GI & Liver » Hepato-biliary-pancreas » Liver & Spleen

Viral hepatitis-Basics

If acute viral hepatitis is suspected, the following tests should be performed: IgM antibodies against hepatitis A, HBsAg, IgM antibodies against hepatitis B core antigen and hepatitis C antibodies. Other viral markers for viral hepatitis D, infectious mono nucleosis, cytomegalovirus infection, herpes simplex virus and parvovirus B19 may be asked in a few selected cases. In Hepatitis A serum ALT concentrations should be monitored weekly until they start to decline.

The disease is self-limiting and complete clinical and biochemical recovery may take 2-3 months. Majority of icteric adults with Hepatitis B with good immune response achieve clinical and biochemical recovery over 4-16 weeks, 5-10% may develop protracted course and less than 1 % develops fulminant hepatitis. Chronicity is well known in HBV infection, particularly in infants and children who contract this infection early in life and in adults with poor immune response and those who develop anicteric course. Persistent HBsAg for more than six months is defined as chronic HBV infection which may be asymptomatic with normal ALT/AST, low HBeAg or may be active with raised ALT/ AST, positive HBeAg and serum HBV DNA load >1OOOOO copies/ml.

Chronic HBV patients should be followed up with ALT/AST at regular interval 3-6 months or earlier, Alpha foeto protein every six months and USG abdomen for liver and colour doppler for Vascular structures. A specific diagnosis of Hepatitis C is obtained by determining serum hepatitis C antibodies and RNA (HCV RNA). Liver biopsy is indicated in a patient with positive HCV-PCR-test and normal ALT, and with genotypes 1 and 4 before considering therapy; signs of chronic hepatitis in the biopsy are an indication for treatment. Delta agent (hepatitis D) occurs as a superinfection with hepatitis B caused by a satellite virus that can only infect a person with hepatitis B. co-infection with both viruses can be acquired at the same exposure. Determining serum antibodies against HDV and HDV antigen can make a specific diagnosis. Hepatitis E is a disease resembling hepatitis A that occurs mainly in developing countries. Determining serum IgG and IgM antibodies against HEV can make a specific diagnosis.

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