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diagnostics of chronic hepatitises at children and teenagers.

At diagnosis statement "a chronic hepatitis" it is necessary to consider following most important factors:

• indicators of activity of "hepatic" enzymes;

• presence or absence of markers of a becoming infected a hepatitis virus (MVG);

• data of the epidemiological anamnesis;

• results of clinical survey of the patient.

[128, 137]

Clinical implications of a chronic hepatitis, in particular HGS, are minimum more often. For this reason, as a rule, it is defined casually, at inspection, for example before operation, endoscopy carrying out etc. [168]

The subsequent clinico-laboratory and morphological research (liver biopsy) allows to diagnose a chronic hepatitis; detection of serumal markers of viruses of a hepatitis identifies its virus aetiology.

Serologichesky methods.

The diagnosis of a chronic virus hepatitis establish on the basis of data of the epidemiological anamnesis, results of clinico-laboratory and morphological researches. At statement of diagnosis HVG it is necessary
To define the etiological agent, a degree of activity and a stage of hepatic process, and also to designate a spectrum of extrahepatic implications of disease. To assume HG it is possible on the basis of revealing in the anamnesis of icteric form OVG or risk factors of infection with hepatitis viruses: intravenous introduction of narcotics and other parenteral manipulations, hemotransfusions, operative measures, contacts to patients OVG, at children till 1 year especially contact to mother [183]

Specific laboratory diagnostics of virus hepatitises is based on definition of markers of these infections in apologicheskih substrates with the help serologicheskih methods or revealing of fragments virus genoma. Most widespread an enzyme immunoassay (IFA) [270].

To distinguish exacerbation HGV and XГD from OGV and ОГD, being guided by spectra of markers of viruses, it is not obviously possible. Other situation develops at differentiation of exacerbation HGS and OGS. In both cases it is defined HCV RNA, but a-HCV at OGS appear in blood serum much later. Terms of primary revealing a-HCV — from 5 to 50 ned (on the average 15-20 ned) after infection. Hence, presence HCV RNA for lack of HCV A testifies in favour of OGS. The spectrum a-HCV can differ depending on the period of an acute hepatitis. It is considered, that the first possible to define the antibodies coded soge and NS5 by zone RNK HCV. a-HCV to the fibers coded NS4 by a zone, in an acute phase of a hepatitis With are absent [27, 128].

It is necessary to notice, that in identification of etiological agent HG there are appreciable difficulties, in particular, caused by low level viremii and presence of mutant forms of viruses [1].

At chemotherapy of malignant tumours and at immunosupressii after transplantation of organs HBs Ag-negative patients can become HBs Ag - positive. Assume, that the HBV-infection of low level which is unmasked under influence immunosupressii [2 serves in these observations by a source of a virus reactivation, 331].

Among other atypical profiles of serumal markers HBV are surveyed "isolated" positive a-nvs which can be taped at it is long existing HGV and presence HBs-Ab in low titre, not defined by standard methods. Infection acknowledgement can be received at use polimeraznoj chain reaction (revealing of low levels HBV DNA in Serum) or at bacterination against a hepatitis In after which within 2 months a-HBs do not appear. It is surveyed as disability of occurrence of the immune answer because of a HBV-infection of very low level. Thus, all patients with "isolated" a-nvs it is necessary to survey on presence HBV DNA in blood serum [1, 2, 78, 183, 385, 386].

Patients with HGS have a similar problem. The term "soft" HGS is widely used in the literature for the description of two categories of patients: patients HGS with constantly normal or nearly so normal (

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Scientific source Dmitriev Tatyana Gennadevna. CHRONIC VIRUS HEPATITISES At CHILDREN And TEENAGERS In REGION GIPERENDEMICHNOM. The PROGRAM of PERFECTION of RENDERING of the MEDIKO-SOCIAL HELP. The dissertation on competition of a scientific degree of the doctor of medical sciences. Yakutsk - 2014. 2014

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Other medical related information diagnostics of chronic hepatitises at children and teenagers.:

  1. INTRODUCTION
  2. 1.1. Epidemiologija chronic hepatitises at children and teenagers
  3. 1.4. Clinical implications of chronic hepatitises at children and teenagers.
  4. diagnostics of chronic hepatitises at children and teenagers.
  5. 1.6. Mediko-social problems of chronic hepatitises at children and teenagers.
  6. 2.1. Research materials
  7. 2.2. Research methods
  8. 3.2. The analysis of work of an office of the doctor-hepatologist.
  9. Chapter 7. The PROGRAM CONCEPT «CHRONIC HEPATITISES At CHILDREN And TEENAGERS»
  10. Chapter 8. The CONCLUSION
  11. THE LITERATURE LIST
  12. APPENDICES