Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.

Treatment for Hepatitis A
- There is no treatment specifically for hepatitis A.
- Doctor will advise the patient to abstain from alcohol and drugs during the recovery.
- The vast majority of patients with Hepatitis A will recover spontaneously.

Treatment for Hepatitis B
- A patient with Hepatitis B needs to rest.
- He will require a diet that is high in protein and carbohydrate.
- This is to repair damaged liver cells, as well as to protect the liver.
- The doctor may prescribe interferon.
- Interferon is an antiviral agent.

Treatment for Hepatitis C
- A patient with Hepatitis C will be prescribed pegylated interferon and ribavirin.

Treatment for Hepatitis D or E
- There is no effective treatment for either Hepatitis D or E.

Treatment for Non-Viral Hepatitis
- If the patient has non-viral hepatitis, the doctor needs to remove the harmful substance.
- It will be flushed out of the stomach by hyperventilation or induced vomiting.
- Patients with drug-induced hepatitis may be prescribed corticosteroids.

How to prevent Hepatitis A?
- Wash your hands with soap after going to the toilet.
- Only consume food that has just been cooked.
- Only drink commercially bottled water, or boiled water if you unsure of local sanitation.
- Only eat fruits that you can peel if you are somewhere where sanitation is unreliable.
- Only eat raw vegetables if you are sure they have been cleaned/disinfected thoroughly.
- Get a vaccine for Hepatitis A if you travel to places where hepatitis may be endemic.

How to prevent Hepatitis B?
- Tell the partner if you are a carrier or try to find out whether he/she is a carrier.
- Practice safe sex.
- Only use clean syringes that have not been used by anyone else.
- Do not share toothbrushes, razors, or manicure instruments.
- Have a Hepatitis B series of shots if you are at risk.
- Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.).

How to prevent Hepatitis C?
- If you are infected do not let others share your toothbrush, razor, manicure equipment.
- If you are infected cover open wounds.
- Do not share needles, toothbrushes, or manicure equipment.
- If your skin is to be pierced, make sure equipment is well sterilized (tattoo, etc.).
- Go easy on the alcohol.
- Do not share drug equipment.

How to prevent Hepatitis D?
- Use the same guidelines as for Hepatitis B.
- Only a person who is infected with Hepatitis B can become infected with Hepatitis D.

How to prevent Hepatitis E?
- Do the same as you would to protect yourself from Hepatitis A infection.

How to prevent Alcoholic Hepatitis?
- Go easy on the alcohol, or abstain from consuming alcohol.

How to prevent Toxic/Drug Induced Hepatitis?
- Make sure you know about the lethal contents of all chemicals.
- Make sure the spray is not pointing at you.
- Make sure you wear protective gear.

Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.

How is Hepatitis diagnosed?
- A blood test is usually needed to determine if a person has hepatitis.
- It is also important to stay well hydrated by drinking lots of fluids.
- Hepatitis B and C can sometimes be treated with medications.
- Some forms of medication used to treat hepatitis C are only approved for use in adults.
- Although treatments for hepatitis B and C are becoming more effective.

Diagnosis of Hepatitis A (HAV)
- A blood test showing the presence of IgM anti-HAV in serum.
- It confirms the diagnosis of acute hepatitis A infection.
- Symptoms of this virus strain include nausea, vomiting, and diarrhea.

Diagnosis of Hepatitis B (HBV)
Acute HBV infection is diagnosed by a simple blood test detecting the presence of hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (anti-HBc IgM).

The following antibody variations can occur, each having a specific implication.

- Anti-HBs +:
Indicates individual has been vaccinated, has received immune globulin, is immune, or is an infant who has received antibodies from its mother.

- Anti-HBc +:
Indicates past or present infection and lasts indefinitely. Also may be detected in someone who has received immune globulin or an infant who has received antibodies from its mother.

- IgM anti-HBc +:
Indicates recent infection with HBV, usually within 4-6 months.

- HBeAg +:
Indicates active viral replication and high infectivity.

- HBsAg +:
Indicates acute or chronic HBV. Persistence for 6 months after acute infection indicates progression to chronic HBV.

