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== Diagnosis ==
== Diagnosis ==
Diagnosis is made by assessing an individuals symptoms and physical exam findings, medical history, risk-factors, and drug and medication use in conjunction with various biochemical markers. [[Liver-function tests]] are often elevated and specific patterns of abnormality may indicate certain etiologies or stages of hepatitis. However, these lab values may be normal in individuals with hepatitis and elevated in
Diagnosis is made by assessing an individuals symptoms and physical exam findings, medical history, risk-factors, and drug and medication use in conjunction with various biochemical markers. [[Liver function tests]] are often elevated but may also be normal.
and specific patterns of abnormality may indicate certain etiologies or stages of hepatitis. However, these lab values may be normal in individuals with hepatitis and elevated in


The colloquial liver-function test panel encompasses a variety of serum chemistry markers used to evaluate liver function. While specific patterns of abnormality may be indicative of certain etiologies or stages of hepatitis, results may be abnormal in otherwise healthy people or normal in individuals with hepatitis.
The colloquial liver-function test panel encompasses a variety of serum chemistry markers used to evaluate liver function. While specific patterns of abnormality may be indicative of certain etiologies or stages of hepatitis, results may be abnormal in otherwise healthy people or normal in individuals with hepatitis.

Revision as of 03:43, 3 December 2013

Giant cell hepatitis

Giant cell hepatitis is a rare form of hepatitis that predominantly occurs in newborns and children. Diagnosis is made on the basis of the presence of multinucleated hepatocyte giant cells.[1] The cause of giant cell hepatitis is unknown but the condition is associated with viral infection, autoimmune disorders, and drug toxicity. 


Cases presenting in adults are rare and tend to be rapidly progressive.[2][3][4][5][6] The cause is currently unknown but an infectious cause is suspected.[7][8] The condition tends to improve with the use of ribivirin suggesting a viral origin.[9][10] Hepatitis E,[11] hepatitis C,[12] paramyxovirus,[13][14][15][16] papillomavirus[17][18] and Human herpes virus 6[19][20] have been suggested as causes. A similar condition has been reported in cats but it is not known if there is any connection between these conditions.[21]


Diagnosis

Diagnosis is made by assessing an individuals symptoms and physical exam findings, medical history, risk-factors, and drug and medication use in conjunction with various biochemical markers. Liver function tests are often elevated but may also be normal.

and specific patterns of abnormality may indicate certain etiologies or stages of hepatitis. However, these lab values may be normal in individuals with hepatitis and elevated in

The colloquial liver-function test panel encompasses a variety of serum chemistry markers used to evaluate liver function. While specific patterns of abnormality may be indicative of certain etiologies or stages of hepatitis, results may be abnormal in otherwise healthy people or normal in individuals with hepatitis.


The following are biochemical markers used in the diagnosis of hepatitis:

Hepatitis A

Hepatitis A[22]
Marker Detection Time Description Significance
Faecal HAV 2–4 weeks or 28days - Early detection
Ig M anti HAV 4–12 weeks Enzyme immunoassay for antibodies During Acute Illness
Ig G anti HAV 5 weeks - persistent Enzyme immunoassay for antibodies Old infection or Reinfection

Hepatitis C

Marker Detection Time Description Significance Note
HCV-RNA 1–3 weeks or 21 days PCR Demonstrates presence or absence of virus Results may be intermittent during course of infection. Negative result is not indicative of absence.
anti-HCV 5–6 weeks Enzyme Immunoassay for antibodies Demonstrates past or present infection High false positive in those with autoimmune disorders and populations with low virus prevalence.
ALT 5–6 weeks - Peak in ALT coincides with peak in anti-HCV Fluctuating ALT levels is an indication of active liver disease.

Data taken from the WHO website on Hepatitis C.[23]

Differential diagnosis

Several diseases can present with signs, symptoms, and/or liver function test abnormalities similar to hepatitis. In severe cases of alpha 1-antitrypsin deficiency (A1AD), excess protein in liver cells causes and inflammation and cirrhosis.[24] Some metabolic disorders cause damage to the liver through a variety of mechanisms. In hemochromatosis and Wilson's disease toxic accumulation of dietary minerals results in inflammation and cirrhosis.[25]

Screening

A recently completed high-quality study evaluating the utility of these tests found that [26]

