Hepatitis and Diseases with Similar Presentations
Hepatitis, inflammation of the liver can develop as a result several etiologies, the best known of which is viral hepatitis. Hepatitis A infection occurs via fecal-oral transmission, while hepatitis B and C infection can occur by way of needle sharing, organ transplant and receipt of blood products, tattoos, occupational exposures (through needle sticks or splashes), sexual contact, body piercing, and even sharing of razors. Hepatomegaly (an enlarged liver) may be present noticed on physical exam, with abdominal imaging, or may not be present at all. In some cases, especially early in the course of infection, patients may not even be jaundice. If you have been immunized against hepatitis B and A have risk factors, your concern should be about hepatitis C. This can be diagnosed by way of a full hepatitis panel, including assays for hepatitis B surface antigen and antibody, hepatitis B core antibody, and hepatitis C virus.
An acute viral hepatitis can lead to extremely high aminotransferase levels. Of the tests included in a liver function panel, alanine transaminase (ALT) is the most revealing regarding damage to hepatocytes, since this enzyme is present in high quantities in liver cells, compared to cells of other tissues.
Alcoholic hepatitis refers to toxic damage to the liver. It can manifest with high transaminase levels, though typically this is dominated by aspartate transaminase (AST), compared to ALT which dominates with infectious causes. Autoimmune hepatitis develops as a result of a patient’s own immune system producing antibodies that cause the liver to inflame. It is most common in middle-age females afflicted with other autoimmune diseases. Compared to men, women are affected by this condition with an incidence ratio of 4:1. Nonalcoholic steatohepatitis involves fatty infiltration into the liver. Though it is the most common cause of elevated liver enzymes in developed countries, it is associated mainly with obesity and diabetes.
Various other diseases can exhibit presentations similar to hepatitis. Gall stone disease features a profile known as cholestatic predominant which means high levels of bilirubin, alkaline phosphatase, and gammaglutamyl transferase. Hemochromatosis a condition on which the body is overloaded with iron, which accumulates in parenchymal organs. It can occur as an inherited autosomal recessive genetic disorder, which is most common in Caucasians, or it may result from conditions that increase the body's iron stores or absorption, or in cases of excessive iron intake. While organomegaly may not be present, liver enzymes are elevated. Additionally, serum iron levels typically are elevated as is ferritin and transferrin saturation, though in many cases, the latter value may be normal, particularly in younger women (generally those younger than 30 years, but not in all cases). Premenopausal women are at risk for the condition if they use using contraceptives, which tend to increase the body's iron stores. Wilson disease is a disorder of copper metabolism resulting in copper accumulation in tissue, the liver included. While transaminases are elevated, ceruloplasmin, the protein that transports copper tends to be abnormally low.
Hepatitis B, Hepatitis C, and also hemochromatosis (especially if it develops from chronic alcohol abuse) increase ones risk significantly of developing hepatocellular carcinoma.