Diagnosis of Hepatitis C (HCV)
- Infection by the hepatitis C virus can be determined by a blood test that detects HCV antibodies in the blood.
- This test is not a part of a routine physical
- People must ask their doctor for hepatitis C test
- If the initial test is positive, a second test should be done to confirm the diagnosis and liver enzymes (a blood test) should be measured.
- Anti-HCV (antibodies to the virus) may not be present in the first four weeks of infection
- HCV infection may be identified by the presence of anti-HCV in approximately 60% of people as early as 5-8 weeks after exposure.
- In some individuals HCV antibodies may not be detected for 5-12 months. HCV-RNA and RT-PCR tests can determine HCV presence in as little as 1-2 weeks.
- A liver biopsy can identify the type and degree of damage (and can determine the severity of the disease).
- The disease may gradually progress over a period of 10-40 years.

Diagnosis of Hepatitis D (HDV)
- A positive test for anti-HDV in a patient with acute hepatitis B indicates HBV/ HDV co-infection.
- Patients with chronic hepatitis B and a positive HDV test are super-infected.

Diagnosis of Hepatitis E (HEV)
- Testing for anti-HEV is usually reserved for returning travelers from the developing world in whom hepatitis is present.
- Other hepatitis viruses cannot be detected.
- Currently there is no treatment for HEV.

Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.
- Hepatitis A
This is caused by eating infected food or water.
- Hepatitis B
This is an STD (sexually transmitted disease).
- Hepatitis C
Hepatitis C is usually spread through direct contact with the blood of a person who has the disease.
- Hepatitis D
Only a person who is already infected with Hepatitis B can become infected with Hepatitis D.
- Hepatitis E
A person can become infected by drinking water that contains HEV (Hepatitis E Virus).
- Hepatitis X
If hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X.
- Hepatitis G:
This is a type of hepatitis caused by the Hepatitis G virus (HGV).

Causes of Hepatitis
- Non-viral infection
- Autoimmune hepatitis
- Non-alcoholic steatohepatitis
- Alcoholic hepatitis
- Drug induced
- Other toxins
- Metabolic disorders
- Obstructive
- Autoimmune

What are the signs and symptoms of hepatitis?
The four main symptoms of hepatitis are:

1. Jaundice
- This is the classic symptom of hepatitis.
- This is an accumulation of a chemical called bilirubin in the body’s tissues.
- The liver usually processes this chemical as a waste product but during this condition it is not able to do that job.
- This chemical accumulates in the blood and starts to leak out into body tissue.
- When enough of this chemical accumulates it’s possible to see a yellow color in the skin, urine and especially around the whites of the eyes.

2. Loss of Appetite
- Loss of appetite is also called anorexia.
- It is often the first symptom of acute hepatitis.
- It is being replaced by nausea and vomiting on further progress

3. Fatigue
- Fatigue is a debilitating tiredness.
- It is a big source of frustration for people with liver disease.
- The liver is a vital organ in metabolizing and storing energy.
- When the liver is damaged, extreme weakness is common.

4. Muscle and Joint Aches
- Pain in the muscles and joints can last from days to weeks.
- These are more common in acute hepatitis than in chronic hepatitis.

Symptoms of Acute phase of Hepatitis
The initial phase of hepatitis is called the acute phase. The symptoms are like a mild flu, and may include:
- Diarrhea
- Fatigue
- Loss of appetite
- Mild fever
- Muscle or joint aches
- Nausea
- Slight abdominal pain
- Vomiting
- Weight loss

As the patient gets worse, these symptoms may follow:
- Circulation problems (only toxic/drug-induced hepatitis)
- Dark urine
- Dizziness (only toxic/drug-induced hepatitis)
- Drowsiness (only toxic/drug-induced hepatitis)
- Enlarged spleen (only alcoholic hepatitis)
- Headache (only toxic/drug-induced hepatitis)
- Hives
- Itchy skin
- Light colored feces, the feces may contain pus
- Yellow skin, whites of eyes, tongue (jaundice)

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.
- Hepatitis A
This is caused by eating infected food or water.
- Hepatitis B
This is an STD (sexually transmitted disease).
- Hepatitis C
Hepatitis C is usually spread through direct contact with the blood of a person who has the disease.
- Hepatitis D
Only a person who is already infected with Hepatitis B can become infected with Hepatitis D.
- Hepatitis E
A person can become infected by drinking water that contains HEV (Hepatitis E Virus).
- Hepatitis X
If hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X.
- Hepatitis G:
This is a type of hepatitis caused by the Hepatitis G virus (HGV).

