatic pathway plays a minimal role (for example, in cases where syphilitic foci are located in the immediate vicinity of the liver or in the mesenteric or portal lymph nodes).

Gummy hepatitis is usually detected 10-20 years after infection. It is therefore understandable that the disease occurs more often in the elderly. However, there are known cases of hepatitis that developed within a year after infection.

This type of hepatitis occurs in syphilis in two forms: in the form of limited gummy hepatitis and in the form of miliary gummy or diffuse interstitial hepatitis.

Focal gummy hepatitis

The pathological picture of focal gummy hepatitis consists in the formation of gum in the liver, the value of which ranges from millet grain to apple. In some cases, there are several large gummas, in others, many small ones.

Gummas are more often located in the peripheral parts of the liver, under the peritoneal leaflet that covers the liver, but they are also found in the depths of the liver. Most often they are found on the upper surface of the liver; on the lower surface, they are located mainly in the spigel lobe, that is, near the trunk of the portal vein and the common hepatic duct, and at a certain value they can squeeze these organs. Sometimes gummas are located along the front edge of the liver and protrude into the abdominal cavity.

On examination, gummas have the appearance of convex tumors of rounded or irregular outlines; the color of fresh gum is pink, of old - whitish-yellowish. Over time, as a result of wrinkling of the connective tissue that is part of them and encapsulating them, gums become denser, and a curdled mass forms in their center, which can then calcify and petrify. In other cases, gumma, undergoing necrosis in the center, softens and suppurates. A dense fibrous tissue, like a capsule, forms around it.

Histologically, in the initial period of gum formation, an infiltrate is found from round cells of blood and local mesenchymal origin (lymphocytes, plasma cells, eosinophils, sometimes giant cells); the number of small vessels increases sharply around the infiltrate. This neoplasm of blood vessels gives the peripheral layer of gum the character of granulation tissue; later, endarteritis and endophlebitis develop, collagen fibers multiply in the peripheral regions and fibrous cords are formed.

Necrotizing of gum in the center usually occurs after scar tissue has formed around the gum. In the necrotic masses, the contours of the vessels are sometimes preserved. Various stages of gum development can be found in the same liver. In some patients, fibroblastic, sclerotic processes predominate in the gummy liver, in others - the phenomenon of gum breakdown, the epithelial tissue of the liver in places of gum undergoes atrophy, in others it is normal. Scars after gum or around them have a radiant and retracted appearance. Gummy changes, if they develop close to the surface of the liver, are usually accompanied by limited perihepatitis, in the form of thickening of the serous membrane covering the liver: sometimes a series of adhesions with neighboring organs are created around the liver. Large vessels are often changed (hepatic artery endarteritis, portal vein pylephlebitis). Sometimes syphilis-affected lymph nodes are found in the gate of the liver. The outcome of gummy hepatitis is a syphilitic "lobular liver": the organ is furrowed with cracks, all in bumps, disconnected from the rest of the tissue. In some cases, only one lobe is disfigured.

In other organs and tissues, there are changes that develop in parallel on the basis of the same infection (aortitis, etc.).

The clinical picture of focal gummy hepatitis can give a wide variety of symptoms and simulate many diseases; it is mistaken for cholelithiasis, disease, malaria, cancer of the stomach or liver, etc. One of the early signs of the disease is pain in the right hypochondrium or in the epigastric region. The pains are quite intense. They are either long lasting, last for several hours or days, or are sharp and short-lived, are cramping in nature. From time to time they weaken and then intensify again; like other syphilis pains, they can get worse at night. The pain usually lasts throughout the entire disease, sometimes it is limited only to the initial period, and then disappears. They are explained by the inflammatory process, capturing the glisson capsule rich in nerves and sometimes the peritoneum. In rare cases, they are absent.

Fever is another characteristic symptom. The temperature usually fluctuates between 37 ° С and 38 ° С, but it can periodically rise and higher - up to 39 ° С. It is of the wrong, often remitting type, sometimes there are sudden rises for 2-3 days, accompanied by chills. At times, for days, weeks, and occasionally even months, the temperature may be normal. Rises in temperature reflect an active inflammatory process in the liver, which can either worsen and seize new areas of the organ, or subside; decay and suppuration of gummies explain, in addition to fever, also chills.

