Hepatitis doctors call any inflammatory disease of the liver. To start the inflammatory response in hepatocytes can viruses, regular abuse of alcohol, taking drugs, poisoning by toxic substances; in a separate group of isolated autoimmune hepatitis, the etiology of which medicine to this day unknown.
The approach to the treatment of hepatitis infectious and noninfectious origin is radically different, so the doctor is very important during examination of the patient with “hepatic” symptoms to determine the cause of the pathology development. How to do it, what methods of diagnostics of hepatitis exist – face it on.
Symptoms indicating a hepatitis
Acute hepatitis in the majority of cases present with a vivid clinical picture: a yellowness of the skin, intoxication, nausea, vomiting, pain abdomen, diarrhea, fever, severe weakness. With chronic hepatitis all the way – they practically did not manifest itself, but the liver when it is destroyed. These patients are often accidentally find out about their disease (during the examination, which may be quite another matter), or when there are consequences of long-term inflammatory process of cirrhosis and liver cancer.
To avoid the second option, it is advisable to pay attention to the following symptoms:
- Any discomfort in the liver area. This can be a feeling of fullness, tingling, heaviness.
- The tendency to bloating.
- Frequent nausea.
- Unhealthy color of the skin and whites of the eyes (they may occasionally purchase a yellowish color).
- Tired all the time.
- A poor appetite.
If something of the above concern, you should definitely consult a therapist. To confirm the diagnosis “Hepatitis” will be required to pass a comprehensive examination, the main of which are the various laboratory tests. But instrumental investigations, imaging of the liver (ultrasound, CT, MRI), are of secondary importance because of low information content- they provide information only about the structural changes in the body, but not on the causes of the disease.
Diagnostic features of different types of hepatitis
During diagnosis, the doctor must, first, find out what hepatitis is, secondly, to determine how deep went the pathological changes in the liver, the activity of the inflammatory process and how severely disturbed the function of an organ.
Hepatitis of virus nature are contagious, so the most common among the population.
There are two groups of hepatitis:
- those who belong to the “diseases of dirty hands” – A, E;
- transmitted through blood or other body fluid through sexual contact, conduct of medical and cosmetic manipulation of contaminated instruments, blood transfusion, C, D, G.
Laboratory methods to identify the causative agent of viral hepatitis
To assess the degree of activity of destruction of hepatocytes and liver function conducted a comprehensive biochemical analysis of blood, in which the concentration of Alt, AST, alkaline phosphatase (enzymes, leaving the blood in the destruction of hepatocytes), fractions of bilirubin (exchange this substance is closely associated with the liver), protein fractions (many proteins are synthesized in the liver). This analysis is also called liver function tests.
In chronic viral hepatitis a compulsory part of the examination of the patient is to assess structural changes and activity of inflammatory process in liver tissue.
It uses the following techniques:
- On biopsy with subsequent morphological analysis of material taken.
- Elastography – definition of degree of fibrous degeneration of the liver (replacement of normal liver tissue is functionally insolvent fibrous cells) using the apparatus of Fibroscan. This study resembles an ultrasound scan.
- FibroTest – modern non-invasive method for diagnosis of fibrosis and inflammatory changes in the liver, based on the determination of the concentration of 6 blood biochemical markers. Indications for use of this methods are chronic viral hepatitis b and C.
Under such hepatitis the culprit of the inflammatory process is self-immune defense system – it attacks the hepatocytes, as foreign cells. Quite often this disease occurs in people with other autoimmune disorders – rheumatoid arthritis, lupus erythematosus, Crohn’s disease etc.
Decided to allocate 2 types of autoimmune hepatitis.
Each type of disease has its own laboratory markers, which define the course of blood tests:
- Type 1 antinuclear antibodies (APA) and antibodies to smooth muscle (ASMA);
- Type 2 antibodies to microsomes of liver and kidney (anti-LKM), antibodies to cytosolic liver antigen (Anti-LC-1).
These markers can be detected in other pathologies, so the “gold standard” diagnosis of autoimmune hepatitis is liver biopsy. This study allows to consider the morphological structure of liver tissue and with high accuracy to establish the autoimmune nature of the inflammatory process, in addition, to identify changes characteristic of fibrosis. To assess the functional capability of the liver performs liver function tests.
