Syphilis is hepatitis. Syphilis of the liver, photo, symptoms Early syphilitic jaundice

The most characteristic in clinical and anatomical terms are two forms of syphilis of the liver of adults:

1. early diffuse hepatitis of the secondary period with jaundice and
2. late sclero-gummous syphilis of the tertiary period, including late congenital syphilis of the liver.

Syphilitic spirochete, when infected with a person, penetrates early into the liver, especially into its vessels; different clinical and anatomical characteristics of liver damage in different periods of syphilis is determined by the changing reactivity of the body and the various interactions of the latter and the syphilitic spirochete.

Early diffuse syphilitic hepatitis

Early diffuse syphilitic hepatitis (hepatitis luetica praecox) is caused by both specific damage to the liver, especially the vessels and perivascular tissue, and nonspecific allergic diffuse damage to the organ. It is often observed together with specific lesions of other organs (nephritis, exanthema, lymphadenitis) or as an isolated liver lesion, especially in connection with increased reproduction or decay of spirochetes in this organ as a result of improperly performed insufficient or excessive specific treatment, the so-called monorelapse of syphilis or Lukashevich-Herksheimer reaction from the liver.
The clinical course of early syphilitic hepatitis resembles Botkin's disease, usually differing in the acceleration of ESR, the absence of leukopenia, and large fluctuations in the duration of the course.
It should be noted that most cases of parenchymal hepatitis with jaundice in secondary syphilis depend, especially in the treatment with injections of organic arsenic preparations (the so-called salvarsan jaundice), as well as in the treatment with injections of other drugs, including penicillin, from accidental injection with extremely resistant virus of Botkin's disease. In particular, cases of acute liver atrophy in the treatment of novarsenol, as a rule, are of exactly the same viral nature as most cases of protracted hepatitis, including cases of liver cirrhosis with a rapid course. In the origin of these “salvarsan jaundices”, the action of the arsenic preparation itself cannot be completely excluded, especially in the case of intolerance to novarsenol, which manifests itself, along with jaundice, rash and fever (the so-called erythema of the 9th day), agranulocytosis, etc. However, it should be considered a fairly reasonable opinion is that most often the so-called salvarsan jaundices are not associated with either an arsenic drug as such, or with a syphilitic infection, as well as a decline in nutrition or any other concomitant conditions for worsening the condition of the liver, but are mainly due to the introduction of a "syringe" infection. Therefore, particularly thorough sterilization of needles and syringes is necessary (at least 3/2 hour dry sterilization at 120°). Since novarsenol (like sovarsen) is still not completely indifferent to the liver, especially in parenchymal hepatitis, specific treatment is recommended if jaundice occurs in the secondary period of syphilis, continue with penicillin, as well as use penicillin and in the presence of a painful enlargement of the liver, increased urobilinuria or increased content bilirubin in the blood (even without jaundice) along with the appointment of glucose, campolone, vitamin C and a complete protein-carbohydrate diet. With intolerance to novarsenol, expressed in fever, rash, jaundice, etc., it is especially indicated to stop the administration of novarsenol, prescribe desensitizing antihistamines (diphenhydramine), as well as intravenous novocaine, calcium salts, campolone, glucose and the latest arsenic antidotes.

Late sclero-gummous syphilis of the liver

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Late sclero-gumous syphilis of the liver (hepatitis luetica sclero-gummosa) is a chronic, predominantly interstitial hepatitis with vascular damage and perivascular infiltrates and outcome in sclerosis or cirrhosis of the liver. In some cases, isolated gummas of the liver with their characteristic patterns of development predominate, more often found only on the section in the active state or already in the form of star-shaped scars. With the most frequent sclero-hummous lesion, the formation of gum occurs in parallel with scarring, and the serous cover of the liver (perihepatitis) is simultaneously affected. With this most characteristic form, the liver increases significantly in volume, becomes hard, uneven; scarring perihepatic cords form deep furrows in the liver, dividing it into uneven parts. Such a disfigured liver is called lobulated. Sometimes one of the lobes protrudes due to hypertrophy, while the other, on the contrary, atrophies due to wrinkling. When palpating, such uneven parts can easily be mistaken for a tumor. The liver is sometimes tender to the touch due to perihepatitis; pain in some cases are independent. The spleen is usually moderately enlarged. In the sclero-gummous form, jaundice is rarely observed, as are signs of liver failure in general, because in these processes, liver damage is more focal than diffuse, and the unaffected parts retain a greater regenerative capacity. In all forms of tertiary syphilis of the liver, there may be fever of the wrong type, amenable to specific treatment. The disease lasts for many years, accompanied by a motley and variable symptomatology. The role of syphilitic infection in the development of normal liver cirrhosis in patients with syphilis should be recognized as insignificant or controversial; more often, the etiology and course of such cirrhosis follow the patterns usual for this painful form (see above).
Late congenital syphilis of the liver is usually characterized by diffuse hepatitis in combination with gummous lesions in the form of numerous small gums.

