Sinusitis

What does ultrasound diagnostics of the liver show? How is laboratory diagnosis of hepatitis C carried out? Do you need to prepare for the test?

Many patients are interested in whether it is possible to accurately diagnose hepatitis C using liver ultrasound? The liver is one of the main organs of the human body. Its task is to remove from the body accumulated toxins and harmful substances that threaten human health and life. But it happens that she herself is in danger. One of the most dangerous diseases of this important organ is hepatitis C. The main method for diagnosing hepatitis is ultrasound of the liver, which is indicated at the slightest suspicion of this disease.

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The patient usually complains of:

malaise;
nausea;
joint pain;
odor from the esophagus;
bitterness in the mouth;
decreased appetite;
feeling of heaviness;
pain in the side (not always).

liver tumor;
presence of cysts;
cirrhosis.

legumes;
milk;
carbonated drinks;
fresh vegetables;
cabbage

How is the research going?

Hepatitis C is an inflammatory disease of the liver of viral origin, transmitted through blood, occurring in acute or chronic form, often having a severe course and often ending in incurable consequences.

Ultrasound examination of the hepatobiliary system is a necessary procedure in the diagnosis of liver diseases. What ultrasound signs of liver inflammation exist and is it possible to detect hepatitis C on ultrasound?

Ultrasound and inflammation

Ultrasound examination is a highly informative diagnostic method that modern medicine offers us. It serves as an assessment of the condition of internal organs, helps determine an accurate diagnosis and makes it possible to monitor the effectiveness of the treatment process. Ultrasound examination is widely used in diagnosing liver pathology.

The liver is an unpaired parenchymal organ and consists entirely of hepatic tissue. The basis of the parenchyma are glandular lobules, which are surrounded by blood collaterals and bile ducts. Healthy tissue on ultrasound appears as a homogeneous, weakly echogenic structure, against which the vessels and ducts are clearly visible.

The size and density of the organ allows it to reflect ultrasound waves well, so it can be perfectly scanned by an ultrasound machine. To assess the inflammation that occurs with hepatitis, its parameters, wall thickness are measured, the structure of the parenchyma and the state of blood flow are assessed. Ultrasound examination is necessarily included in the comprehensive diagnosis of all hepatobiliary pathologies.

Indications for ultrasound examination of the hepatobiliary system are:

Abnormal liver tests (indicates decreased function).
Jaundice (yellowing of the skin and mucous membranes).
Injuries and diseases of the abdominal cavity.
Gallbladder problems.
Suggestion of an oncological process.
Feverish state of unknown origin.

Ultrasound detects diffuse changes, including: fibrosis, hypertrophy, sclerosis, swelling of the parenchyma or its degeneration. Such manifestations are characteristic of a number of pathologies, so ultrasound examination fully complements the understanding of the state of health.

Ultrasound helps identify various abnormalities

What are the ultrasound signs of hepatitis and is one ultrasound examination always enough to make a diagnosis?

Viral infection leads to inflammation of the liver tissue and functional disorders. Depending on the etiotropic cause and severity of inflammation, symptoms can be pronounced (acute) or blurred (chronic). The inflammatory process leads to swelling of the organ and its increase in size, the spleen enlarges.

On ultrasound, this will manifest itself as a decrease in echogenicity (the ability to conduct ultrasound). On the device’s monitor screen, the inflamed, swollen gland will appear dark or almost black (depending on the degree of inflammation).

The acute form of the disease occurs with typical bright symptoms: fever, pain in the right hypochondrium, dysfunction.

The main symptom of acute hepatitis C is yellowing of the skin and mucous membranes, a characteristic increase in the blood of the endogenous enzymes ALT, AST and the bile pigment bilirubin, the culprit of the “yellowing.” Specific markers of hepatitis C appear.

Characteristic, but not specific

Is it possible to see acute hepatitis C on an ultrasound of the liver?

We can assume: an ultrasound examination will show an increase in the inflamed organ due to its swelling; this sign is typical, but not specific. A similar picture can be caused by completely different problems. The onset of the disease and its mild course may not be reflected on the monitor of the ultrasound machine.

The diagnosis of acute hepatitis C is made on the basis of clinical complaints, examination of the patient, medical history and results of biochemical tests.

What does chronic hepatitis C look like on ultrasound?

Is it possible to draw a conclusion about chronic inflammation of the liver based on the results of an ultrasound examination? Theoretically, it is possible, but not always; the initial damage to the gland is not always possible to see with such a study; additional tests are necessary.