Acute Causes

1. Viral hepatitis:
- Hepatitis A, B, C, D, and E.
- Yellow fever
- Adenoviruses
- Parvovirus B19

2. Non-viral infection
- Toxoplasma
- Leptospira
- Q fever
- Rocky mountain spotted fever
- Alcohol
- Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida
- Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below).
- Ischemic hepatitis (circulatory insufficiency)
- Pregnancy
- Auto immune conditions, e.g., systemic lupus erythematosus (SLE)
- Metabolic diseases, e.g., Wilson’s disease

Chronic Causes
Viral hepatitis:
- Hepatitis B with or without hepatitis D.
- Hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis).

Autoimmune Causes
- Alcohol
- Drugs
- Methyldopa
- Nitrofurantoin
- Isoniazid
- Ketoconazole

Heredity Causes
- Wilson’s disease.
- Alpha 1-antitrypsin deficiency.
- Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis.

Alcoholic Hepatitis Causes
- Long term alcohol consumption.
- Patients with chronic alcoholic liver disease.
- Alcoholic cirrhosis.

A large number of drugs can cause hepatitis:
- Agomelatine (antidepressant).
- Allopurinol.
- Amitriptyline (antidepressant).
- Amiodarone (antiarrhythmic).
- Atomoxetine.
- Azathioprine.
- Halothane (a specific type of anesthetic gas).
- Hormonal contraceptives.
- Ibuprofen and indomethacin (NSAIDs).
- Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics).
- Ketoconazole (antifungal).
- Loratadine (antihistamine).
- Methotrexate (immune suppressant).
- Methyldopa (antihypertensive).
- Minocycline (tetracycline antibiotic).
- Nifedipine (antihypertensive).
- Nitrofurantoin (antibiotic).
- Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine.
- Phenytoin and valproic acid (antiepileptics).
- Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis).
- Zidovudine (antiretroviral i.e., against HIV).
- Some herbs and nutritional supplements.

Other Toxins that can cause hepatitis:
- Amatoxin-containing mushrooms.
- White phosphorus, an industrial toxin and war chemical.
- Carbon tetrachloride.
- Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria.

Metabolic disorders can cause hepatitis:
- Hemochromatosis (due to iron accumulation).
- Wilson’s disease(copper accumulation) can cause liver inflammation.
- Necrosis.
- Non-alcoholic steatohepatitis (NASH) is effectively a consequence of metabolic syndrome.

Overview
- This manifests as neurological or psychiatric symptoms and liver disease.
- It is treated with medication that reduces copper absorption
- Medication that removes the excess copper from the body also can be used.
- Occasionally a liver transplant is required for this disorder.
- The condition is due to mutations in the Wilson disease protein (ATP7B) gene.
- A single abnormal copy of the gene is present in 1 in 100 people.
- If a child inherits the gene from both parents, the child may develop Wilson’s disease.
- Symptoms usually appear between the ages of 6 and 20 years.
- Wilson’s disease occurs in 1 to 4 per 100,000 people.
- Wilson’s disease is named after Samuel Alexander Kinnier Wilson (1878–1937) who was the British neurologist who first described this condition in 1912.
- This condition is most common in eastern Europeans, Sicilians, and southern Italians.
- A small amount of copper obtained from food is needed to stay healthy, but excess copper is poisonous.
- High copper levels can cause life-threatening organ damage.

In Wilson disease, copper builds up in:
- the liver
- brain
- kidneys
- eyes
- other organs

Treatment of Wilson Disease
- The goal of treatment is to reduce the amount of copper in the tissues.
- This is done by a procedure called chelation.
- This process is where certain medications can bind to copper and help remove it through the kidneys or gut.
- Treatment must be done for lifelong.

The following medications may be used:
- Penicillamine (Cuprimine, Depen) binds to copper and leads to increased release of copper in the urine.
- Trientine (Syprine) binds (chelates) the copper and increases its release through the urine.
- Zinc acetate (Galzin) blocks copper from being absorbed in the intestinal tract.
Vitamin E supplements may also be used.

