Hepatitis diagnosis

Classification of chronic hepatitis. Diagnosis, grading and staging. Hepatology 1994 19 1513-1520... 

Detailed hepatic diagnosis with exact classification of the liver disease... 

Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made by blood tests which detect elevated antibody levels of specific antibodies to hepatitis E in the body or by reverse transcriptase polymerase chain reaction (RT-PCR). Unfortunately, such tests are not widely available. 

The nurse obtains the vital signs at die time of the initial assessment to provide baseline data. The primary healtii care provider may order many laboratory and diagnostic tests, such as an electroencephalogram, computed tomographic scan, complete blood count, and hepatic and renal function tests to confirm the diagnosis and identify a possible cause of the seizure disorder, as well as to provide a baseline during therapy with anticonvulsants. 

In the ED setting, the diagnosis of ketamine intoxication is a clinical one. Ketamine is not routinely detected by urine toxicology tests, although it can be detected with high-performance liquid chromatography (Koesters et al. 2002). As with MDMA, the initial assessment for ketamine intoxication includes the use of routine laboratory tests to detect electrolyte abnormalities and to evaluate renal and hepatic functioning (Koesters et al. 2002). 

HBD is a biochemical rather than electrophoretic assessment of the LD isoenzyme which is associated with heart. All five isoenzymes of LD exhibit some activity toward cx-hydroxy-butyrate as substrate, but heart LD shows the greatest activity. Serum HBD measurement is not as valuable as the electrophoretic determination of heart LD isoenzyme. High HBD activity has also been found in diseases of the liver. Rises associated with the hepatic effects of congestive heart failure can be disconcerting in the differential diagnosis of myocardial infarction. Wilkinson has used the serum HBD/LD ratio for the differentiation of myocardial disease from other disorders in which HBD activity is elevated, whereas Rosalki has not found the ratio to be helpful (39). 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

The diagnosis of hepatitis A is made by detecting immunoglobulin antibody to the capsid proteins of the HAV. The presence of IgM anti-HAVin the serum indicates an acute infection. IgM appears approximately 3 weeks after exposure and becomes undetectable within 6 months. In contrast, IgG anti-HAV appears in the serum at approximately the same time IgM anti-HAV develops but indicates protection and lifelong immunity against hepatitis A.1... 

The diagnosis of hepatitis E is based on the presence of anti-HEV antibodies. A test for hepatitis E RNA levels is not yet available for commercial use but is used in clinical trials. 

Kaneko, S., et al. (1990). Detection of hepatitis B vims DNA in semm by polymerase chain reaction. Application for clinical diagnosis. Gastrology 99,799-804. 

Suggested Alternatives for Differential Diagnosis Influenza, infectious mononucleosis, hepatitis, leptospirosis, infective endocarditis, malaria, tuberculosis, typhoid fever, cryptococcosis, histoplasmosis, ankylosing spondylitis and undifferentiated spondyloarthropathy, collagen vascular disease, chronic fatigue syndrome, malignancy, and osteomyelitis. 

Suggested Alternatives for Differential Diagnosis Hepatitis, Legionnaires disease, myocarditis, pericarditis, cardiac tamponade, pneumonia, ehrlichiosis, relapsing fever, Rocky Mountain spotted fever, and tularemia. 

Suggested Alternatives for Differential Diagnosis Dengue, measles, Rocky Mountain spotted fever, rubella, tick bite fever, epidemic typhus, Q fever, typhoid, malaria, trypanosomiasis, hepatitis, infectious mononucleosis, herpes, and influenza. 

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. 

CDC Case Definition A mosquito-borne viral illness characterized by acute onset and constitutional symptoms followed by a brief remission and a recurrence of fever, hepatitis, albuminuria, and symptoms and, in some instances, renal failure, shock, and generalized hemorrhages. Laboratory criteria for diagnosis is (1) fourfold or greater rise in yellow fever antibody titer in a patient who has no history of recent yellow fever vaccination and cross-reactions to other flaviviruses have been excluded or (2) demonstration of yellow fever virus, antigen, or genome in tissue, blood, or other body fluid. 

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