Additional tests are needed to accurately diagnose the disease.

In some forms of the disease, the liver may become slightly enlarged, but its tissue remains unchanged. Considering that some parameters depend on gender, age, height and constitution, a moderate increase at first, without diffuse changes, can be taken as the norm.

The chronic form often has a latent course and appears when changes in the structure are already quite clearly expressed and noticeable on ultrasound.

For what purpose is ultrasound prescribed for viral hepatitis?

In order to determine the state of the organ at the moment, the progression of the disease or make a conclusion about the effectiveness of treatment.

If focal compaction is noted, fibrotic areas of tissue, unevenness and tuberosity of the liver suggest the onset of cirrhosis.

An increase in echogenicity (light-colored liver) indicates fatty degeneration of the hepatic parenchyma. Fatty hepatosis.

During the study, the following parameters are assessed: shape, size, structure and condition of the ducts and hepatic collaterals.

The results obtained are compared with standards and a conclusion is drawn.

Let us list the main ultrasound moments that suggest hepatitis.

Increase in size.

An unstable and nonspecific sign; at the onset of the disease and with a mild course of the disease, the size may not change. Enlargement of the organ can be observed in other pathologies, in particular heart disease and vascular disorders. The acute form of the disease is characterized by an enlargement of the right lobe.

One of the signs of hepatitis is an enlarged liver

Reduced echogenicity.

A characteristic but nonspecific indicator indicating swelling of the inflamed organ. On the monitor this is manifested by darkening, in the conclusion it will be noted with the phrases: hypoechogenicity or anechoicity (black liver). A similar phenomenon is observed in chronic heart failure (congestive liver).

Heterogeneity of the liver parenchyma.

Does not always indicate viral hepatitis; such changes may indicate sclerosing cholangitis, fatty transformation of liver tissue, cirrhosis and autoimmune hepatitis.

Pronounced vessels.

A consequence of swelling of inflamed tissues, against a “dark” background of which the vessels become clearly visible, this is a frequent, but not constant indicator.

Dangerous chronicle

The chronic form occurs unnoticed; at the onset of the disease there are practically no symptoms. During ultrasound examination, the liver looks normal, no abnormalities in its structure are observed. There may be a slight increase in size, which is not a reason for making a diagnosis. In this case, biochemical research is important.

The appearance of visible signs of chronicity is observed with further progression of the viral infection. A cause for concern is the identification during an ultrasound examination of:

A noticeable increase in the size of the liver (both lobes).
The appearance of uneven edges and blurred outline (a characteristic sign of cirrhosis).
Rounding of the lower edge, increased echogenicity of the tissue (progression).
Heterogeneity.
Gradual depletion of the vascular pattern.
A decrease in sound conductivity indicates the growth in the parenchyma of dense connective tissue that does not conduct ultrasound waves well.

It is impossible to diagnose hepatitis C on the basis of a single ultrasound examination of the liver; for a final conclusion, an examination and interview of the patient and important biochemical studies of his blood are necessary. Determination of a certain type of virus must be confirmed by laboratory methods, including PCR (polymerase chain reaction) analysis.

Ultrasound of the liver is a good diagnostic procedure that helps the doctor understand a complex or controversial situation, make an accurate diagnosis and monitor the effectiveness of the selected treatment.

Ultrasound of the liver

What does an ultrasound of the liver show?

During an ultrasound examination, the doctor examines the structure, size, lobes and segments of the liver, as well as the gallbladder, common bile duct, intrahepatic ducts, portal vein and intrahepatic vessels.

What can be revealed?

Indications for the procedure

Changes in biochemical blood test readings indicating organ disease.
Yellowness of the skin and whites of the eyes.
Trauma to the abdominal organs.
Suspicion of the presence of a tumor or distant metastases.
Acute and chronic diseases, gallbladder diseases.
Fever of unknown etiology.
Portal hypertension.
The period after liver transplant surgery.
Puncture for taking a biopsy.

Preparation for the procedure

Ultrasound diagnosis is complicated by obesity and the presence of rare cases of metabolic disorders in the patient, for example, hemochromatosis.

The condition for performing an ultrasound of the liver is the exclusion of gas-forming foods from the diet of the person being examined for 3 days.

You cannot eat cabbage (white cabbage, cauliflower, broccoli), legumes (beans, peas, lentils, soybeans), milk and dairy products, carbonated drinks, fruits (apples, pears, plums), flour products.