Risks
- Medications that chelate copper (especially penicillamine) can affect the function of the brain and nervous system (neurological function).
- Other medications under investigation may bind copper without affecting neurological function.
- Lifelong treatment is needed to control Wilson’s disease.
- The disorder may cause fatal effects.
- Loss of liver function and toxic effects of copper on the nervous system are some of the side effects.
- In cases where the disorder is not fatal, symptoms may be disabling.

Dietary Recommendations
A low-copper diet may also be recommended.
Foods to avoid include:
- Chocolate
- Dried fruit
- Liver
- Mushrooms
- Nuts
- Shellfish

Other things to care about:
- You may want to drink distilled water.
- Most tap water flows through copper pipes.
- Avoid using copper cooking utensils.
- Symptoms may be treated with exercise or physical therapy.
- People who are confused or unable to care for themselves may need special protective measures.
- A liver transplant may be considered in cases.
- This is done where the liver is severely damaged by the disease.

Possible Complications:
- Anemia (hemolytic anemia is rare)
- Central nervous system complications
- Cirrhosis
- Death of liver tissues
- Fatty liver
- Hepatitis
- Increased number of bone fractures
- Increased number of infections
- Injury caused by falls
- Jaundice
- Joint contractures or other deformity
- Loss of ability to care for self
- Loss of ability to function at work and home
- Loss of ability to interact with other people
- Loss of muscle mass (muscle atrophy)
- Psychological complications
- Side effects of penicillamine and other medications used to treat the disorder.
- Spleen problems

Overview
- This manifests as neurological or psychiatric symptoms and liver disease.
- It is treated with medication that reduces copper absorption
- Medication that removes the excess copper from the body also can be used.
- Occasionally a liver transplant is required for this disorder.
- The condition is due to mutations in the Wilson disease protein (ATP7B) gene.
- A single abnormal copy of the gene is present in 1 in 100 people.
- If a child inherits the gene from both parents, the child may develop Wilson’s disease.
- Symptoms usually appear between the ages of 6 and 20 years.
- Wilson’s disease occurs in 1 to 4 per 100,000 people.
- Wilson’s disease is named after Samuel Alexander Kinnier Wilson (1878–1937) who was the British neurologist who first described this condition in 1912.
- This condition is most common in eastern Europeans, Sicilians, and southern Italians.
- A small amount of copper obtained from food is needed to stay healthy, but excess copper is poisonous.
- High copper levels can cause life-threatening organ damage.

In Wilson disease, copper builds up in:
- the liver
- brain
- kidneys
- eyes
- other organs

Who gets Wilson disease?
- Patients who inherit two abnormal copies of the ATP7B gene, one from each parent.
- Who have only one copy of the abnormal gene, do not have symptoms.
- Most people with Wilson disease have no known family history of the disease.
- A person’s chances of having Wilson disease increase if one or both parents have it.
- It equally affects men and women.
- Symptoms usually appear between ages 5 to 35.
- New cases have been reported in people aged 2 to 72 years.

General Symptoms
- Abnormal posture of arms and legs
- Confusion or delirium
- Dementia
- Difficulty moving arms and legs, stiffness
- Difficulty walking (ataxia)
- Emotional or behavioral changes
- Enlargement of the abdomen (abdominal distention)
- Personality changes
- Phobias, distress (neuroses)
- Slow movements
- Slow or decreased movement and expressions of the face
- Speech impairment
- Tremors of the arms or hands
- Uncontrollable movement
- Unpredictable and jerky movement
- Vomiting blood
- Weakness
- Yellow skin (jaundice) or yellow color of the white of the eye (icterus)

Exams and Tests
A slit-lamp eye examination may show:
- Limited eye movement.
- Rusty or brown-colored ring around the iris (Kayser-Fleischer rings).

A physical examination may show signs of damage to the central nervous system. This includes:
- loss of coordination
- loss of muscle control
- muscle tremors
- loss of thinking and IQ
- loss of memory
- confusion (delirium or dementia)

Lab tests may include:
- Complete blood count (CBC)
- Serum ceruloplasmin
- Serum copper
- Serum uric acid
- Urine copper
If there are liver problems, lab tests may find:
- High AST and ALT
- High bilirubin
- High PT and PTT
- Low albumin

Other tests may include:
- 24-hour urine copper test
- Abdominal x-ray
- Abdominal MRI
- CT scan of the abdomen
- Head CT scan
- Head MRI
- Liver biopsy

DNA Testing
- The gene responsible for Wilson’s disease has been found.
- It is called ATP7B.
- DNA testing is available for this gene.
- Testing is complicated as different ethnic groups may have different changes (mutations) in this gene.

