Treatment process of viral hepatitis

In the prodromal stage the serum bilirubin is usually normal. However, there is bilirubinuria and increased urinary urobilinogen. A raised serum AST, which can sometimes be very high precedes the jaundice.

In the icteric stage the serum bilirubin reflects the level of jaundice. Serum AST reaches a maximum 1-2 days after the appearance of jaundice, and may rise above 500 IU liter.

Serum AP is usually less than 300 IU liter. After the jaundice has subsided, the AST may remain elevated for some weeks and occasionally up to 6 months.

Hematological tests:

There is leucopenia with a relative lymphocytosis. Very rarely there is a coombs positive haemolytic anaemia or an associated aplastic anaemia. The PT is prolonged in severe cases. The erythrocyte sedimentation rate is raised.

Viral markers:

Antibodies to HAV, IgG antibodies are common in the general population over the age of 50 years but an anti-HAV IgM means an acute infection.

Other tests:

Ultrasound: This should be performed if bile duct obstruction is suspected and always in an older patient. Liver Biopsy: This is only indicated when there is doubt about the diagnosis.

HDV infection can occur either as a coinfection with HBV or as a superinfection in an HBsAg positive patient. Coinfection of HDV and HBV is clinically indistinguishable from an acute icteric HBV infection but a biphasic rise of serum.

AST may be seen. Diagnosis is confirmed by finding serum IgM anti- b in the presence of IgM anti HBc. IgM anti-B appears at 1 week and disappears by 5-6 weeks (occasionally 12 weeks) when serum IgG anti-B is seen. The infection may be transient but the clinical course is variable.

Superinfection results in an acute flare-up of previously quiescent chronic HBV infection. A rise in serum AST may be the only indication of infection.

Diagnosis is by finding serum IgM anti-B at the same time as IgG HBc, patients are usually negative for IgM andti HBc. Fulminant hepatitis can follow both types of infection but is more common after coinfection.

Antibodies to HCV are found in the serum. The first generation tests using the c100 antigen were relatively insensitive. Second generation tests (enzyme linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA)) include c22 and c33 antigens are more sensitive and specific.

Anti-HCV positive patients should have the presence of viral RNA confirmed by a PCR test. This is expensive and not generally available. Patients with a positive PCR test. This is expensive and not generally available. Patients with a positive PCR should have a liver biopsy to detect chronic hepatitis and cirrhosis.

Laboratory features of chronic hepatitis B do not distinguish adequately between histologically mild and severe hepatitis. Amino transferase elevations tend to be modest for chronic hepatitis B but may fluctuate in the range of 100 to 1000 units.

As is true for acute viral hepatitis B, alanine aminotransferase (ALT or SGPT) tends to be more elevated than aspartate aminotransferase (AST OR SGOT), however once cirrhosis is established.

AST tends to exceed ALT. Levels or alkaline phosphatase activity tend to be normal or only marginally elevated. In severe cases, moderate elevations in serum bilirubin (3 to 10 mg/ dL or 51.3 to 171 U.mol/L) occur.

Hypoalbuminemia and prolongation of the prothrombin time occur in severe or end stage cases. Hyperglobulinemia and detectable circulating autoantibodies are distinctly absent in chronic hepatitis B (in contrast to autoimmune chronic active hepatitis).

Management of chronic hepatitis B depends on the level of virus replication. Although progression to cirrhosis is more likely in chronicactive than in chronic persistent or lobular hepatitis B, all three forms of chronic viral hepatitis can be progressive.

Randomized perspective controlled trials have established that patients with well compensated chronic replicative hepatitis B, selected to have chronic hepatitis on liver biopsy and aminotranferase elevations, regardless of histologic features, respond to antiviral therapy with interferon.

A 4-month course of subcutaneous injections, daily at a dose of 5 million units or three times a week at a dose of 10 million units, is replicative to nonreplicative HBV infection, with a concomitant improvement in liver histologic features and an approximately 10 percent chance of losing detectable HBsAg.

| Various complications in viral hepatatis | Different types of viral hepatitis | Treatment process of viral hepatitis | What are the various Causative organisms in viral hepatitis | How to treat & prevent viral hepatitis | What is Prognosis in viral hepatitis | Conceived your First Baby with Hepatitis C in your Blood? | Got Diagnosed for Hepatitis C Infection? | The Difficult Task of Diagnosing Hepatitis C in Aged People | How to deal with Emotionally Disturbed Hepatitis C Infected Persons | How to Handle the Undeterred Hepatitis C Infection Spread | Know the Multiple Entry Routes of Hepatitis C Infection | How to Trap and Fix Eluding Hepatitis C Symptoms in a Person | Correlativity between Hepatitis C and HIV Infection | Varied Treatment Options for Your Hepatitis C Infection | How Young Children Play Safe with Hepatitis C Viral Infection |

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