These recommendations should be taken especially seriously by older people and people with digestive system disorders, one of whose complaints is flatulence and bloating. This diet eliminates the appearance of swollen intestinal loops that partially cover the liver and other organs, which prevents the ultrasound diagnostician from completely visualizing the organ and can complicate the diagnosis. Drinking water or tea before the procedure is not prohibited.

The attending physician, if necessary, prescribes enzyme preparations and enterosorbents.
For constipation, the patient needs to have an enema in the evening or prescribe laxatives.
The patient comes to the procedure in the morning on an empty stomach.

How is liver ultrasound performed?

Ultrasound can be performed with the patient standing, lying, or sitting. When examining the gallbladder, the patient is asked to lie on his left side. Before carrying out the manipulation, the ultrasound diagnostician applies a special gel to the examined area. Next, the doctor conducts an examination according to the scheme.

In case of cirrhosis and for the purpose of examining blood flow in the portal vein system, it is recommended to use color Doppler mapping (CDC).

Interpretation of liver ultrasound, normal values

The size of the liver depends on gender, age, constitution

The weight of the liver is approximately 1400-1600 g.
Length – 14-20 cm.
Width – 23-27 cm.
Right lobe -< 12,5.
Left lobe – 6-8 cm.
The edges are smooth and even.
The structure is homogeneous.

Interpretation of liver ultrasound also includes:

diameter of the common hepatic duct – 3-5 mm;
the diameter of the inferior genital vein is up to 15 mm.

Gallbladder:

length – 6-10 cm;
width – 3-5 cm;
wall thickness – 4 mm;
diameter of the common bile duct – 6-8 mm;
The diameter of the lobar bile ducts is 3 mm.

What does granular liver mean?

A granular liver according to ultrasound is considered normal if the granularity is fine, the structure of the liver is homogeneous and no pathology is detected. With coarse focal granularity, the question of possible sarcoidosis, metastasis and abscess is raised.

What can an ultrasound indicate about an enlarged liver in a child?

In children under 7 years of age, hepatomegaly is normal; upon palpation, the edge of the liver may protrude by 1-2 cm.

As the child grows, the organ becomes normal in size.

Pathological enlargement of the liver in children can occur with:

treatment with hepatotoxic drugs;
congenital infections;
fatty hepatosis, which develops in children with metabolic disorders and excess nutrition;
chronic diseases of the gastrointestinal tract.

Ultrasound of the liver during pregnancy

Indications:

cholecystitis, exacerbation;
chronic hepatitis, aggressive form;
gallstone disease.

Ultrasound of the liver for hepatitis C, A and B

In this case, this method serves not for diagnosis (for hepatitis, laboratory tests are crucial), but for monitoring the course and progression of the disease, the transition to cirrhosis, and allows one to monitor and draw conclusions about the effectiveness of treatment.

The following ultrasound picture is characteristic of liver cirrhosis: focal thickening of the liver, an increase in the size of the liver, areas of fibrosis, the edges of the liver are uneven and lumpy. In case of cirrhosis, an ultrasound scan of the kidneys and gallbladder is required.

The severity of symptoms depends on the stage of cirrhosis. This can be seen upon systematic examination of such patients. The description of their protocols is different at different periods of time. Often, when performing an ultrasound, such patients have liver signs on the examined skin, such as, for example, liver dots or asterisks, which patients often confuse with moles.

What can changes in the echogenicity of the liver indicate on ultrasound?

After an ultrasound scan of the liver, the examinee is given the result with the final conclusion, a photo is attached (if necessary, and a video). The cost of this procedure depends on the clinic where you will undergo the examination (private or public), and the experience of the ultrasound doctor. The price may be inflated if you have a high-quality ultrasound diagnostic device.

Ultrasound examination of the liver allows you to determine the characteristics of the organ. It is carried out in the presence of symptoms of certain diseases, as well as for preventive purposes for people at risk.

Ultrasound is a type of diagnostic procedure when, through the interaction of a device, it becomes possible to study the structure of the liver. The method is reliable and allows you to determine individual indicators and parameters.

Anatomy

The liver is one of the largest organs. Its size and weight vary depending on age.

In an adult, the weight of the organ ranges from 1300-1800 g. In newborns, it occupies almost half of the abdominal cavity.

The organ is covered on all sides by peritoneum. The exception is the gate and the back of the surface. The parenchyma is covered with a fibrous membrane.