The most important and persistent symptom of the disease is an uneven enlargement of the liver. Sometimes large bumps emanating from the liver are already visible to the eye, or the entire area of ​​the liver protrudes. Often, any one lobe of the liver increases, or protrusions are felt on the surface or along the edge of the liver; they can be flat, round, bumpy. There is usually soreness in the region of the protrusions. In the early period, the consistency of the liver is not particularly dense: the gums themselves are usually denser than the rest of the organ tissue. In the later period, the liver becomes smaller, denser, the protrusions can even acquire cartilaginous density. Sometimes, on the contrary, the bumps soften and even get the property of swelling. A friction noise of the peritoneum is sometimes determined above the tubercles.

Jaundice usually does not occur. Only in rare cases does it appear, sometimes even early, in those cases when gummas squeeze large bile ducts (while jaundice is mechanical in nature and there are no functional disorders of the liver). Jaundice can develop in the late period, when the function of the liver tissue begins to be disrupted, urobilinuria appears, violations of the synthetic ability of the liver, etc. The spleen with gummy hepatitis is rarely palpated, mainly in the late stage, if portal hypertension develops. Portal hypertension, however, does not develop in many cases, and ascites and collaterals are absent. There may be cases of ascites, which develops as a result of compression of the trunk of the portal vein with gum or scars in the gate of the liver. The composition of the blood has changed little. Moderate anemia is present only in severe forms. Small leukocytosis is common. The general condition of the patients is initially good. In the later stages, it is disturbed, weight drops.

The outcome of focal gummy hepatitis in cases with a small number of gums is favorable: gums may undergo resorption and scarring. In cases of large changes, severe consequences can develop; portal hypertension with bleeding from the gastrointestinal tract mucosa, perihepatitis with the transition of the inflammatory process to neighboring organs (pleura, lungs, stomach) and mechanical disorders in them, etc. peritonitis, etc.). Hemorrhages in the liver are possible due to rupture of the vessel. The disease lasts for many years, but it is difficult to count (gum in the liver is sometimes found at autopsy in people who were not expected to have liver disease during their lifetime).

Miliary gummy, or diffuse interstitial, hepatitis

With miliary gummy hepatitis, a uniform increase in the liver is observed; its surface is covered with small whitish plaques or nodules (with millet grain and less). In the later phases of the disease, the liver may shrink. At microscopic examination, the liver is dotted with granulomas consisting of round mesenchymal elements of local and blood origin (reticuloendothelial elements, lymphocytes, neutrophils, eosinophils), around them - capillary networks and collagen fibers, later endophlebitis and endarteritis of small vessels are formed. As a result, the center of the foci becomes necrotic and scars form in place of the granules. Along with this granulomatous form, there is a common form of syphilitic inflammation of the liver. In this case, there is a diffuse infiltration of small cells around the blood vessels throughout the liver.

Infiltrates can also undergo necrotization, resorption, or scar tissue replacement. Over time, significant fibrosis of the organ is formed, resembling annular cirrhosis in the pattern in the sense that connective tissue multiplies mainly between the lobules (that is, where granulomas and infiltrates are located in the vicinity of the vessels). In this form, the spleen is often enlarged with changes in it, similar to those observed in cirrhosis of the liver.

The clinical picture of this form of syphilitic hepatitis differs in many respects from that in epithelial and gummy focal forms.

The first stage is characterized by:

Uniform enlargement of the liver with a slight compaction;

Painful phenomena from the liver and its soreness when palpating (however, the pains are not as pronounced as in the focal form, and are less often of a paroxysmal nature);

Fever (but the fever is still not high);

Enlargement of the spleen (whereas in the focal form the spleen is usually not enlarged);

Absence of jaundice (and there is no such obstructive jaundice, which sometimes develops with a focal form on the basis of compression of the bile ducts with gums);

Absence of functional disorders of the liver (in contrast to chronic syphilitic epithelial hepatitis).

Nutrition, the state of the gastrointestinal tract, the cardiovascular apparatus, and the composition of the blood are disturbed relatively little.

In the second stage, the liver decreases and becomes denser, symptoms of portal stagnation appear, including ascites, health worsens, patients lose weight.

The outcome of the disease is less favorable than with focal hepatitis, although the course is long. Death occurs from the same reasons as in liver cirrhosis in general.

