Hepatitis

Imaging has a limited direct role in hepatitis, with laboratory studies and biopsy being bulwarks of diagnosis. Magnetic resonance, however, is of potential value. Among patients with proven chronic hepatitis, histopathology in about two thirds of those with patchy enhancement on early postgadolinium MRI revealed a macrophage infiltrate, hepatocyte necrosis, and steatosis. Prominent linear enhancement on delayed postgadolinium MRI is found with fibrosis.
Hepatitis has no specific imaging findings, with imaging generally performed to exclude other disorders. Necrosis and regeneration on precontrast CT appear as hypodense regions. Periportal edema is seen as periportal hypodense regions on CT and hyperintense regions on T2-weighted MRI. Ultrasonography is usually
normal, although at times a heterogeneous hyperechoic appearance is found. During the initial stage of severe acute hepatitis, a transient decrease in portal blood velocity is followed by a rebound, but in chronic viral hepatitis decreased portal blood velocity correlates with the degree of fibrosis.

Viral An unusual cause of acute hepatitis is measles virus infection. Viral hepatitis is common throughout the world, with the highest prevalence in East Asia. Currently viruses A through G have been identified. At least one other type of enterically transmitted hepatotropic virus probably exists. Hepatotropic viruses A through E induce hepatocellular damage either through a direct cytotoxic effect or through some yet undefined mechanisms. The common end point is hepatocellular necrosis. Co-infection is not uncommon, especially in end-stage disease.
Fat ingestion normally results in gallbladder constriction. In some patients with acute hepatitis, fat results in paradoxical gallbladder dilation, a useful imaging finding. Some patients with acute viral hepatitis present with what clinically appears to be acute cholecystitis. They recover with conservative medical management. Gallbladder US in these patients reveals considerable gallbladder wall thickening, but the gallbladder returns to normal thickness with clinical recovery.
Hepatitis A Humans appear to be the only host for hepatitis A virus. This infection has decreased in prevalence, especially in East Asia. It is an acute infection and does not lead to a chronic carrier state. Effective immunization exists against hepatitis A virus. Some patients with hepatitis A virus infection develop acute renal failure and nephrotic syndrome, presumably due to hepatitis A virus– triggered immune-mediated renal injury in genetically susceptible individuals. Acute viral hepatitis A can progressed to autoimmune hepatitis.
Hepatitis B
In many patients hepatitis B virus (HBV) infection is subclinical; others, however, become chronic carriers, serve as a reservoir for further spread, and develop chronic liver disease, including cirrhosis. A direct relationship exists between chronic hepatitis B infection and hepatocellular carcinoma. Thus in South African blacks, those positive for hepatitis B surface antigen had a 23-fold increased risk of developing a hepatocellular carcinoma; those positive for hepatitis C serology had a sevenfold increased risk,while those with both hepatitis B and C markers had a relative risk of 82. The study estimates that HBV causes about 43%
of hepatocellular carcinomas in South African blacks, hepatitis C 5%, and co-infection with both 20%. Hepatitis B infection probably is a factor in China, while hepatitis C virus plays a similar role in Southern Europe and Japan. Hepatitis B virus is also suspected to have a role in other cancers.
Hepatitis B infection is transmitted vertically from mother to child. Infection in some infants progresses to fibrosis and eventual cirrhosis. A histologic finding of hepatocyte loss, cholestasis, periportal fibrosis, and inflammation is called fibrosing cholestatic hepatitis. It is a variant of HBV infection, and affected patients have a high rate of liver failure. Immunization against HBV is available.
Hepatitis C
Hepatitis C virus (HCV) infection is believed to cause at least 90% of previously called non-A,