The body is responsible for:

Digestion. Plays an important role in the production of bile.
Metabolism. All blood passes through the hepatic portal vein. It is responsible for the absorption of carbohydrates, lipids, proteins and their transformation into biologically useful materials.
Detoxification. Hepatocytes control the quality of blood and remove toxic compounds from it.

Indications

Most often, the procedure is performed on older people, since serious pathologies of the organ may appear over the years. Indications for the procedure are:

Yellowness of the skin, whites of the eyes and mucous membranes.
Coloration of urine in a bright color with simultaneous discoloration of feces.
Long-term treatment using serious medications.
Radiation exposure to the body and chemotherapy.
Abdominal pain on the right side.
Feeling of heaviness after eating.
Severe abdominal injuries.

A procedure is also prescribed to clarify the presence and size of a focus of inflammation in the liver, which was discovered after other research methods. Sometimes there is a suspicion of an abscess in the organs.

Ultrasound allows you to determine the diameter and size of the organ, identify the presence of deviations from the norm and analyze the structure of the tissue.

Contraindications

The procedure is painless and does not imply an aggressive effect on the body through the introduction of special drugs and liquids. The examination is carried out on an outpatient basis.

There are no absolute contraindications to it, but the study is postponed if the patient was taking medications that can change the clinical picture. Infectious skin diseases may appear in the liver projection area. Then, to prevent the spread of the disease, the date of the ultrasound is postponed.

Contraindications include the patient's consumption of alcoholic beverages and food, which cause flatulence. In this case, the possibility of making an erroneous diagnosis increases.

Preparing the patient for the procedure

It is needed to obtain more accurate information about human health. At the time of the examination, there should be no gas in the intestines, so examination on an empty stomach or with a change in diet is recommended.

A few days before the ultrasound, fiber, cabbage, whole milk, legumes, fruits and bread are excluded.

Sometimes the doctor prescribes a sorbent and an enema. Drugs such as Smecta, Activated Charcoal, and Espumezan will help reduce the amount of gas in the intestines. It is possible to take enzyme preparations, for example, Pancreatin and Creon.

Video on how to prepare for a liver ultrasound:

Methodology

The duration of the procedure is from 15 to 30 minutes. The person is placed on a couch in a supine position. Sometimes the doctor may ask you to change your position.

After the procedure, you can immediately return to your daily activities and get behind the wheel of your car. In emergency situations, liver ultrasound is performed without preparation.

Normal organ sizes in adults and children

The dimensions of a healthy liver in adults are as follows:

The thickness of the right lobe is 110-130 cm, length – 110-150 mm.
The maximum vertical oblique size is up to 150 mm.
The thickness of the left lobe is 50-70 mm, height – up to 100 mm.

When studying the dimensions, the uniformity, clarity of the contour, and the condition of the veins are immediately taken into account. The liver in men and women has the same parameters. In this case, the maximum size of the hepatic artery reaches a maximum of 13 mm, the portal vein - 11-18 mm, and the hepatic veins up to 10 mm.

In children, the examination takes into account age:

But these data are for informational purposes only, since only a hepatologist or a general practitioner can judge deviations and features.

What does an ultrasound of the liver show: explanation

The structure must be assessed. The edge of the liver should be smooth. After this, the sizes of the shares are examined. After this, the parenchyma of the gland is analyzed for the presence of nodes, compactions and calcifications that form changes in the signal received by the device.

Based on the strengthening or weakening of ultrasonic waves, a functional diagnostics doctor recognizes the presence of liquid and solid formations.

Developmental anomalies

Using an ultrasound machine, a large number of anomalies can be detected, including congenital liver hypoplasia in children.

The hardware diagnostic method allows you to determine:

Agenesis of the right lobe of the liver and the left. The latter is more common. When the disease occurs, one lobe or part of it is missing. Additionally, other diagnostic methods are used to make a diagnosis.
Riedel's share. It is characterized by a change in the shape of the organ. The doctor may detect the formation of a tongue shape.
Additional shares. They are located above the diaphragm or in the hernial sac. They are connected to the main organ by a fibrous cord.
Cystic and polycystic diseases. the latter appear on the walls of organs during intrauterine development. Diseases may not manifest themselves for many years.

Diffuse parenchymal changes

With advanced processes, they indicate the presence of a serious pathological process. Anomalies and changes in liver tissue can occur in the event of disorders and severe damage to the organ.

Usually, with diffuse changes in the parenchyma, deformation or thinning of the walls of the parenchyma and surrounding tissues is formed. This leads to disruption of the integrity and normal functioning of the liver.