Liver with congenital syphilis

With congenital syphilis, liver damage can be of different types. Pathoanatomically, two forms of congenital syphilis of the liver are distinguished:

1) flint liver;

2) gummy liver.

The first term means the liver, in which there are sharp changes both in the parenchyma and in the interstitium in the form of small islets distributed throughout the organ; the liver is enlarged, heavy and dense. The second term refers to gummy hepatitis.

Clinically distinguish between hepatitis with early congenital syphilis and hepatitis with late congenital syphilis. With early congenital syphilis, in addition to hepatitis, there are other signs that quite clearly depict the general disease (the senile appearance of children, cachexia, pemphigus, etc.); children die quickly. With late congenital syphilis, liver damage gives the same syndromes as with acquired syphilis, with some, however, features:

With congenital syphilis, there is a great tendency to the formation of ascites in connection with the development of pylephlebitis of the portal zone;

The spleen enlarges more strongly and early;

There are such common stigmata as infantilism, deformation of the skull, changes in limbs, teeth, keratitis, etc.

"Silicon liver" is observed in early syphilis, other forms - in late.

Diagnosis of syphilitic hepatitis

For the recognition of chronic syphilitic hepatitis (various forms), the Wasserman reaction, the corresponding anamnesis (including family history) and simultaneous syphilis affection of other organs (aortitis, aortic valve insufficiency, syphilitic disease of the cerebral vessels, tabes of the spinal cord, syphilis of the organs of movement, are of great importance) stomach, lungs, etc.), as well as such traces of former syphilitic lesions as radiant scars on the skin and mucous membranes, bone deformation, enlarged lymph nodes, pigmentation disorder, developmental defects.

If we take together all forms of chronic liver syphilis, the Wasserman reaction turns out to be negative quite often (40% of cases); a negative answer is more often obtained with epithelial hepatitis, whereas with gummy hepatitis, the reaction is positive in 80% of cases. Since infection with syphilis sometimes proceeds without primary affect, it is clear that both the fact of infection and its prescription in many cases cannot be established.

Parallel damage to other organs should be assessed with reasonable caution when making a diagnosis: sometimes it is due to it, and not due to liver damage, the Wasserman reaction can be positive. Proving the specificity of extrahepatic lesions by the specificity of the process in the liver and, conversely, the specificity of the process in the liver - by damage to other organs, one should bear in mind the possibility of a combination of diseases of different ethnology. But still, if a patient with liver damage has a positive Wasserman reaction, then the hepatic process should be considered syphilitic, especially in cases where there are no other localizations of syphilis, and even more so when the history and the very nature of the hepatic disease correspond to a similar etiology.

The effect of anti-syphilitic treatment is very important for recognition.

Treatment

Treatment of syphilitic chronic hepatitis should include both nonspecific and specific agents.

Specific drugs include the appointment of penicillin derivatives. However, in the case of a patient's allergy to penicillin or the resistance of the patient's pale treponema strain to penicillin and its derivatives, it is possible, as an alternative method of treatment, to use drugs such as erythromycin or tetracycline derivatives, as well as cephalosporins.

With tertiary syphilis and high resistance of pale treponema to antibiotics, in case of a satisfactory general condition of the patient, bioquinol, miarsenol and novarsenol can be used as additional therapeutic drugs.

Nonspecific treatment of syphilitic hepatitis includes the use of vitamin preparations, adherence to the dietary regimen, etc.

Prevention

Prevention of chronic hepatitis due to syphilis consists, of course, in a general fight against syphilis and vigorous treatment of syphilis following its detection, followed by long-term monitoring of Wasserman's reaction. A huge role in the development of liver damage is played by the absence or insufficiency of timely treatment of syphilis: most patients with tertiary syphilis of the liver were not treated at all or were clearly insufficiently treated. This is especially true for patients whose syphilitic infection has gone unnoticed for a long time.

Health education, medical examination, etc. are of great importance in the prevention of liver syphilis.

As for congenital syphilis, in addition to general social and preventive measures, compulsory examinations of pregnant women and careful timely treatment of syphilis discovered in them play an important role.

The information provided in this article is for informational purposes only and cannot replace professional advice and qualified medical assistance. At the slightest suspicion of the presence of this disease, be sure to consult your doctor!