Diagnosis and differential diagnosis. The diagnosis of syphilis of the liver is based on the clinical picture, simultaneous damage to other organs (syphilitic aortitis, syphilitic lesion nervous system, including tabes dorsalis), on anamnestic indications, positive serological complement fixation test, favorable result of trial treatment (iodine, bismuth, novarsenol, penicillin).
In the differential diagnosis of sclero-humous hepatitis, one should keep in mind liver cancer (due to enlargement and significant disfigurement of the liver), purulent cholangitis or liver abscess, including festering echinococcus (due to fever, pain in the liver), malaria, septic processes, etc. The correct timely diagnosis of liver syphilis is important because of the possibility to significantly improve the patient's condition through specific treatment.

Forecast depends to a large extent on the timely recognition of the disease and the implementation of specific treatment. Without specific treatment, gummous lesions can lead to amyloid degeneration of organs, sclerotic processes can lead to compression. biliary tract; severe damage to the vessels can join - phlebitis of the portal or hepatic veins, suppuration with a severe, often fatal course. With active treatment, even a significantly disfigured liver can remain in a compensated state for a long time.

Prevention and treatment. Early systematic treatment of syphilitic infection protects against secondary and tertiary liver damage. When treating with novarsenol, as well as when injecting other drugs, measures should be taken against the accidental introduction of the Botkin disease virus, especially during epidemic outbreaks of this disease. Complete nutrition with enough proteins and vitamins, elimination of severe physical activity, alcohol and other liver poisons also prevent or alleviate liver damage to a certain extent.
Treatment of early and late syphilitic lesions of the liver requires, along with antisyphilitic therapy, adherence to the regimen and ancillary drug treatment as in diffuse liver damage in general. Of the specific means, the most appropriate treatment is penicillin, taking into account the possibility of severe reactive exacerbation (Lukashevich-Herxheimer reaction) in patients with syphilis who are not prepared by other means. It is more expedient to start treatment, especially in chronic destructive processes, with iodine, bismuth or mercury preparations (see treatment of syphilitic aortitis). Treatment with novarsenol, as a drug that is not indifferent to the liver, should be carried out with extreme caution.

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

We can safely say that this fairly common infection does not spare any organ, 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.

Syphilis of the liver can be congenital or acquired. Both types can have acute and chronic course of the disease. An acute course occurs with syphilitic hepatitis, and chronic forms 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.

Damage to the liver tissue in 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 pathoanatomical changes in the liver tissue, characteristic of a specific syphilitic infection, occur mainly due to the penetration and stay for a long time of pale spirochetes in the liver tissue; the possibility of syphilitic intoxication acting on the hepatic tissue is also not denied.

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

Usually in such cases, the liver increases, its tissue becomes painful, soft-elastic consistency. In the later stages, due to chronic irritation of the hepatic tissue with syphilitic poison, the connective tissue ruptures, which subsequently leads to cirrhotic changes in the organ. The formation of single or multiple gums is also specific, which, disintegrating, resolving, are replaced connective tissue, which leads to severe deformation of the liver, a decrease in its volume, the formation of a lobed liver with large constrictions, sometimes lacing off 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 ability of this organ. Significant changes in the body of patients also occur with sharp violations of hepatic functions, which is reflected in the clinical picture of the disease.

Clinical picture

And the symptoms of syphilis of the liver are rather confused and do not have the characteristic signs that are characteristic only of syphilis. In the initial, acute period of the 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, subfebrile temperature, an increase in the size of the liver, its soreness, slight leukocytosis and other morphological and biochemical changes in the blood picture. In such cases, the true etiology of hepatitis is clarified only by a carefully collected anamnesis. In the presence of anamnestic indications of the disease with syphilis, especially with its 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 diseases of the liver, a careful history of this disease makes the diagnosis of hepatic syphilis most likely.

If syphilis of the liver is suspected, the Wassermann reaction and other serological reactions should be performed. In such cases, positive reactions fully confirm the presence of liver syphilis, and negative reactions do not yet indicate the absence of such.