Cysts

This is a focal cavitary change in the liver, manifested by pain, abdominal asymmetry, and nausea. Using ultrasound, you can find such benign formations in various segments, lobes and ligaments of the liver. The diameter usually ranges from a few millimeters to 25 cm.

Cysts in the liver are found in 0.8% of the population. They occur more often in women than in men. This disease is often combined with cholelithiasis, liver cirrhosis, and polycystic ovary syndrome.

Congenital

This type is formed as a result of a violation of the development of the ducts. It turns out to be blocked, so bile cannot come out of it. Gradually, a cavity forms. The pressure increases so much that further liver flow becomes impossible.

Congenital cysts have their own capsule. This is how they differ from other types. Ultrasound can detect both single and multiple forms.

Fluid formations are usually anechogenic. If the fluid is heterogeneous, then the echogenicity may vary.

Echinococcal

There are two forms of the disease:

The hydative form has the form of cysts.
Alveolar – tumor-like formations.

Sometimes both types are combined. On an ultrasound, the doctor will see rounded limited areas of altered liver tissue that contain fluid. Additionally, to clarify the diagnosis, an immunological test is prescribed.

Traumatic

They have a spherical or oval shape and are free from echoes. Traumatic ones develop after a central or subcapsular rupture of the liver; they can appear after treatment of a liver abscess.

Such a benign formation appears with strong blows, falls, or rib fractures.

Tumor formations

Liver ultrasound can detect both benign and malignant tumors.

The first type is adenoma. It looks on the device as a simple formation with smooth contours.

Hemangiomas are formed from vascular tissue. On ultrasound, the picture is represented by a formation with uneven contours and a heterogeneous structure.

Possible detection of liver lipoma. This is a fatty tumor that is similar to hemanigoma and metastases. A rare formation is biliary cystadenoma. Ultrasound shows that the walls of the cyst have a rich blood supply and multiple papillary foci.

For malignant tumors, ultrasound confirms the presence of dense formations. The technique makes it possible to determine the presence of such dangerous diseases as carcinoma, angiosarcoma, and hepatoblastoma. With a primary lesion, the ultrasound picture is varied.

Suspicion of the presence of a tumor may be caused by:

seals in the area of the portal vein branches,
changes in the vascular pattern,
increase in organ size,
rounding the bottom edge
effect of weak ultrasound conduction.

Due to the attenuation of ultrasonic waves, the image of the diaphragm becomes blurred.

Why is the organ enlarged?

The liver is said to be enlarged when its dimensions at the intersection of the organ with the right midclavicular line start from 12 cm, and the left lobe is located in the epigastric region. Such formations can be provoked by both formations and:

An increase can be assumed by the appearance of heaviness in the right side, emotional instability, changes in color and stool. Dangerous consequences include oncological processes, cirrhosis and the development of liver failure.

The concept of grain

The liver consists of cells that are slightly flattened. Thanks to this, we can talk about the porous structure of the organ. This is necessary for the organ to function properly.

Normally, the internal structure of the liver is fine-grained and soft.

Pathological processes develop gradually.

Medium or coarse grain appears first. The latter indicates the appearance of hepatitis, severe obesity or the presence of diabetes mellitus.

Ultrasound can show a significant increase in segments of the liver structure and heterogeneity of the lymph nodes.

Elastography study

This method is used to assess the severity of fibrosis. With a regular ultrasound, the first stages of fibrosis, cirrhosis and hepatitis look the same. Previously, liver biopsy was used to make an accurate diagnosis. This procedure is expensive and has many side effects.

The elastographic technique makes it possible to make an adequate diagnosis. Transient ultrasound elastometry is performed through the intercostal spaces.

A special device has an ultrasound sensor with a source of low-frequency vibrations. They reach the desired tissues and are then transformed into electromagnetic waves. This method determines the speed of wave distribution, which depends on the elastic component.

With the method, two modes are performed simultaneously, thanks to which an ultrasound picture of the liver and color mapping that evaluates tissue density are visible. This research method gives a complete picture of the pathological process developing in the liver.

Where can I get tested?

A routine liver ultrasound can be performed both in a clinic and during treatment in a hospital. Typically, you should sign up for the procedure in advance at the reception desk or through the website of the selected institution. Diagnostics are also carried out in various medical centers, which are located in all major cities.

Price

The most expensive research method is ultrasound with elastography. In Moscow and St. Petersburg, 2-3 years ago you could pass it for 7 thousand rubles. Today prices are more affordable, so on average the procedure will cost 4 thousand.

