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Longstanding biliary tract obstruction (by gallstones or external obstruction by cancer) or atresia can result in liver damage and hepatitis.
Ischemic hepatitis
Injury to liver cells due to insufficient blood or oxygen results in ischemic hepatitis (or shock liver).[1] The condition is most often associated with heart failure but can also be caused by shock or sepsis. Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT). The condition usually resolves if the underlying cause is treated successfully. Ischemic hepatitis rarely causes permanent liver damage.[2]
Diagnosis
Diagnosis is made by assessing an individual's symptoms, physical exam findings, medical history, risk-factors, drug and medication use, and, possibly, in conjunction with blood tests and liver biopsy. Blood testing includes blood chemistry, liver enzymes, and serology.[3]
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.
Hepatitis A
| 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.[5]
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.[6] 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.[7]
Screening
A recently completed high-quality study evaluating the utility of these tests found that [8]
- ^ Medline Plus (8/10/2012). "Hepatic ischemia". National Library of Medicine. Retrieved 4 December 2013.
{{cite web}}: Check date values in:|date=(help) - ^ Feldman, Friedman and Brandt, ed. (2010). "Chapter 83 Vascular Diseases of the Liver". Sleisenger and Fordtran's Gastrointestinal and Liver Disease (Online). Saunders. ISBN 978-1416061892. Retrieved 4 December 2013.
- ^ Green, RM (2002 Oct). "AGA technical review on the evaluation of liver chemistry tests". Gastroenterology. 123 (4): 1367–84. PMID 12360498.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ "Acute Viral Hepatitis : Introduction Harrison's Principle of Internal Medicine, 17 Edition".
- ^ "WHO | Hepatitis C". Who.int. 2010-12-08. Retrieved 2012-08-26.
- ^ 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) - ^ 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) - ^ 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)