Acute hepatitis differential diagnosis

Suggested Alternatives for Differential Diagnosis Acute poststreptococcal glomerulonephritis, spotted fevers, typhus, malaria, hepatitis, Colorado tick fever, septicemia, heat stroke, disseminated intravascular coagulation, leptospirosis, hemolytic uremic syndrome. 

The respective lesions in the area of the lobules and portal fields and at the hepatocytes, the mesenchyma and connective tissue differ in intensity from case to case (also depending on the respective stage of the disease) - yet the picture of acute hepatitis predominates. In each case of liver disease which remains unresolved in terms of differential diagnosis, thought must be given to the possibility of acute hepatitis with its wide range of aetiological causes, (s. fig. 22.6)... 

Direct detection of HAV and HAAg in the blood or stools is only necessary for scientific purposes. Serological diagnostics is based on the specific detection of anti-HAV IgM, the presence of which confirms acute viral hepatitis A. In differential diagnosis, it is necessary to rule out acute viral hepatitis E, with which anti-HAV IgM may likewise occur Anti-HAV IgM rises in the serum during the first 2 weeks of the disease, i. e. 3 to 4 weeks after infection. It persists for about 2 or 3... 

Just as with acute viral hepatitis A and B, an HCV infection can induce extrahepatic manifestations and syndromes. (300,313,357, 358) Such associations with various diseases not only make differential diagnosis very difficult, but they also have an unfavourable influence on the course of disease in certain cases. The capability of the C virus to induce autoimmunity is of special significance, (s. tab. 22.8) (see chapter 34.6.2)... 

The differential diagnosis in most areas of the world has malaria at the top of the list. However, the presence of parasitemia in patients partially immune to malaria does not prove that malaria is the cause of the symptoms (48). Other confounding infections include typhoid fever, rickettsial and leptospiral diseases, nontyphoidal salmonellosis, shigellosis, relapsing fever, fulminant hepatitis, and meningococ-cemia. In patients with DIG, the differential diagnosis includes acute leukemia, lupus erythematosus, idiopathic or thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (48). 

Schmeding M, Dankof A, Krenn V, et al. C4d in acute rejection after liver transplantation—a valuable tool in differential diagnosis to hepatitis C recurrence. Am J Transplant. 2006 6 523-530. 

Other hepatic responses that can be occupationally related include steatosis, cholestatic injury, hepatoportal sclerosis, and hepatic porphyria. The acute care provider should always consider a toxic chemical etiology in the differential diagnosis of liver disease. 

In conclusion it may be stated that cathepsin is an earlier observable, longer persisting, and more universal indicator of hepatic lesions than the transaminases, since when increased it indicates not only both acute and chronic processes, but also cases of mechanical icterus. The differential diagnosis should be supported by additional tests. 

The cause of autoimmune hepatitis (AIH) is unknown. Autoimmune reactions lead to a chronic (rarely acute) inflammatory process (periportal piecemeal necrosis, infiltration of portal zones). AIH is frequently associated with autoimmune diseases of other organs. It occurs predominantly among women, particularly in younger years. Hypergammaglobulinaemia is invariably in evidence. Various autoantibodies to components of the liver parenchyma are found. The presence and specificity of these antibodies, together with the respective clinical symptoms, facilitate differentiation between the various subtypes of AIH. Diagnosis is substantiated by the response to immunosuppressive therapy. If left untreated, AIH progresses rapidly with transition to cirrhosis and/or liver failure. If treated adequately, the course taken by the disease is favourable. 

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