Prices for classic ultrasound examinations start from 700 rubles.

What is hepatitis?

Hepatitis is an inflammation of the tissue or, in other words, the liver parenchyma. Moreover, this inflammation affects the entire liver tissue, and therefore refers to diffuse diseases. In contrast to focal diseases, which do not affect the entire tissue of an organ, but some part of it (focus).

The word “hepatitis” itself comes from the Greek “hepar”, in the genitive case - “hepatos”, which means “liver”. And the ending “it”, in all medical terms, indicates that we are talking about inflammation. Still, the word, as you now understand, is translated as “inflammation of the liver.” Which is quite true.

According to the nature of the course, all hepatitis is divided into acute and chronic

Acute hepatitis

Acute course is the rapid development of inflammation, occurring with severe symptoms characteristic of any inflammation:

temperature rise
swelling of the inflamed organ
dysfunction of the inflamed organ

Therefore, during acute hepatitis, a person’s body temperature rises, he feels pain in the right hypochondrium (where the liver is located), the liver enlarges due to swelling of the entire parenchyma. Liver function is also affected, which can be determined by doing blood tests.

And externally, liver dysfunction is visible by the appearance of yellowness of the skin and mucous membranes. This is the so-called jaundice.

Is it possible to see acute hepatitis on an ultrasound?

Ultrasound signs of acute hepatitis exist. But the trouble is that these signs are not specific. What does it mean? This means that the same symptoms can be observed in other diseases.

Therefore, it is impossible to make a diagnosis of acute hepatitis based only on ultrasound examination. In order to make a diagnosis of acute hepatitis, you also need to examine the patient, question him, and do blood tests.

On ultrasound you can see the following signs of acute hepatitis:

1. Enlarged liver is not a permanent and non-specific sign. Not permanent, because at the beginning of the disease and with a mild degree of the disease, there may not be an enlarged liver. And not specific - because the liver can be enlarged in many diseases, and not just in acute hepatitis. In acute hepatitis, the right lobe increases more significantly than the left. 2. Diffuse decrease in liver echogenicity In simple terms, the liver on the ultrasound machine screen becomes darker than usual. Such a dark image of the organ is explained by its swelling. Edema is the saturation of an organ with fluid. And the liquid perfectly conducts ultrasound and practically does not reflect it. Therefore, the liquid on the screen appears dark (not echogenic or anechoic), almost black. And organs saturated with fluid (edematous) are darker than normal ones (reduced echogenicity, hypoechoic). You can read about what echogenicity is in the article “What does echogenicity mean?” This increases the sound conductivity of the liver tissue. And this is understandable: the more fluid an organ contains, the better it conducts ultrasound. A diffuse decrease in echogenicity is also a non-specific sign, as it is characteristic not only of acute hepatitis, but also of some other diseases. For example, for congestive liver in chronic heart failure. With heart failure, swelling of many organs and the liver is also observed - including. Of course, an experienced ultrasound diagnostic doctor will always distinguish a dark, congested liver from a dark, inflamed liver by other signs. But, nevertheless, this symptom is not specific for acute hepatitis. And not permanent. Since with a mild degree of the disease, the edema may not be pronounced and the liver will remain of normal echogenicity. 3.Heterogeneity of liver tissue This sign indicates that different areas of the liver tissue are susceptible to swelling to varying degrees. Areas of tissue more saturated with edematous fluid appear darker. Areas of parenchyma less saturated with edematous fluid are lighter in color. This sign is also not specific and not constant. 4. More pronounced vascular pattern of the liver This sign is also a consequence of edema of the liver parenchyma. Since the liver tissue becomes darker, the dense walls of the blood vessels are more clearly visible against its background. This effect is observed only when tissue swelling is well expressed. It is also not constant and not specific. It is also important that the vascular pattern in acute hepatitis is visible too well, but there is no deformation or distortion of this pattern, which happens with other liver diseases. 5. With sufficiently pronounced edema, the liver capsule is too clearly visible. The image of the capsule is echogenic, that is, light, and it is visible very well against the background of the dark liver. Better than when the liver has normal echogenicity.

Chronic hepatitis

Chronic hepatitis is a long-term disease, lasting for years, during which periods of calm and relative well-being are replaced by exacerbations.

Speaking about chronic hepatitis, it should be noted that the initial stages and mild degrees of this disease, as a rule, are not determined by ultrasound.

The liver in these cases looks normal, its structure is not disturbed. There may be a slight increase in liver size. But this is not enough to suspect chronic hepatitis.

