STUDIES ON CLINICAL. LABORATORY AND HISTOLOGICAL FINDINGS OF LIVER BIOPSY IN EPIDEMIC VIRAL HEPATITIS

This is a report of the clinical and laboratory findings of acute viral hepatitis, based on 163cases experienced in the ROKA during the period from April to Sept. , 1960. These cases were followed up for 12 weeks after the onset of jaundice. Some of the prominent findings are as follows; 1. The jaundice appeared within 1 week after the onset of illness among 31 out of 42 cases in which the history could be confirmed. 2. The symptoms are classified into gastrointest· inal and nervous symptoms. The frequency of major gastrointestinal symptoms were: indigestion (94%) , abdominal pain(92%)' anorexia(85%), nausea(67%), diarrheaC42%), vomiting(29%), com:tipation04%) ill orde r. The frequency of major nervous symptoms were: fatigability(98%) , cigarette distaste(78%), vertigo(75%), headache(74%), thirst(58%), drawsinessC56%), itching sensation (43%) and joint pain(30%) in orde r. These symptoms were generally prominent in the early stages However, the fatigability was persistently prolong• ed, and the itching sensations were marked in the recovery stage. 3. The major signs, in order of frequency , were as follows: yellowishconjunctiva(98%), hepa' tomegaly(84%) , tender liver(67%), skin rashes (27%), splenomegalyC22%), spider angiomata 03%) and petechia of skin (3%). Tender liver was most prominent during the 1st week, and so were splenomegaly during the 2nd week, hepatomegaly during the 4th week and skin rashes after the 4th week after the onset of jaundice 4. The incidences of symptoms and signs usu ally paralleled the severity of hepatic damage, but occasionally some of the clinical findings which tended to be persistently prolonged were not so. During the early stages, within 2 weeks after the onset of jaundice, hepatomegaly was less frequent in severe cases than in less severe cases. 5. The peak of the serum bilirubin level occurred ill the 1st week after the onset of jaundice At that time, an average value of total serum bilirubin was 14.8mg%, and the maximal level was 44.7mg%. In early stages, direct reactive bilirubin was relatively higher than in the recov' ery stages. Positive correlation was found between the serum bilirubin levels and the severity of histological changes. While there was an anicteric stage in the moderately severe case, there was complete histologic healing in one post-hepatitic hyperbilirubinemia case. 6. The peak of the serum iron level was reached in the 2nd week after the onset of jaundice; it was a somewhat later manifestation com pared to the peak of serum bilirubin leve l. The average level of the peak was 245 gamma% with one case showing a maximum level of 451 gam rna%. It did not necessarily prallel the degree of hepatic cell necrosis. 7. The maximal activity of serum transamin ase was revealed in the 1st week after the onset of jaundice: the average level of GP-T activity was 515.17 units, with a maximum level of 1610 units. The average level of GO-T activity waS 426.04 units with a maximum level of 1570 units. There was an apparent parallel between the rise of GP-T activity and hepatic cell necrosis, and the rise of GO-T activity and the degree of fibrosis. 8. In cases having no complications, alterations of electrophoretic pattern of the serum proteins generally showed a moderate decrease of albumin and a moderate increase of gamma globulin, with decrease in albumin in the earlier stages and a rise of gamma globulin in the later stages. The most marked rise of gamma globulin level was seen in a case with the most severe fibrosis