VIRAL HEPATITIS

A. Hepatitis is defined broadly as liver parechymal inflammation. The differential diagnosis of

this inflammation is extensive and includes a wide variety of infections, drug and toxin
exposures, vascular disease, and metabolic and immune derangements. This practice
parameter focuses on viral hepatitis; however, other causes of hepatitis must be excluded
5 in the workup of a patient with evidence of inflammatory liver disease. Indeed, in view of
the prevalence of viral hepatic infection, the presence of serologic markers of hepatitis
may not represent the only cause of the patient’s disease.
B. Laboratory evaluation is a necessary adjunct in the assessment of the patient with liver
disease and complements the history and physical examination. In the evaluation of
10 hepatic disease, laboratory test results can indicate parenchymal injury, biliary injury;
abnormalities of bilirubin metabolism; excretory function or synthetic function; evidence
of immunologic damage; hepatic neoplasia; and viral hepatic diseases. These categories
can be expanded to include several specific blood tests, such as measurement of alpha-
antitrypsin, antinuclear antibodies, antismooth muscle antibodies in autoimmune
15 hepatitis, antimitochondrial antibodies in primary biliary cirrhosis, iron studies in
hemochromatosis, and ceruplasmin in Wilson disease.
C. The history and physical examination findings are, for the most part, nonspecific in
patients with viral hepatitis but may suggest risk factors for hepatitis A (eg, travel to an
endemic area, ingestion of contaminated food or shellfish), hepatitis B (eg, intravenous
20 drug use, homosexuality, occupational exposure), or hepatitis C (eg, multiple transfusion
or intravenous drug abuse). Clinically, hepatitis A and B are difficult to distinguish from one
another. Hepatitis A, however, has an abrupt onset, whereas hepatitis B has an insidious
onset. Hepatitis C, also insidious, usually is asymptomatic and has a subclinical protracted
course in most cases.
25 D. The most characteristic laboratory findings in acute viral hepatitis are elevation of the
serum transaminase levels, which may reach 100 times their normal ranges. Direct and
indirect bilirubin levels usually are elevated in roughly equal proportions in icteric patients.
The prothrombin time most often is normal; if significantly elevated (>4 seconds beyond
upper limit of reference range). It portends hepatic failure and a poor prognosis. Alkaline
30 phosphotase and lactate dehydrogenase levels are normal or only midly elevated.
E. In pratical terms, chronic hepatitis is defined as the presence of elevated liver
transaminase levels for longer than 6 months, although levels may fluctuate between
normal and elevated, especially in hepatitis C infection. The diagnosis of viral hepatitis
depends on the identification of serologic markers, typically detected by enzyme
35 immunoassays. These assays are automated readily, and therefore are relatively fast and
inexpensive. The results are semiquantitative; the presence or absence of an antibody or
antigen is reported without quantification of titers. In selected cases, viral genomic assays
can be performed.
 VIRAL HEPATITIS

I. The text is divided into sections A, B, C, D and E. Using EACH LETTER ONLY ONCE,
identify wich section of the text

1. Discusses the most suitable type of lab test for the variety of hepatitis that this text is
5 focusing on.
2. Gves examples of possible causes of the three types of hepatitis, and distinguishes
between them with regard to one specific difference.
3. Tells the reader that only one type of hepatitis will be examined.
4. List a series of possible underlying causes for hepatitis that can be indicated by
10 laboratory findings.
5. Indicates test alterations that distinguish one particular type of hepatitis.

II. Are these statements True (T) or False (F) according to the text?

15 6. History and physical examinations can reveal whether a patient has been exposed to a
situation of infection, but are not in themselves conclusive.
7. In hepatitis C infection liver transaminase levels range from normal to elevated.
8. Enzyme immunoassays are prohibitively expensive.

20 III. What do the underlined words and expressions mean in the text?

9. “broadly” (Line 1) 10. “in view of” (Line 6)

a) specifically a) having seen

b) correctly 30 b) as with
25 c) generally c) in the case of
d) wrongly d) taking into account

IV. Indicate which option is the correct explanation of whats these words refer to in
35 the text

11. “whereas” c) elevated

(Line 25) 50 prothrombin time
12. “it” d) normal
a) and 45 (Line 32) prothrombin time
40 b) while
c) thus a) upper limit of 13. “therefore”
d) where reference range (Line 38)
b) hepatic failure
 VIRAL HEPATITIS

a) as a result
b) in addition
c) in those serologic
markers
5 d) for hepatitis C