Diagnosis Hepatitis B HBsAg in serum (acute or chronic infection);IgM anti-HBc (early anti-HBc indicative of acute or recent infection).

Most sensitive test is detection of HBV DNA in serum; not generally required for routine diagnosis. Diagnosis Hepatitis C Anti-HCV in serum. Current second- and third-generation enzyme immunoassay detects antibody to epitopes designated C200, C33c, C223; may appear after acute illness but generally present by 35 months after exposure. A positive enzyme immunoassay can be confirmed by recombinant immunoblot assay (RIBA) or by detection of HCV RNA in serum CHRONIC HEPATITIS B Follows up to 12% of cases of acute hepatitis B in immunocompetent hosts; more frequent in immunocompromised hosts. Spectrum of disease: asymptomatic antigenemia, chronic hepatitis, cirrhosis, hepatocellular cancer; early phase often associated with continued symptoms of hepatitis, elevated aminotransferase levels, presence in serum of HBeAg and HBV DNA, and presence in liver of replicative form of HBV; later phase in some pts may be associated with clinical and biochemical improvement, disappearance of HBeAg and HBV DNA and appearance of anti-HBeAg in serum, and integration of HBV DNA into host hepatocyte genome. In Mediterranean and European countries as well as in Asia, a frequent variant is characterized by readily detectable HBV DNA, but without HBeAg (anti-HBeAg-reactive). Most of these cases are due to a mutation in the pre-C region of the HBV genome that prevents HBeAg synthesis (may appear during course of chronic wild-type HBV infection as a result of immune pressure and may also account for some cases of fulminant hepatitis B). Chronic hepatitis B ultimately leads to cirrhosis in 2540% of cases (particularly in pts with HDV superinfection or the pre-C mutation) and hepatocellular carcinoma in many of these pts (particularly when chronic infection is acquired early in life).
CHRONIC HEPATITIS C

Follows 5070% of cases of transfusion-associated and sporadic hepatitis C. Clinically mild, often waxing and waning aminotransferase elevations; mild chronic hepatitis on liver biopsy. Extrahepatic manifestations include essential

mixed cryoglobulinemia, porphyria cutanea tarda, membranoproliferative glomerulonephritis, and lymphocytic sialadenitis. Diagnosis confirmed by detecting anti-HCV in serum. May lead to cirrhosis in _20% of cases after 20 years Kegagalan hati untuk mendetoksikasi agen berbahaya terhadap system saraf pusat, misalnya ammonia karena penurunan fungsi hati dan shunting portosistemik. Ammnonia dapat mendeplesikan glutamate otak, suatu neurotransmitter eksitatori dan membentuk glutamin False neurotransmitters may also enter CNS due to increased aromatic and decreased branched-chain amino acid levels in blood.