non-B hepatitis. In the United States approximately 1.4% of the population is infected. Infection is acquired by either blood product transfusions or intravenous drug abuse. It is a common infection in hemophiliacs. In some patients the mode of transmission is not known. Vertical and sexual transmission is uncommon. Hepatitis during the acute phase is invariably mild and often subclinical, but most infections become chronic. The clinical course of hepatitis C infection is unpredictable.A rough estimate of mean time between initial infection and diagnosis of chronic hepatitis is 10 years, 10 years more for cirrhosis to develop, and another 10 years before hepatocellular carcinoma is discovered, although considerable individual variation exists. Even with advanced disease, half the patients are asymptomatic.Normal biochemical tests do not exclude viral replication in anti- HCV–positive individuals. Different viral genotypes are associated with different severity of liver disease. For instance, HCV type 1b is overrepresented in patients developing cirrhosis and hepatocellular carcinoma and influences the carcinoma risk in cirrhosis.
An association exists between HCV infection and autoimmune diseases. Infection leads to autoimmune hepatitis, membranoproliferative glomerulonephritis, thyroiditis, and such skin disorders as porphyria cutanea tarda and possibly lichen planus.A relationship with Sjögren’s syndrome and possibly even Behçet’s syndrome is suspected. An association with Guillain-Barré syndrome (an acute demyelinating neuropathy believed to have an autoimmune basis) has been suggested. It has been implicated in periarteritis nodosa.
Unlike many other human viruses, hepatitis C virus is an RNA virus and does not appear to be integrated into host cell genome. Carcinogenesis of HCV infection is generally explained by its ability to cause hepatic inflammation, regeneration, fibrosis, and eventual cirrhosis, yet some patients appear to progress from chronic hepatitis directly to carcinoma without developing cirrhosis.
An interesting association appears to exist between HCV serology and primary hepatic lymphoma. Hepatitis C virus is both hepatotropic and lymphotropic and in some patients results in a mixed essential cryoglobulinemia, a lymphoproliferative condition that on occasion evolves into non-Hodgkin’s lymphoma. The
virus is detected in some lymphoma tissue. Anti–hepatitis C virus antibodies are detected in almost half of B-cell non-Hodgkin’s lymphoma patients. Likewise, an occasional patient with chronic HCV infection develops reactive lymphoid hyperplasia (pseudolymphoma),with imaging suggesting a focal hepatocellular carcinoma; biopsy should be diagnostic. Gray-scale US findings do not correlate with liver biopsy findings in patients with chronic HCV infection. Imaging does detect perihepatic lymphadenopathy, however, with number and size related to HCV activity. Gray-scale US can document the response to therapy. Lymph nodes appear hyperintense relative to the liver on T2-weighted MRI. No current immunization is available against this virus. Interferon is the treatment of choice for chronic HCV infection, but relapse rate is high.
Hepatitis D Humans are probably the only host for hepatitis D virus. Its major focus in the United States is in drug addicts. It progresses to chronic hepatitis and cirrhosis.
Hepatitis E
Hepatitis E has a worldwide distribution and is a cause of considerable morbidity and mortality in the developing world. This virus is spread through contaminated water. Infected individuals develop cholestatic jaundice, generally with few sequelae, although in pregnancy it has led to fulminant hepatic failure.
Hepatitis G Hepatitis G virus (HGV) is a RNA virus in the family Flaviviridae and is transmitted by blood transfusion. Both acute and chronic infections occur, but its role in hepatitis is uncertain. Parenteral transmission appears common, and IV drug users, hemodialysis patients, and hemophiliacs are prone to this infection, often in association with HBV and HCV infections. Hepatitis G virus appears to be sensitive to interferon therapy.
Epstein-Barr Virus Infectious mononucleosis (Epstein-Barr virus infection) is a rare cause of hepatitis; it has led to fulminant hepatic failure.