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

Surgical treatment of liver syphilis

Syphilis of the liver in all its forms is not of great interest to, since in most cases it is not subject to surgical treatment. With the marginal location of the deformed, detached parts of the liver, with marginal gummas, it is possible to resort to excision (resection) of parts of the liver, although such resections are not safe for patients. More accepted is a conservative-specific method of treatment, which is especially appropriate for syphilitic acute and chronic hepatitis, as well as for gummies of the liver. Ineffective, almost useless is the use of conservative treatment when the process has ended, when the formed lobular fibrous growths have already led to a complete deformation of the liver. Nevertheless, when making a diagnosis of liver syphilis, they begin systematic antisyphilitic treatment.

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

Syphilis of the liver is diverse. The most typical form of chronic syphilitic hepatitis of the liver is gummy hepatitis. This form is specific to syphilis in nature, moreover, such as is characteristic of all kinds of other localizations of syphilis. But there are other forms of chronic syphilitic lesions of the liver. Gummy hepatitis is a type of syphilitic interstitial (mesenchymal) hepatitis. He needs to be contrasted with syphilitic parenchymal (epithelial) hepatitis and associated with it.

Syphilitic chronic epithelial hepatitis

The basis of the disease is the defeat of hepatic cells of a dystrophic-degenerative nature with a secondary reaction from the mesenchyme.

Syphilotoxic hepatitis can be put in parallel with syphilitic nephrosis or amyloidosis. There, too, we are talking about deep dystrophic processes caused by some toxic influences 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 gummous hepatitis.

Epithelial hepatitis occurs at any age. At a young age, it is either the result of dystrophic disorders that accompany 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 acute hepatitis(jaundice). At a later age, it develops either as a result of prolonged syphilitic intoxication, or joining gummous hepatitis.

With regard to the pathoanatomical 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 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 (often the latter, the insular type, predominates);

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 remains enlarged 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 gums, etc., found during pathological anatomical examination.

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

In the second stage, the liver becomes denser and somewhat smaller, but usually it retains its enlarged size and smooth surface for a long time. Collaterals are rarely formed and are 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 occurs is not mechanical, but mostly dyscrasic in nature and is rarely profuse. Anemia is common and often macrocytic in nature. A common symptom is leukopenia. Monocytosis occurs frequently to a pronounced degree. Damage to the cardiovascular system, nervous system and kidneys are often observed as parallel manifestations of syphilis.

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

Syphilitic chronic mesenchymal (interstitial) hepatitis

The basis 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 applies to acquired syphilis. This is understandable, since it generally spreads predominantly 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 path 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 penetration of spirochetes into the portal blood from arterial system under any conditions. 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).

Hummous hepatitis is usually detected 10-20 years after infection. It is therefore clear that the disease occurs more often in the elderly. However, there are 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 gummous hepatitis and in the form of miliary gummous or diffuse interstitial hepatitis.

Focal gummy hepatitis

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

Gummas are more often located in peripheral departments liver, under the peritoneal sheet, dressing the liver, but are also found in the depths of the liver. More often they are found on the upper surface of the liver; on the lower surface, they are located mainly in the Spigelian lobe, i.e., close to the trunk of the portal vein and the common hepatic duct, and at a certain value they can compress these organs. Sometimes the gummas are located along the anterior edge of the liver and protrude into the abdominal cavity.

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

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), and the number of small vessels sharply increases around the infiltrate. This neoplasm of vessels gives the peripheral layer of gum the character of granulation tissue; later, endarteritis and endophlebitis develop, collagen fibers multiply in the peripheral sections and fibrous bands form.

Necrotization of the gums in the center usually occurs after scar tissue has formed around the gums. In necrotic masses, the contours of the vessels are sometimes preserved. In the same liver, various stages of gum development can be found. In some patients, fibroblastic, sclerotic processes predominate in the gummous liver, in others - the decay of the gumma, the epithelial tissue of the liver in the places of the gumm undergoes atrophy, in others it is normal. Scars after gummas or around them have a radiant and retracted appearance. Hummous changes, if they develop close to the surface of the liver, are usually accompanied by limited perihepatitis, in the form of a thickening of the serous membrane that dresses the liver: sometimes a number of fusions with neighboring organs are created around the liver. Large vessels are often changed (endarteritis of the hepatic artery, pylephlebitis of the portal vein). Sometimes lymph nodes affected by syphilis are found in the gates 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, lasting for several hours or days, or acute and short-lived, are cramp-like in nature. From time to time they weaken and then again intensify; like other pains in syphilis, they can get worse at night. Pain usually lasts throughout the disease, sometimes it is limited only to the initial period, and then disappears. They are explained by an inflammatory process that captures the Glisson capsule rich in nerves and sometimes the peritoneum. In rare cases, they are absent.

