Viral hepatitis: clinical, laboratory and ultrasonographic evaluation

ABSTRACT

Viral hepatitis is a major health problem allover the world. Perihepatic lymph nodes [LN] enlargement detected by ultrasonography [US] has been observed in acute and chronic hepatitis; a correlation has been found between hepatic inflammatory activity and total LN volume. Ultrasonography can detect many other changes in patients with acute viral hepatitis. This study included 35 patients with viral hepatitis; 20 with acute viral A hepatitis [11 males and 9 females, their age ranged from 2.5-7 years [yr]], and 15 with chronic viral hepatitis [10 HCV and 5 HBV] [9 males 8. 6 females, their age ranged from 3-16 yr]. Patients were taken from the hepatology clinic, Cairo University Children's Hospital. Another 15 children were taken as controls. History taking, thorough clinical examination, investigations [CBC, liver function tests, and serologic liver markers], and liver biopsy [for some chronic cases] with histopathologic examination were done for patients. Abdominal US was done for patients and controls. Results revealed that in chronic hepatitis patients, the most frequent risk factors for acquisition of hepatitis include dental extraction [60%], blood transfusion [40%], and surgical operation [33%]. Also, there was a low HB vaccination coverage among chronic hepatitis patients [33%]. Anorexia, malaise, jaundice, and dark-colored urine were the main symptoms present in all patients with acute viral A hepatitis. On examination, jaundice and tender hepatomegaly were detected in 65% of cases. In patients with chronic viral hepatitis, malaise was present in all cases while anorexia and abdominal pain were present in 65% of cases. On examination, firm hepatomegaly was detected in 50% of cases whilejaundice and splenomegaly were detected in 33% of cases. No evidence of fulminant hepatitis or liver cell failure was found in all patients. Concerning laboratory parameters, serum transaminases were significantly elevated in patients with acute viral A hepatitis compared to those with chronic viral hepatitis. Also, chronic hepatitis patients were significantly anemic [mean HB concentration = 10.6g/dl] and thrombocytopenic [mean platelets count = 202 x 10 3/mm3] compared to patients with acute viral hepatitis [anemia was detected in 33% and thrombocytopenia was detected in 25% of chronic cases]. Abdominal US revealed that LN at the hepatoduodenal ligament [HDL] were found in 90% of patients with acute viral A hepatitis compared to 53% of patients with chronic viral hepatitis [B, C], and this difference was significant. Of importance, a direct positive relationship was found between total LN volume and liver function tests in patients with acute and chronic hepatitis, but this relationship was significant only for serum bilirubin [total, direct] of acute hepatitis patients