Artikel Terkait

Hepatitis
4/ 5
Oleh

Berlangganan

Suka dengan artikel di atas? Silakan berlangganan gratis via email

This below all content of radiology information

Neuroradiology Musculoskeletal radiology MRI Musculoskeletal MRI Abnormal Mri Brain X-RAY differential diagnosis Head Neck Anatomy mnemonic CT Teleradiology Radiology News chest Radiology musculoskeletal salary pediatrics ultrasound ultrasound images job Brain tumour abdomen interventional radiology CT Abdomen with contrast DAMS Imaging Apk Android radiology ramblings residency c nature pediatric radiology random ramblings xray C T Radiology Top basics body imaging guide procedure web 2.0 Chest X Ray Interpretation Teleradiology Providers head and neck radiology video Fun b cancer chest radiology salary 1 CXR GenitoUrinary ORTHOPEDICS Sonographic Measurements Stroke Ultrasound Hepatitis dams md/ms coaching mammography radiology business tuberculosis BRAIN Clinicoradiological series FETUS GI radiology Gastrointestinal x ray Radiology 4 Radiology Conferences Radiology Images Telemedicine UPPER LIMPS Ultrasound in Emergencies dynamic MRI lifestyle radiology links renal case spine 3 tesla MRI Dams clinicoradiological series Entrepreneur Gastrointestinal Tract Images Literature Liver abscess ultrasound MD/MS coaching Radiology 40 Radiology Imaging Radiology Journal Radiology PDF Radiology mcqs Ultrasound Technique blog bone tumour cardiac CT career cerebral venous thrombosis chest xray d fracture gadolinium gastrointestinal genitourinary radiology hepatobiliary imaging lipoma medical blogs mri lower abdomen pelvis psychiatry radiation concern social networking technology training urogenital imaging weblog 3D CT Arachnoid cyst CT Cardiac Chest X Ray Diploma Guid Equipment Cost FDA Fibrous dysplasia Interventional Ultrasound Guiding Biopsi MDCT MR Pancreas MRI Vertebrae MRI Vertebrae lumbal MRI contrast MRS RTA Radiology Teaching resource TB Hip TECHNIQUE Tech Thorax X Ray Upper Ext aiims ankle sprain bowel cancer brain abscess case study computers and radiology contrast ependymoma epidermoid facebook guest post internet journal of radiology iphone kienbock disease liver liver segments ct locum tenens mri abdomen multislice CT pericallosal lipoma plain film teaching files private practice radiology humour shoulder arthrogram shoulder dislocation small bowel social media trigeminal neuralgia tuberous sclerosis venous x ray Vertebrae 3d printing 7 tesla MRI ACL reconstruction ACL tear ACLS AIIMS nov 2008 ALPSA lesion ANGIOGRAPHY ATFL B12 deficiency BLS BOLD Breast imaging Breast imaging Mammography CHF CT Paranasal CT Scanner Price CT angiography CT coronary angiography CT technology CV junction CXR teaching files Carcinoid Contrast Agent Creutzfeldt-Jakob Disease Dams MD/ms Dams grand rounds Diffusion weighted imaging Dysmenorrhea E E World Award 2011 EYE Embolization Imaging Entrepreneurship FMG India FMGE FNH Focal liver lesions ultrasound Focal nodular hyperplasia GBM GI Gall bladder Glioblastoma multiforme Glomus jugulare HEAD HEART HRCT HSG Head injury ICA dissection IRIA 2011 IUGR IVC filter Iliotibial Band Friction Syndrome Job Info Kidney Cancer LV thrombus Leptomeningeal cyst MAMOGRAPHY MCI Screening MD MPPG MR mammography MR urography MRA MRCP MRI Cervical MRI update MRI/PET MRV Mesenteric ischemia Middle East respiratory syndrome coronavirus (MERS-CoV) Motor neuron disease NECK Normal Liver US Oncology trial PDF Radiology PM and R Physician PNS Partial anomalous pulmonary venous drainage Persistent trigeminal artery Pg entrance Physiatrist Physiatry Physician Assistant Plastic Surgery Price MRI Machines 2017 Pulmonology Pulvinar sign Radiology Price List Radiology Today Radiology Updates Radiology grandrounds Radiology images of GI Tract Renal Ultrasound Retinal Surgery Rheumatology Ryles tube SKULL Seizure Sellar Masses Sleep Medicine Sports Medicine Subdural hematoma Surgery TBM TRIANGULAR FIBROCARTILAGE COMPLEX Trauma Surgery URI Ultrasound HIV Umbilical vein Update Article Upper Extremity X Ray Urology Usmle VHL Vascular Surgery Veteran Affairs X Ray Head about accessory bone acute cerebillitis acute pancreatitis aiims may 2011 aipg ankle ankle fracture apple articular cartilage aspergilloma atherosclerosis avulsion injury awards bankart lesion basilar artery thrombosis bilateral phaeochromocytoma biopsy bipolar bohler's angle bone tumours brachial plexus brain tb