Other characteristic symptom is fever. The temperature usually fluctuates between 37°C and 38°C, but can periodically rise even higher - up to 39°C. It is irregular, more often of a remitting type, sometimes there are sudden rises in it for 2-3 days, accompanied by chills. At times, for several days, weeks, and occasionally even months, the temperature can be normal. Rise in temperature reflects the active-inflammatory process in the liver, which can then become aggravated and capture new parts of the organ, then subside; disintegration and suppuration of the gums explain, in addition to fever, also chills.

The most important and constant symptom of the disease is uneven enlargement of the liver. Sometimes large bumps emanating from the liver are already visible to the eye, or the entire area of ​​\u200b\u200bthe liver sticks out. 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 area 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 tissue of the organ. In the late period, the liver becomes smaller, denser, protrusions can even acquire cartilaginous density. Sometimes, on the contrary, the bumps soften and even get the property of swaying. Above the tubercles, the peritoneal friction noise is sometimes determined.

Jaundice usually does not occur. Only in rare cases does it appear, sometimes even early, in cases where gummas compress large bile ducts (in this case, jaundice is mechanical in nature and there are no functional disorders from the liver). Jaundice can develop in the late period, when the function of the liver tissue begins to be disturbed, urobilinuria appears, violations of the synthetic ability of the liver, etc. The spleen is rarely palpated with gummous hepatitis, mainly in the late stage, if portal hypertension develops. Portal hypertension, however, in many cases does not develop, and ascites and collaterals are absent. There may be cases of ascites that develops as a result of compression of the trunk of the portal vein by gums or scars in the gates of the liver. The composition of the blood changed little. Only in severe forms there is moderate anemia. Slight leukocytosis is common. General state sick at first good. In the later stages, it is broken, weight falls.

The outcome of focal gummous hepatitis in cases with a small number of gums is favorable: the gums can undergo resorption and scarring. In cases of large changes, severe consequences may develop; portal hypertension with bleeding from the gastrointestinal mucosa, perihepatitis with the transition of the inflammatory process to neighboring organs (pleura, lungs, stomach) and mechanical disturbances in them, etc. peritonitis, etc.). Possible hemorrhages in the liver due to rupture of the vessel. The disease continues for many years, but is difficult to account for (gummies in the liver are 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 gummous hepatitis, a uniform increase in the liver is observed; its surface is dotted 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 are 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. There is diffuse infiltration of small cells around the blood vessels throughout the liver.

Infiltrates may also undergo necrosis, resorption, or replacement with scar tissue. Over time, a significant fibrosis of the organ is formed, resembling annular cirrhosis in the sense that the connective tissue multiplies mainly between the lobules (i.e., 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 ways from that of the epithelial and gummy focal forms.

The first stage is characterized by:

A uniform increase in the liver with a slight induration;

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

An increase in temperature (but the fever is still not high);

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

The absence of jaundice (at the same time, there is no obstructive jaundice, which sometimes develops in a focal form due to compression bile ducts gums);

The absence of functional disorders of the liver (as opposed to chronic syphilitic epithelial hepatitis).

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

In the second stage, the liver shrinks and becomes denser, symptoms of portal stagnation appear, including ascites, the state of 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 causes as in cirrhosis of the liver in general.

Liver in congenital syphilis

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

1) flint liver;

2) gummous liver.

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

Clinically distinguish between hepatitis in early congenital syphilis and hepatitis in late congenital syphilis. With early congenital syphilis, in addition to hepatitis, there are other signs that quite clearly depict the general disease (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 greater tendency to form ascites due to the development of pylephlebitis of the portal zone;

The spleen enlarges more strongly and early;

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

"Flint liver" is observed with early syphilis, other forms - with late.

Diagnosis of syphilitic hepatitis

For the recognition of chronic syphilitic hepatitis (various forms), the Wassermann reaction, the corresponding anamnesis (including family history) and the simultaneous damage of other organs by syphilis (aortitis, insufficiency aortic valves, syphilitic disease of the vessels of the brain, tabes of the spinal cord, syphilis of the organs of movement, stomach, lungs, etc.), as well as such traces of former syphilitic lesions as radiant scars on the skin and mucous membranes, bone deformity, increase lymph nodes, pigmentation disorder, developmental defects.

If we take together all forms of chronic syphilis of the liver, then the Wasserman reaction turns out to be negative quite often (40% of cases); a negative response is more often obtained with epithelial hepatitis, while with gummy the reaction is positive in 80% of cases. Since infection with syphilis sometimes proceeds without a 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 when making a diagnosis with reasonable caution: sometimes it is due to it, and not due to damage to the liver, 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 ethnologies. But still, if the Wasserman reaction is positive in a patient with liver damage, 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 anamnesis and the very nature of the liver disease correspond to a similar etiology.