Overview
- Iron is a mineral found in many foods.
- Too much iron is toxic to your body.
- It can poison your organs and cause organ failure.
- In hemochromatosis, iron can build up in most of your body’s organs.
- It builds especially in the liver, heart, and pancreas.
- Too much iron in the heart can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs) and heart failure.
- Too much iron in the pancreas can lead to diabetes.
- If hemochromatosis isn’t treated, it may even cause death.

Too much iron in the liver can cause:
- an enlarged liver,
- liver failure,
- liver cancer,
- cirrhosis (sir-RO-sis): scarring of the liver, which causes the organ to not work well.

Signs and Symptoms of Hemochromatosis:
- Joint pain
- Fatigue
- Lack of energy
- Abdominal pain
- Loss of sex drive
- Heart problems
- Arthritis
- Amenorrhea
- Early menopause
- Loss of sex drive
- Impotence
- Shortness of breath
- Liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure.
- Damage to the pancreas, possibly causing diabetes
- Chronic (ongoing) abdominal pain

The goals of treating hemochromatosis include:
- Reducing the amount of iron in your body to normal levels.
- Preventing or delaying organ damage from iron overload.
- Treating complications of the disease.
- Maintaining a normal amount of iron in your body for the rest of your life.
- The most effective treatment for hemochromatosis is to reduce iron in the body by phlebotomy (withdrawal of blood from the arm veins).
- One unit of blood, which contains 250 mg of iron, usually is withdrawn every one to two weeks.
- Serum ferritin and transferrin saturation are checked every two to three months.
- Once ferritin levels are below 50 ng/ml and transferrin saturations are below 50%, the frequency of phlebotomies is reduced to every two to three months.
- When hemochromatosis is diagnosed early and is treated effectively, damage to the liver, heart, testicles, pancreas and joints can be prevented completely.
- In patients with established cirrhosis, effective treatment can improve the function of the heart, skin color, and diabetes.
- The cirrhosis is irreversible and the risk of developing liver cancer remains.

The benefits of therapeutic phlebotomy in hemochromatosis are as follows:
- It prevents the development of liver cirrhosis and liver cancer upon early detection.
- It improves liver function partially in patients who have already developed advanced cirrhosis.
- It improves and completely resolves symptoms of weakness, liver pain, joint pain, and fatigue.
- It improves function of the heart in patients with mild and early heart disease.

What are dietary recommendations in hemochromatosis?
- A normal balanced diet is recommended.
- Iron containing foods are not totally avoided.
- Alcohol should be avoided.
- Alcohol consumption increases the risk of developing cirrhosis and liver cancer.
- Ingestion of high doses of vitamin C in patients with iron overload may lead to fatal abnormal heart rhythms.
- It is reasonable to avoid vitamin C supplementation until patients are adequately treated.
- Raw seafood should be avoided.
- Patients with hemochromatosis are at risk of acquiring bacterial infections that flourish in iron rich environment.

Overview
- Iron is a mineral found in many foods.
- Too much iron is toxic to your body.
- It can poison your organs and cause organ failure.
- In hemochromatosis, iron can build up in most of your body’s organs.
- It builds especially in the liver, heart, and pancreas.
- Too much iron in the heart can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs) and heart failure.
- Too much iron in the pancreas can lead to diabetes.
- If hemochromatosis isn’t treated, it may even cause death.

Too much iron in the liver can cause:
- an enlarged liver,
- liver failure,
- liver cancer,
- cirrhosis (sir-RO-sis): scarring of the liver, which causes the organ to not work well.

