/ / Differential diagnosis of viral hepatitis

Differential diagnosis of viral hepatitis

The term "viral hepatitis" is traditionallyA disease caused by one of the six currently known hepatitis A, B, C, D, E and F viruses. The most clinically relevant of them are hepatitis A, B and C. Differential diagnosis of viral hepatitis will help you avoid complications of the disease.


Acute hepatitis has a similar clinical picture,Irrespective of the pathogen. Patients have a mild form of influenza-like illness with nausea, vomiting and loss of appetite, sometimes with a significant deterioration in overall well-being. Other symptoms include:

• fever;

• fatigue;

• stomach ache;

• diarrhea.

Since the virus affects the liver cells, usually jaundice of the skin and dark urine color appear.

Viral hepatitis A

Infection with the hepatitis A virus occurs whenDrinking contaminated water or food. The virus replicates when hygienic norms of cooking are violated, in places with unsatisfactory sanitary control. During the incubation period lasting about four weeks, the virus multiplies rapidly in the intestine and is excreted with feces. Isolation of the virus stops with the manifestation of the first symptoms of the disease. Therefore, usually by the time the diagnosis is made, the patient is already not contagious. In some people, the disease is asymptomatic, and most of them completely recover without special treatment, although they are usually recommended bed rest.

Viral hepatitis B

Infection with the hepatitis B virus occurs whenContact with contaminated blood and other body fluids. Several decades ago, there were frequent cases of transmission of the virus with blood transfusions, however, modern blood donor control programs allowed to reduce the risk of infection to a minimum. Most often, the infection spreads among drug addicts who share needles. The risk group also includes people leading a promiscuous sexual life, and medical workers. Usually the symptoms of the disease appear gradually after the incubation period lasting from 1 to 6 months. About 90% of the sick recover. However, in 5-10% of hepatitis passes into a chronic form. Rarely occurring lightning-fast form of hepatitis B is characterized by rapid development of clinical symptoms and high lethality.

Viral hepatitis C

Infection occurs in the same way asAt a virus hepatitis In, however the sexual way of distribution is observed less often. In 80% of cases the virus is transmitted through the blood. The incubation period lasts from 2 to 26 weeks. Often, patients do not know that they are infected. Most often, the virus is detected when analyzing blood from practically healthy people. Flowing asymptomatically, viral hepatitis C often turns into a chronic form (up to 75% of cases). Recover no more than 50% of the sick. In the acute phase of hepatitis A, immunoglobulins M (IgM) are produced in the body, which are then replaced by immunoglobulins G (IgG). Thus, the detection in the blood of a patient with IgM indicates the presence of acute hepatitis. If a patient has had hepatitis A in the past and is immune to the disease, IgG will be detected in his blood.

Hepatitis B antigens

Hepatitis B has three antigen-antibody systems that make it possible to distinguish the active form of the disease from the developed immunity and create effective vaccines.

• Surface antigen -HBsAg - isThe first marker of infection, which disappears when recovered. Anti-HBs - antibodies that appear after recovery and last for a lifetime, indicate a transferred infection. The persistent detection of HBsAg and the low level of Anti-HBs indicate chronic hepatitis or the carrier of the virus. Surface antigen is the main diagnostic marker of hepatitis B.

• Core antigen-HHcAg - detect inInfected liver cells. Usually it appears when the disease worsens, and then its level decreases. It may be the only sign of a recent infection.

• Shell antigen -HbeAg - detectedOnly in the presence of a surface antigen and indicates a high risk of infection of contact persons and an increased likelihood of transition to a chronic form.


To date, severalVarieties of the hepatitis C virus, which differ depending on the region of residence of patients. In addition, in carriers, the virus can change over time. By the presence of antibodies to the virus in the blood, the active form of the disease is diagnosed. To protect against hepatitis A and hepatitis B vaccines have been created, with the help of which active immunity to the virus is developed. They can be used simultaneously or separately. However, the antigenic diversity of the hepatitis C virus excludes the possibility of developing a vaccine against it. Passive immunization (injection of immunoglobulins) helps to reduce the risk of disease in contact with hepatitis A and B viruses. Active immunization prevents the development of the acute form of the disease and its transition to a chronic form. The only treatment for hepatitis C is the administration of interferons (antiviral drugs), which are not always effective and have a side effect.


If hepatitis lasts more than six months, they sayAbout its chronic course. The severity of the pathology can range from mild inflammation to cirrhosis, in which the affected liver cells are replaced by a functionally inactive fibrous tissue. Hepatitis B and C have an acute course in only one third of cases. Most often they develop gradually and are accompanied by nonspecific symptoms, such as fatigue, lack of appetite and deterioration in general well-being without a pronounced acute period.

Chronic hepatitis

Many patients are unaware that they haveChronic hepatitis. Often the disease lasts for many years, sometimes even decades. However, it is known that with prolonged course chronic hepatitis often turns into cirrhosis and hepatocellular carcinoma (primary liver cancer).

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