  1. ^ Raj, S. (23 March 2011). "Giant Cell Hepatitis With Autoimmune Hemolytic Anemia: A Case Report and Review of Pediatric Literature". Clinical Pediatrics. 50 (4): 357–359. doi:10.1177/0009922810379501. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  2. ^ Hayashi H, Narita R, Hiura M; et al. (2011). "A case of adult autoimmune hepatitis with histological features of giant cell hepatitis". Intern. Med. 50 (4): 315–9. doi:10.2169/internalmedicine.50.4063. PMID 21325763. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  3. ^ Hartl J, Buettner R, Rockmann F; et al. (2010). "Giant cell hepatitis: an unusual cause of fulminant liver failure". Z Gastroenterol. 48 (11): 1293–6. doi:10.1055/s-0029-1245476. PMID 21043007. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  4. ^ Gábor L, Pál K, Zsuzsa S (1997). "Giant cell hepatitis in adults" (PDF). Pathol. Oncol. Res. 3 (3): 215–8. doi:10.1007/BF02899924. PMID 18470733. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ^ Alexopoulou A, Deutsch M, Ageletopoulou J; et al. (2003). "A fatal case of postinfantile giant cell hepatitis in a patient with chronic lymphocytic leukaemia". Eur J Gastroenterol Hepatol. 15 (5): 551–5. doi:10.1097/01.meg.0000050026.34359.7c. PMID 12702915. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ Bianchi L, Terracciano LM (1994). "[Giant cell hepatitis in adults]". Praxis (Bern 1994) (in German). 83 (44): 1237–41. PMID 7973279. {{cite journal}}: Unknown parameter |month= ignored (help)
  7. ^ Duhaut P, Bosshard S, Ducroix JP (2004). "Is giant cell arteritis an infectious disease? Biological and epidemiological evidence". Presse Médicale (Paris, France : 1983). 33 (19 Pt 2): 1403–8. doi:10.1016/S0755-4982(04)98939-7. PMID 15615251. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ Shet TM, Kandalkar BM, Vora IM (1998). "Neonatal hepatitis--an autopsy study of 14 cases". Indian J Pathol Microbiol. 41 (1): 77–84. PMID 9581081. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  9. ^ Hassoun Z, N'Guyen B, Cote J; et al. (2000). "A case of giant cell hepatitis recurring after liver transplantation and treated with ribavirin". Can. J. Gastroenterol. 14 (8): 729–31. PMID 11185540. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  10. ^ Durand F, Degott C, Sauvanet A; et al. (1997). "Subfulminant syncytial giant cell hepatitis: recurrence after liver transplantation treated with ribavirin". J. Hepatol. 26 (3): 722–6. doi:10.1016/S0168-8278(97)80440-0. PMID 9075682. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Harmanci O, Onal IK, Ersoy O, Gürel B, Sökmensüer C, Bayraktar Y (2007). "Postinfantile giant cell hepatitis due to hepatitis E virus along with the presence of autoantibodies". Digestive Diseases and Sciences. 52 (12): 3521–3. doi:10.1007/s10620-006-9698-8. PMID 17410455. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Moreno A, Moreno A, Pérez-Elías MJ, Quereda C, Fernández-Muñoz R, Antela A, Moreno L, Bárcena R, López-San Román A, Celma ML, García-Martos M, Moreno S (2006). "Syncytial giant cell hepatitis in human immunodeficiency virus-infected patients with chronic hepatitis C: 2 cases and review of the literature". Human Pathology. 37 (10): 1344–9. doi:10.1016/j.humpath.2006.05.003. PMID 16949926. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. ^ Fimmel CJ, Guo L, Compans RW; et al. (1998). "A case of syncytial giant cell hepatitis with features of a paramyxoviral infection". Am. J. Gastroenterol. 93 (10): 1931–7. doi:10.1111/j.1572-0241.1998.00548.x. PMID 9772058. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Krech RH, Geenen V, Maschek H, Högemann B (1998). "[Adult giant cell hepatitis with fatal outcome. Clinicopathologic case report and reflections on pathogenesis]". Pathologe (in German). 19 (3): 221–5. doi:10.1007/s002920050277. PMID 9648148. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. ^ Koff RS (1991). "Acute and chronic giant cell hepatitis: a paramyxovirus infection?". Gastroenterology. 101 (3): 863–4. PMID 1860651. {{cite journal}}: Unknown parameter |month= ignored (help)
  16. ^ Phillips MJ, Blendis LM, Poucell S; et al. (1991). "Syncytial giant-cell hepatitis. Sporadic hepatitis with distinctive pathological features, a severe clinical course, and paramyxoviral features". N. Engl. J. Med. 324 (7): 455–60. doi:10.1056/NEJM199102143240705. PMID 1988831. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  17. ^ Drut R, Gómez MA, Drut RM, Cueto RE, Lojo M (1998). "[Human papillomavirus, neonatal giant cell hepatitis and biliary duct atresia]". Acta Gastroenterol. Latinoam. (in Spanish; Castilian). 28 (1): 27–31. PMID 9607071.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unrecognized language (link)
  18. ^ Drut R, Gómez MA, Drut RM, Lojo MM (1996). "Human papillomavirus (HPV)-associated neonatal giant cell hepatitis (NGCH)". Pediatr Pathol Lab Med. 16 (3): 403–12. PMID 9025842.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ^ Potenza L, Luppi M, Barozzi P; et al. (2008). "HHV-6A in syncytial giant-cell hepatitis". N. Engl. J. Med. 359 (6): 593–602. doi:10.1056/NEJMoa074479. PMID 18687640. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  20. ^ Kuntzen T, Friedrichs N, Fischer HP, Eis-Hübinger AM, Sauerbruch T, Spengler U (2005). "Postinfantile giant cell hepatitis with autoimmune features following a human herpesvirus 6-induced adverse drug reaction". Eur J Gastroenterol Hepatol. 17 (10): 1131–4. doi:10.1097/00042737-200510000-00020. PMID 16148562. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. ^ Suzuki K, Nakayama H, Doi K (2001). "Giant cell hepatitis in two young cats". J. Vet. Med. Sci. 63 (2): 199–201. doi:10.1292/jvms.63.199. PMID 11258461. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  22. ^ "Acute Viral Hepatitis : Introduction Harrison's Principle of Internal Medicine, 17 Edition".
  23. ^ "WHO | Hepatitis C". Who.int. 2010-12-08. Retrieved 2012-08-26.
  24. ^ Stoller, James K (2005). "α1-antitrypsin deficiency". The Lancet. 365 (9478): 2225–2236. doi:10.1016/S0140-6736(05)66781-5. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  25. ^ Hansen, Keli (2008). "Metabolic liver disease in children". Liver Transplantation. 14 (5): 713–733. doi:10.1002/lt.21520. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  26. ^ Lilford, RJ (2013 Jul). "Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study". Health technology assessment (Winchester, England). 17 (28): i–xiv, 1–307. PMID 23834998. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
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