The effect of antisyphilitic treatment is very important for recognition.

Treatment

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

Specific means include the appointment of penicillin derivatives. However, in the case of a patient's allergy to penicillin or the resistance of the patient's strain of pale treponema 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 the case of a satisfactory general condition of the patient, biyoquinol, miarsenol and novarsenol can be used as additional therapeutic drugs.

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

Prevention

Prevention of chronic hepatitis on the basis of syphilis, of course, consists in the general fight against syphilis and the vigorous treatment of syphilis after its detection, followed by many years of control by the Wasserman reaction. A huge role in the development of liver damage is played by the absence or insufficiency of timely treatment of syphilis: most of the patients with tertiary syphilis of the liver were not treated at all or were clearly insufficiently treated. This is especially true for patients in whom a syphilitic infection has gone unnoticed for a long time.

Of great importance in the prevention of syphilis of the liver is health education, clinical examination, etc.

As for congenital syphilis, in addition to general social and preventive measures, mandatory examinations of pregnant women and careful timely treatment of syphilis detected 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 care. At the slightest suspicion of this disease Be sure to consult your doctor!

Etiology. In the early period of the disease, a syphilitic infection can cause acute parenchymal hepatitis, which, however, often also occurs from an accidentally introduced virus of Botkin's disease ("syringe" infection, see Botkin's disease). With syphilis of the liver, a gummous process is more often observed in the tertiary period, with a dense, tuberous liver. Decaying, the gummas 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 gummous lesions in the form of numerous small gums.

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

Diagnosis. Acute syphilitic hepatitis is differentiated from hepatitis of other etiology; gummoany and cirrhotic process - with liver cancer and cirrhosis of other origin. Syphilitic hepatitis may be indicated by anamnesis data, positive reaction Wasserman, clinical features of the course of liver disease and other manifestations of syphilitic infection in a patient.

Treatment. Specific treatment: penicillin, mercury preparations, biyoquinol, iodine; with the use of novarsenol, care must be taken, especially in the presence of jaundice, since novarsenol itself can cause toxic hepatitis (see Acute Salvarsan Hepatitis). General regimen, diet and non-specific medicinal treatment, as in acute parenchymal hepatitis (see)

Prevention. Vigorous antisyphilitic treatment in initial stages diseases, as well as prevention, common with chronic hepatitis (see) and salvarsan hepatitis (see). With exacerbations of illness, fever, jaundice, the patient is temporarily disabled; during remission, with good health, compensated liver function - limited able-bodied: the patient should not overwork and do hard physical work (see Chronic hepatitis).

Testing for HIV (AIDS), syphilis, hepatitis C and B is given when a person is being prepared for hospitalization, surgery, an impending pregnancy, before blood donation, after casual sexual contact, during regular examination of risk groups, and also if a person has symptoms indicating one of these diseases. A test for AIDS (HIV), syphilis and hepatitis allows you to differential diagnosis one disease from another, having decided on the subsequent therapy of the patient. However, due to the serious consequences for the body of infection with spirochetes, cases of a combination of these diseases are not uncommon.

With long-term therapy from pale treponema, syphilitic hepatitis develops, which can be caused both by the second stage of the disease and be an infectious-allergic reaction. Usually, liver diseases of various etiologies are combined under the name of hepatitis, while syphilis, affecting the liver, causes necrotic foci in it that disrupt the functioning of the organ, which is manifested by intense pain in the liver area, an increase in its density on palpation, and an increase in liver size. As the disease progresses to general symptoms joins itching and jaundice. Similar clinical picture observed at HIV infection leading to the development of AIDS.

If a patient has, in addition to syphilis, hepatitis or HIV infection (AIDS), the doctor most often prescribes treatment, focusing on a disease that can cause more harm to the body, that is, first of all, they try to remove pale treponema from the body, and only then proceed to treatment liver. Such a therapeutic tactic is justified in most cases, but it should be borne in mind that in the process the fight against antibiotics with spirochetes, the liver will be subjected to additional stress, and the processes of its destruction will accelerate. In this regard, during therapy, both with liver damage and without it, patients are advised to refrain from drinking alcohol and pay due attention to proper nutrition.

However, it should be borne in mind that the analysis for syphilitic hepatitis may be false positive in more than 20% of cases, which is associated with tumors, hepatocholecystitis, cirrhosis of alcoholic origin, HIV and some other diseases. Therefore, in order to be sure that the liver damage was caused by a syphilitic factor (syphilis), they are guided by the data of RIBT, RIF and the results of trial therapy.