User:Emhawkins/sandbox
Diagnosis
Diagnosis is made by assessing an individual's symptoms, physical exam, and medical history, in conjunction with blood tests, liver biopsy, and imaging. Blood testing includes blood chemistry, liver enzymes, and serology. Abnormalities in blood chemistry and enzyme results are may be indicative of certain etiologies or stages of hepatitis.[1][2] Imaging can identify steatosis of the liver but liver biopsy is required to demonstrate fibrosis and cirrhosis.[3] A biopsy is not necessary if the clinical, laboratory, and radiologic data suggests cirrhosis. Furthermore, there is a small but significant risk to liver biopsy, and cirrhosis itself predisposes for complications caused by liver biopsy.[4]
| Liver chemistry test | Clinical implication of abnormality |
|---|---|
| Alanine transaminase (ALT) | Hepatocellular damage |
| Aspartate transaminase (AST) | Hepatocellular damage |
| Bilirubin | Cholestasis |
| Alkaline phosphatase | Cholestasis |
| Prothrombin time | Impaired synthetic function |
| Albumin | Impaired synthetic function |
| Gamma-glutamyl transpeptidase (GGT) | Cholestasis |
| Bile acids | Cholestasis |
| Lactate dehydrogenase | Hepatocellular damage |
Viral hepatitis
Serologic testing may be used to evaluate for viral hepatitis.
| 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 |
| 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. |
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.[7] 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.[8]
Screening
A recently completed high-quality study evaluating the utility of these tests found that [9]
- ^ 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) - ^ Pratt, DS (2000 Apr 27). "Evaluation of abnormal liver-enzyme results in asymptomatic patients". The New England journal of medicine. 342 (17): 1266–71. PMID 10781624.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Masuoka, Howard C. (2013). "Nonalcoholic fatty liver disease: an emerging threat to obese and diabetic individuals". Annals of the New York Academy of Sciences. 1281 (1): 106–122. doi:10.1111/nyas.12016.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Grant, A (1999). "Guidelines on the use of liver biopsy in clinical practice". Gut. 45 (Suppl 4): 1–11. doi:10.1136/gut.45.2008.iv1. PMC 1766696. PMID 10485854.
The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68 000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding.
{{cite journal}}: 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)