Therefore, at this stage, blood tests are of particular importance, which in the early stages of hepatitis indicate impaired liver function, while its appearance remains (for now) normal.

With further progression of this disease, ultrasound signs appear. Which?

1. An increase in the size of the liver, both its right and left lobes 2. The contour of the liver remains smooth and clearly visible. Only with severe hepatitis, turning into cirrhosis, an uneven and unclear contour is noted. 3. The lower edge of the liver becomes more rounded 4. The echogenicity of the tissue increases. Moreover, the more pronounced the hepatitis, the greater the echogenicity of the liver. An increase in echogenicity indicates that the amount of dense connective tissue in the liver tissue increases. And this is a sign of any chronic inflammation. 5. Heterogeneity of the parenchyma This sign may be absent for a long time and appear only in the later stages of the development of the disease. The more pronounced the process of chronic inflammation, the greater the heterogeneity of the tissue. 6.The vascular pattern of the liver gradually becomes depleted. This happens because the small vessels of the liver become less and less visible. This effect is explained by the fact that the more echogenic, lighter liver parenchyma masks the thin walls of small vessels. 7. Depletion of the vascular pattern occurs due to deterioration in the visibility of the hepatic veins and small branches of the portal vein, while large branches of the portal vein are often more clearly visible. This effect is explained by the fact that in some forms of chronic hepatitis there is a more intense proliferation of connective tissue around the portal vessels. In this case, large branches are visible more clearly than usual. 8. The sound conductivity of the organ decreases. This effect is caused by the fact that during chronic inflammation, dense connective tissue grows in the parenchyma of the organ, which does not conduct ultrasonic waves well. You can read about what sound conductivity is in the article “What is sound conductivity?”

As you can see, there are quite a lot of ultrasound signs that allow you to see hepatitis on an ultrasound. And, although these signs are characteristic not only of hepatitis, an experienced doctor will take into account their combination and compliance with the patient’s complaints, receive confirmation in blood tests and be sure to make the correct diagnosis.

But a correct diagnosis is the very first and most important step towards correct and effective treatment.

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Indications for examination and diseases detected by ultrasound

Such diagnostics should be carried out not only if hepatitis is suspected; it also helps to detect other liver pathologies. Indications for liver ultrasound are as follows:

Suspicion of an abscess;

Abdominal trauma;

Monitoring the progress of treatment;

Prevention goals.

Ultrasound diagnostics reveals the following diseases:

Acute hepatitis and its chronic form;

Tumors;

Cirrhosis;

Hemangiomas and hematomas.

Using ultrasound, all changes in the structure of the liver are determined, which allows the doctor to determine the presence or absence of hepatitis. To be completely sure, a blood test is performed, which provides additional data necessary to establish an accurate diagnosis.

Preparation for liver ultrasound

Before the examination, refrain from eating food, especially if it is planned in the first half of the day. You should also clear the intestines of gases to prevent interference during the ultrasound. To do this, follow a special diet for 3 days. Avoid foods such as beans, peas, milk, fresh vegetables, cabbage, and carbonated drinks.

Ultrasound examinations may be difficult for overweight patients. Therefore, a day before diagnosis, they are recommended to undergo a cleansing enema (in the evening and in the morning). More detailed information on preparing for Ultrasound of the liver for hepatitis you will receive from your attending physician.

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When is an ultrasound scan prescribed for hepatitis C?

This diagnostic method is very informative, absolutely safe and painless. An ultrasound of the liver can detect even minor changes in the organ and make an accurate diagnosis. An ultrasound scan of the liver shows the doctor the extent of the infection, the general condition, the functioning of the organ and the nature of the lesion.

If hepatitis C is diagnosed, the patient is prescribed an additional ultrasound with color Doppler mapping. This type of ultrasound allows specialists to monitor the functioning of the vessels that feed the gland and the blood flow over time. This method makes it possible to track the movement of blood through the vessels of the liver in real time and in color images.

The diagnostic specialist will see the direction of fluid movement and speed, and will also track places where there is no blood supply. Ultrasound in combination with color Doppler mapping (color Doppler mapping) is one of the most informative, popular and common types of diagnosis of liver diseases. To form a complete picture of the nature and extent of the disease, in addition to ultrasound, a blood test is prescribed for the patient.

What does an ultrasound scan show?

The patient usually complains of:

malaise;
nausea;
joint pain;
yellowness or gray tint of the skin and whites of the eyes;
odor from the esophagus;
bitterness in the mouth;
decreased appetite;
feeling of heaviness;
pain in the side (not always).

