Lab Diagnosis of Hepatitis

Information about Lab Diagnosis of Hepatitis

Published on July 9, 2014

Author: drrizwanabarakzai



Lab Diagnosis of Hepatitis: Lab Diagnosis of Hepatitis 1 LAB TESTS AST AND ALT RESULTS : LAB TESTS AST AND ALT RESULTS ELEVATION INDICATES HEPATIC CELL DAMAGE / NECROSIS 10 TO 100 FOLD INCREASE CAN BE EXPECTED IF ALT IS DISPROPORTIONATELY LOW COMPARED TO AST , ALCOHOLIC HEPATITIS IS MORE LIKELY THAN VIRAL HEPATITIS 2 LAB TESTS SERUM ALKALINE PHOSPHATASE: LAB TESTS SERUM ALKALINE PHOSPHATASE EXHIBITS LITTLE OR NO CHANGE IN VIRAL HEPATITIS A LARGE INCREASE IS SEEN IN IMPAIRED BILE EXCRETION SUCH AS CHOLESTATIC HEPATITIS 3 LAB TESTS SERUM BILIRUBIN: LAB TESTS SERUM BILIRUBIN RISE AFTER OCCURRENCE OF LIVER DAMAGE LEVELS MUST APPROACH 3mg/100ml TO MANIFEST AS JAUNDICE WHY MOST CASES ARE ANICTERIC JAUNDICE OFTEN FIRST MANIFESTS IN SCLERA OFTEN COMPLAIN OF SEVERE ITCHING (PRURITUS) 4 LAB TESTS BLOOD TESTS: LAB TESTS BLOOD TESTS WBC COUNT MAY BE SLIGHTLY ELEVATED RELATIVE LYMPHOCYTOSIS ATYPICAL CELLS MAY BE PRESENT LIKE INFECTIOUS MONONUCLEOSIS HIGHER THE PROTHROMBIN TIME (PT), THE MORE SEVERE THE HEPATIC DAMAGE 5 HEPATITIS TYPE A (HAV): HEPATITIS TYPE A (HAV) AGENT A 27nm SINGLE-STRANDED RNA VIRUS (NO ENVELOPE) GENUS HEPATOVIRUS WITHIN THE FAMILY PICORNAVIRIDAE SPREAD MAINLY BY ORAL-FECAL ROUTE SEXUAL TRANSMISSION MAY OCCUR 6 HEPATITIS A (HAV): 7 HEPATITIS A (HAV) HAV Transmission Close personal contact Household member Sex contact Childcare centers Contaminated food or water Fecal – oral contact Contaminated shellfish Infected food handlers Blood exposure rare HEPATITIS A (HAV): 8 HEPATITIS A (HAV) Clinical Features Incubation period is usually about 30 days after exposure, the range is 15 – 50 days Jaundice (turning yellow) is most commonly seen in the older patients Under 6 years old (10%) 6 to 14 years old (40 – 50%) Greater than 14 years old (70 – 80%) Fatigue Dark urine Fever Nausea and vomiting Abdominal pain Complications of this type of viral infection include rare liver failure and relapsing hepatitis Chronic sequelae are not seen 33% of the US population has evidence of past infection and thus immunity HEPATITIS A (HAV): 9 HEPATITIS A (HAV) Diagnosis - Hepatitis Panel For diagnosis of Hepatitis A -IgM anti-HAV Liver Enzymes EVENTS IN HEPATITIS A INFECTION (CDC): 10 EVENTS IN HEPATITIS A INFECTION (CDC) As the immune system responds to the infection, the amount of virus in the blood ( viremia ) and in the stool (HAV in stool) disappears. The liver enzyme, ALT goes up at the beginning of the infection, but descreases to normal at about 8 weeks. IgM shows acute infection and IgG is positive long – term. HEPATITIS A (HAV): 11 HEPATITIS A (HAV) HAV Treatment No specific medical treatment Avoid alcohol and all medications that are metabolized in the liver Manage symptoms If the spleen is enlarged avoid activities that could lead to abdominal pressure or injury HAV: HAV TWO-DOSE VACCINE 6 MONTHS APART AVAILABLE SINCE 1994 HEALTH CARE PROVIDERS - RECOMMENDED INTERNATIONAL TRAVELERS AT RISK FOR INFECTION - ARE ENCOURAGED TO HAVE COMPLETE SERIES BEFORE TRAVEL HEPATITIS B (HBV): HEPATITIS B (HBV) HB VIRUS STRUCTURALLY MORE COMPLEX THAN HAV CLASSIFIED IN HEPADNAVIRIDAE FAMILY CAN CAUSE A WIDE VARIETY OF ACUTE / CHRONIC AND EXTRAHEPATIC DISEASES, AND A CHRONIC CARRIER STATE HEPATITIS B LABORATORY NOMENCLATURE : 14 HEPATITIS B LABORATORY NOMENCLATURE HOW TO INTERPRET COMMON HEPATITIS B: 15 HOW TO INTERPRET COMMON HEPATITIS B HEPATITIS B (HBV): 16 HEPATITIS B (HBV) Prevention Vaccination should be offered to Persons with more than one sex partner in 6 months Men who have sex with men (MSM) Persons diagnosed with a sexually transmitted disease (STD) Commercial sex workers Illegal injectable drug users Persons with HIV/AIDS Persons with chronic liver disease including Hepatitis C Inmates Healthcare workers Staff and clients (developmentally disabled) Persons receiving hemodialysis Adopted persons from HBV endemic countries Recipients of certain blood products HEPATITIS B (HBV): 17 HEPATITIS B (HBV) Prevention Twinrix is a combination hepatitis A and B vaccine made by GlaxoSmithKline and approved for persons aged 18 years and older. It is indicated for persons at risk for both hepatitis A and B It is administered in a 3 dose series at 0, 1, and 6 months HDV: HDV In most persons with HBV-HDV co-infection, both IgM antibody to HDV (anti-HDV) and IgG anti-HDV are detectable during the course of infection. However, in about 15% of patients the only evidence of HDV infection may be the detection of either IgM anti-HDV alone during the early acute period of illness or IgG anti-HDV alone during convalescence. Anti-HDV generally declines to sub-detectable levels after the infection resolves and there is no serologic marker that persists to indicate that the patient was ever infected with HDV. 18 HDV: HDV Hepatitis Delta Antigen (HDAg) can be detected in serum in only about 25% of patients with HBV-HDV co-infection. When HDAg is detectable it generally disappears as HBsAg disappears and most patients do not develop chronic infection. Tests for IgG anti-HDV are commercially available in the United States. 19 HDV: HDV In patients with chronic HBV infection who are super-infected with HDV several characteristic serologic features generally occur, including: the titer of HBsAg declines at the time HDAg appears in the serum HDAg and HDV RNA remain detectable in the serum because chronic HDV infection generally occurs in most patients with HDV superinfection, unlike the case with co-infection high titers of both IgM and IgG anti-HDV are detectable, which persist indefinitely. 20 HEV: HEV No serologic tests to diagnose HEV infection are commercially available in the United States . 21 HDV: HDV 22

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