brainstem stroke branchial cyst breast cancer screening buford complex business today calcaneal fracture calcium scoring canned reports carcinoma esophagus carcinoma stomach cardiac ct/pet cardiac pacemaker cardiogen 82 cardiothoracic imaging catrotid artery dissection cavernoma cervical lymphnode levels chest radiographic score chest radiographs choledocolithiasis classification cloud computing cochlear implant colloid cyst communication in radiology compare case concha bullosa congenital brain anomalies congenital heart disease coronary CT coronary artery disease corpus callosum agenesis craniopharyngioma cryptococcal meningitis ct abdomen and pelvis cystic renal disease dams usmle dams visual treat deep brain stimulator dengue dengue hemorrhagic fever developmental dysplasia devices diagnostic imaging dialysis diffusion MR imaging diffusion tensor imaging diffusion tractography digital radiography distal facial neuroma dsa duplication gall bladder echinococcus echocardiography ectopic kidney elearning elevated diaphragm epilepsy esop facial neuroma fibular osteosarcoma functional mri gastrointenstinal tuberculosis germinoma gifts glioma google google plus gun shot injury haemangioblastoma health 2.0 healthcare consultancy hemangiblastoma hemophilia hippocampus hirayama disease hydatid cyst hypercoagulable hypoxic ischemic encephalopathy indian conferences inferior rectus anomaly infrared interior tomography interstitial lung disease intramedullary metastates intramedullary tuberculomas ipad ipad 2 jacoud's arthropathy kernohan's notch knee kohler's disease krukenberg tumour laceration leber's optic atrophy liver transplant lung contusion lymphatics macros marchifava bingami disease mastoiditis maxillary sinus mucocele medial malleolus ossicle medial tibial stress syndrome medical writting medicare medicolegal aspects of teleradiology migraine mortality motor area mri knee mri lumbal msk penang course mucinous cystadenoma multicentric Glioblastoma multiforme mycotic pseudoaneurysm of superficial temporal artery nephrogenic systemic fibrosis nephrology neurosurgery meets nonradiologist oesophagus olecranon spur online medical games open access opercular syndrome opinion orbit os odontoideum os radiale externum osirix osteochondritis osteochondroma osteoid osteoma outsourcing radiology ovarian tumour parameniscal cyst paranasal sinuses parotid vascular mass patellar sleeve avulsion fracture patent ductus arteriosus patent foramen ovale patient information pelvic MRI pericardial fat phaeochromocytoma pharmaceutical writting pineal tumour placenta accreta placenta increta placental insufficiency pneumococcal pneumonia polycystic kidney disease portal Hypertension posterior circulation stroke power point presentation primary complex protected health information pseudobulbar palsy pseudomyxoma peritonei publications pulmonary edema pulmonary embolism pulmonary tuberculosis rabbit ear sign rad radiographic deterioration pattern radiography radiolo radiologist blogs radiology city radiology debate radiology images of spleen radiology intervensional radiology learning radiology search engine radiology spotter radiology spotters radiolopolis raditudes rathke cleft cyst renal imaging renal sinus tumour right sided aortic arch robot round cell tumour sacral agenesis scaphoid fracture schatzki ring scientific content screening search engine secondaries secondary ossification centres silicosis social radiology soft tissue chondroma solitary pulmonary nodule spectroscopy spinal arachnoid cyst spinal cord tumours spinal osteochondroma spine tumour spinoglenoid cyst sternal tuberculosis stress fracture sacrum stroke mri sub-acute combined degeneration subclavian pseudoaneurysm subependymal giant cell astrocytoma sumer sethi swyer-james syndrome syringomyelia tb teaching video teleradiolo teleradiology business models teleradproviders teleultrasound temporal bone fracture tendoachilles testicular tumour tethered cord. MRI tibial stress fracture total knee arthroplasty total shoulder replacment trachea. tracheal diverticulum tracheal stenosis tracheomalacia traumatic lung cyst triceps tear triquetral fracture tubercular abscess tuberculoma tuberculosis elbow ultrasound image of The segments of the liver umblical artery doppler uroradiology vascular malformation vasovist venous angioma ventriculitis video ct scan video mri viral encephalitis vitamin deficiency