Many of the chemicals destructive to liver cells – such action is called hepatotoxicity. To provoke the development of toxic hepatitis may alcohol (this is important not so much dose, how much is the regularity of eating), drugs, natural and industrial poisons. Among the drugs most hepatotoxicity have antibiotics, TB drugs, sulfonamides, anticonvulsant and antitumor agents, many with fever and pain medicines.
In the diagnosis of toxic hepatitis is of great importance anamnesis data, i.e. establishing whether the use of hazardous substances. But laboratory research is conducted not so much to identify the causes of inflammatory reaction of the liver, how to determine the degree of dysfunction of the organ.
Tests for viral hepatitis
Because viral hepatitis most often identified, their diagnosis should be considered in more detail. The most informative in terms of identifying the causative agent of viral hepatitis is considered a blood test for specific markers. These indicators can be judged on the type of virus and the duration of the disease (stage of disease).
Viral hepatitis a is diagnosed by the antibodies (immunoglobulins) to the antigen of the virus. Detection of immunoglobulin M indicates an acute process. If the blood is “through the roof” immunoglobulins of the G class has probably already started a recovery (recovery). Detection of RNA of hepatitis A virus in routine diagnosis is almost never used.
The hepatitis In markers much more:
- HBsAg (surface or Australian antigen) appears in blood of patients the first.
- HBeAg – marker of active reproduction of the virus.
- Antibodies to antigens of a virus of a different class.
- DNA viruswhich is detected by PCR (in the diagnosis of chronic hepatitis b is important not only to establish the fact of presence of viral DNA in the blood, but its quantity is so-called viral load).
Depending on the presence of certain markers, the physician can determine acute or chronic is hepatitis. If the inflammatory process is acute, it is possible to specify the period of the disease: incubation, acute phase or recovery. In the chronic form of hepatitis the markers can distinguish between replicative (when the virus replicates) and integrative (when the virus is asleep) phase of the disease. This information is very important to plan treatment and determine the degree of infectiousness of the patient.
Diagnosis of hepatitis C is based on:
- The detection of blood, serological markers – antibodies to antigens of the virus.
- Detection of virus (its RNA by PCR).
- Establishing the genotype of the virus. This study is necessary for predicting the effectiveness of antiviral treatment and assessment of the risk of severe consequences of the disease – hepatocarcinoma, cirrhosis.
The main blood marker of viral hepatitis D is an RNA virus. This virus cannot parasitize on their own, since it has no shell, his constant companion is a virus of hepatitis B. In this regard, patients with hepatitis b must examine and hepatitis D. the determination of the latter is considered a poor prognostic sign.
For the diagnosis of the hepatitis in the blood of the patient determine the concentration of antibodies of class G and M to E. the virus In the acute stage of the disease are always present in the immunoglobulin M and immunoglobulin G that appear after the resolution of the disease.
Hepatitis G is quite often combined with hepatitis C, so if the latter is discovered, the patient is further carried out:
- a blood test for virus RNA G;
- serological tests for antibodies to the antigens of the virus G.
How the doctor determines what analysis it is necessary to take the patient
At first glance may show that the diagnosis of hepatitis is a very complex process. In fact, experienced Hepatology (doctor specializing in liver diseases) have developed the scheme of actions at detection of the patient signs of liver disease.
In the first stage the doctor will gather information that can shed light on the causes of hepatitis:
- the patient’s relationship to alcohol, drugs;
- contacts with people who are sick or ill with viral hepatitis;
- the disease;
- get treatment, etc.
The next stage is evaluation of the functional capacity of the liver using biochemical analysis of blood. If liver function tests showed abnormalities, are screening serological tests for markers of viral hepatitis (three major – A, b, C) is the third step. If negative serology continues an extended examination of the liver to exclude autoimmune process. If the nature of viral hepatitis was confirmed, are appointed by additional tests and instrumental investigations to select the correct treatment tactics.
Modern laboratory centers offer package services for the diagnosis of hepatitis. Such a study it is advisable to undergo regular people with a high risk of transmission of viral hepatitis, for example, those who received transfusions of blood products or hemodialysis.
Remember! With timely detection of viral and non-infectious hepatitis the chances of a full recovery or maximum stabilization is very high.