Signs and Symptoms of Hemochromatosis:
- Joint pain
- Fatigue
- Lack of energy
- Abdominal pain
- Loss of sex drive
- Heart problems
- Arthritis
- Amenorrhea
- Early menopause
- Loss of sex drive
- Impotence
- Shortness of breath
- Liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure.
- Damage to the pancreas, possibly causing diabetes
- Chronic (ongoing) abdominal pain

Diagnosis of Hemochromatosis
- Medical history
- Perform a physical examination
- Order routine blood tests

How Blood Tests Help in Diagnosing Hemochromatosis ?
- Blood tests can determine if the amount of iron stored in the body is too high.
- The transferrin saturation test determines how much iron is bound to the protein.
- This is the protein that carries iron in the blood.
- The total iron binding capacity (TIBC) test measures how well your blood can transport iron.
- The serum ferritin test shows the level of iron in the liver.
- If any of these tests shows higher-than-normal levels of iron in the body, healthcare providers can order a special blood test to detect the HFE mutation.
- This test will help confirm the diagnosis of hemochromatosis.
- If the mutation is not present, hereditary hemochromatosis is not the reason for the iron buildup.

Serum transferrin saturation:
- This test measures the amount of iron bound to a protein (transferrin) that carries iron in your blood.
- Transferrin saturation values greater than 45 percent are considered too high.

Serum ferritin:
- This test measures the amount of iron stored in your liver.
- If the results of your serum transferrin saturation test are higher than normal then the doctor will check your serum ferritin.

Using a Liver Biopsy to Confirm the Diagnosis
- A liver biopsy is a procedure where a tiny piece of liver tissue is removed and examined under a microscope.
- This may be needed to confirm a hemochromatosis diagnosis.
- It will show how much iron has accumulated in the liver.
- It will show whether the liver is damaged as a result.

Additional testing

Testing for gene mutations:
- Your doctor can test a sample of your DNA for mutations in the HFE gene.
- This test can help confirm a diagnosis of hereditary hemochromatosis.

Removing a sample of liver tissue for testing:
- During a liver biopsy, your doctor removes a sample of tissue from your liver, using a thin needle.
- The sample is sent to a laboratory where it’s checked for the presence of iron and also for evidence of liver damage, especially scarring or cirrhosis.
- Risks of biopsy include bruising, bleeding and infection.

Screening healthy people for hemochromatosis:
- Doctor may recommend a blood test to determine if you have hemochromatosis even with no linked symptoms.
- Patients undergo screening tests to determine whether they have the condition before complications can occur.

Diagnosis of Liver Cancer

Blood Tests
- Liver cancer depends so much on the vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in the blood and radiological imaging studies.
- If the blood tests become abnormal or worsen due to liver cancer, this usually signifies extensive cancerous involvement of the liver.
- in liver cancer, the cancerous liver cells may take on the characteristics of other types of cells.
- For example, liver cancer cells sometimes can produce hormones that are ordinarily produced in other body systems.
- These hormones then can cause certain abnormal blood tests
- These include a high red blood count (erythrocytosis), low blood sugar (hypoglycemia) and high blood calcium (hypercalcemia).
- High serum cholesterol (hypercholesterolemia), is seen in up to 10% of patients from Africa with liver cancer.
- The high cholesterol occurs because the liver cancer cells are not able to turn off (inhibit) their production of cholesterol.
- There is no reliable or accurate screening blood test for liver cancer.
- The most widely used biochemical blood test is alpha-fetoprotein (AFP)
- AFP is a protein normally made by the immature liver cells in the fetus.

In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:
- Liver cancer.
- Germ cell tumors (cancer of the testes and ovaries).
- Metastatic cancer in the liver (originating in other organs).

There are a number of other liver cancer tumor markers like:
- Des-gamma-carboxyprothrombin (DCP),
- A variant of the gamma-glutamyltransferase enzymes,
- Variants of other enzymes (for example, alpha-L-fucosidase).

Imaging Studies
These studies provide information
- as to the size of the tumor.
- the number of tumors.
- whether the tumor has involved major blood vessels locally or spread outside of the liver.

Ultrasound Examination
- It is usually the first study ordered if liver cancer is suspected in a patient.
- The accuracy of an ultrasound depends very much on the technician and radiologist.
- Computerized axial tomography (CT scan) is a very common study used in the U.S.
- The ideal CT study is a multi-phase, spiral CT scan using oral and intravenous contrast material.

Pictures are taken in three phases:
- Without intravenous contrast.
- With intravenous contrast (enhanced imaging) that highlights the arterial system (arterial phase).
- When the contrast is in the venous phase.