Master the board step 3

Gastroenterology
Most accurate tests:
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For hepatitis A, C, D, and E, the confirmatory test is serology. IgM levels
acutely rise, and IgG levels rise in the recovery phase.
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Surface antigen, core antibody, e-antigen, or surface antibodies are not
present in hepatitis A, C, D, or E. These tests are associated with hepatitis B.
Acute Hepatitis B
The first test to become abnormal in acute hepatitis B infection is the surface
antigen. Elevation in ALT, e-antigen, and symptoms all occur after the appearance
of hepatitis B surface antigen. The following table shows the appearance
of the antigens and antibodies through the course of the disease:
Surface Antigen e-Antigen Core Antibody Surface Antibody
Acute disease
(hepatitis B)
Window period
(recovering)
+ + + + + + –
– – + + –
Vaccinated – – – + +
Healed/recovered – – + + + +
Chronic hepatitis B gives the same serologic pattern as acute hepatitis B, but
it is based on persistence of the surface antigen beyond 6 months.
Surface Antigen e-Antigen Core Antibody Surface Antibody
Acute hepatitis B + + + –
Chronic hepatitis B + + + –
Resolved infection – – + +
Window period – – + –
These 3 tests are essentially equal in meaning. They all indicate active viral
replication:
Hepatitis B DNA polymerase = e-Antigen = Hepatitis B PCR for DNA
No treatment is available for acute hepatitis B.
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