At its onset, acute hepatitis mimics various non-specific diseases. Usually, hepatitis is suspected only when jaundice develops. At this stage hepatitis should be differentiated from other disorders associated with jaundice.
Hepatitis diagnosis includes non-specific liver function tests: aminotransferases (ALT and AST), bilirubin, alkaline phosfatase, etc. AST and ALT are usually highly elevated in hepatitis (> 400 IU/L) and ALT is usually higher than AST. The level of aminotransferases not always correlates with clinical severity of hepatitis, which means that ALT and AST can be markedly increased, but the evolution of hepatitis can be relatively mild, and vice versa.
Hyperbilirubinemia can be variable in hepatitis and usually is preceded by urinary bilirubin (darkening of urine). Alkaline phosphatase is moderately elevated in hepatitis.
If viral hepatitis is suspected, it is necessary to effectuate serological studies, to determine the type of virus.

Jaundice

Diagnosis
25 Apr 08

Jaundice, also called icterus, represents a condition characterized by the yellowing of skin, sclera (white of eye) and other tissues, caused by excessive blood bilirubin levels.
The normal level of bilirubin is about 0.5mg/dL. Jaundice becomes visible only when the level of bilirubin exceeds 1.5 mg/dL.
Jaundice causes arte classified into three categories: pre-hepatic causes, hepatic causes and post-hepatic causes.
Jaundice is a frequent sign in hepatitis. Hepatitis, as a cause of jaundice is classified into hepatic causes category. In hepatitis jaundice is usually preceded by the darkening of the urine and discoloration of stool. Also, jaundice is frequently associated with skin itchiness (pruritus), especially in post-hepatic jaundice (also called obstructive jaundice).


Acute hepatitis evolution has several phases. First is the incubation period, when the virus multiplies and spreads. This period is asymptomatic (shows no signs). The second phase is the prodromal period, which manifests with such symptoms as anorexia, nausea, vomiting, fever and, possibly, dull pain in the right part of the upper abdomen. Than follows the icteric period, characterized by jaundice and preceded by urine darkening and, sometimes, itchiness. During this phase the liver is usually enlarged and sensitive to touch. Jaundice period can last up to 2-4 weeks.
Hepatitis evolution can be mild, with no jaundice and sometimes can show no symptoms at all. These patients present a high risk of infection for the others, as long as they do not know that they have hepatitis.


Hepatitis C virus is a RNA flavivirus and can cause acute and chronic hepatitis.
Most frequently hepatitis C is transmitted through blood (shared needles), and also tattoo and body piercing.
Relatively rarely hepatitis C is transmitted through sexual contact and vertically, from mother to infant.
Chronic hepatitis C can lead to such serious conditions as cirrhosis, liver failure and liver cancer.
Alcohol intake in patients with hepatitis C exacerbates liver damage and accelerates its progression to cirrhosis and cancer.


Hepatitis B virus belongs to the family Hepadnaviridae and can cause acute infectious hepatitis, as well as chronic hepatitis.
Chronic hepatitis develops in 15% of those who have been infected with hepatitis B virus. Sources of infection are patients with acute and chronic forms of hepatitis B, as well as virus carriers.
Virus transmission results from contact with infected blood and other body fluids, such as sperm and vaginal secretions.
Most common forms of virus transmission are: blood transfusions, unprotected sexual intercourse, contaminated needles and syringes. Another important form of virus transmission is vertical transmission - from mother to child during childbirth.


Hepatitis A is an acute infectious disease, cased by a virus from the family Picornoviridae, called Hepatitis A Virus.
The most common route of transmitting is fecal-oral route. Virus penetrates in the organism through contaminated food products, drinking water and household goods. The main sources of infection are virus carriers who do not present any obvious clinical symptoms (without jaundice).
Main Hepatitis A symptoms are: fatigability, fever, muscle pain, vomiting, diarrhea, dull pain in the right-upper part of the abdomen, large liver mass, darkening of urine color, jaundice (yellowing of the skin), etc.