In this case, the doctor may suspect hepatitis C and prescribe an ultrasound of the abdominal organs. But such symptoms do not always indicate this disease. An ultrasound examination can accurately determine the presence or absence of a viral infection or identify other liver pathologies. The following diseases can be determined by ultrasound:

hepatitis C (its acute or chronic form);
liver tumor;
various hematomas and hemangiomas;
presence of cysts;
cirrhosis.

Since the liver is closely connected by blood vessels to an abdominal organ such as the gallbladder, a liver scan can reveal cholelithiasis or cholecystitis.

Moreover, with a disease such as hepatitis C, the condition of the gallbladder plays an important role, therefore, if this pathology is suspected, it is also examined. With hepatitis, problems with general health are often associated specifically with the functioning of the gallbladder. Such a symptom as pain due to gland pathology rarely appears, but the gallbladder signals with painful sensations about violations in the diet. Cholecystitis can be a consequence or some complication of hepatitis C, which will require separate treatment.

What does ultrasound show for hepatitis? A liver ultrasound can help diagnose the various stages of hepatitis C and cirrhosis. The monitor shows what the liver looks like, its size, density, foreign inclusions and other various parameters of the organ. Each of the diseases, including hepatitis C and its various stages, has its own special ultrasound signs.

From the results of this study you can see:

In acute hepatitis C, ultrasound shows a slightly increased size of the organ, its surface is smooth and even. Several foci of necrosis are visible, and foci of fatty degeneration are detected. The blood flow is clearly visible and is not disturbed.
Chronic hepatitis on ultrasound is determined by the following indicators. A large number of foci of necrosis. The liver tissue is almost destroyed, and in its place is overgrown connective tissue. Fibrous strands are visible.
With cirrhosis of the liver, an ultrasound will show poor circulation, varicose veins and the formation of additional vessels through which some of the blood circulates, bypassing the gland.

Thanks to ultrasound diagnostics, it is possible to diagnose hepatitis at an early stage and begin treatment immediately, without waiting for complications and cirrhosis. The main thing that an ultrasound can show in the initial stage of the disease is that the size of the liver immediately becomes enlarged during hepatitis.

But the danger and insidiousness of this disease lies in the fact that in the early stages it is most often asymptomatic, although inflammation in the liver due to infection is in full swing.

Alarming signs may appear only in the later stages of the disease: with exacerbation of chronic hepatitis C or cirrhosis of the liver. Therefore, it is recommended to undergo regular examinations in order to monitor the condition of the liver and the behavior of the viral infection.

How to prepare for a liver ultrasound?

In order for ultrasound readings to be as accurate and informative as possible, you should properly prepare for the procedure. In this case, it is recommended to refrain from eating for several hours. In order to free the abdominal cavity from excess gases, you should not consume the following products for 3 days before the procedure:

legumes;
milk;
carbonated drinks;
fresh vegetables;
cabbage

A day before the study, you need to perform a cleansing enema (especially for those patients who are overweight). In each specific case, the doctor may recommend taking any other measures in order to properly prepare for an ultrasound scan for hepatitis C.

How is the research going?

An ultrasound of the liver is performed with an ultrasound probe. The patient should lie down and hold his breath. At this time, the doctor, moving the sensor across the abdomen, receives data about the organ being examined on the monitor screen.

The screen reflects in real time the condition of the patient’s liver, its structure, size and other parameters. Most often, 2 D ultrasound is used when examining the liver. This device displays on the screen a two-dimensional, flat black and white image that has height and length. Recently, three-dimensional ultrasound devices - 3D and 4D - have become increasingly widespread.

Both of these types of research differ from the previous one in volumetric image and color. They differ from each other in that the 3D picture shows a three-dimensional image of the organ from one point of view. When conducting a 4D study, the doctor can expand the three-dimensional image of the organ and examine it from all sides, so the parameters of the liver will be very clearly visible.

When is 3D and 4D examination indicated? Sometimes a two-dimensional ultrasound is enough to make an accurate diagnosis, but there are cases when the diagnosis needs to be clarified, supplemented or confirmed. Before planned surgery, a three-dimensional ultrasound is indicated.

Preparation for such an ultrasound must be thorough, in compliance with all the above recommendations and one more important point: if an X-ray examination was carried out the day before, you must inform the doctor about this, since the results may be distorted.

Indications

Indications for ultrasound of the gallbladder and liver:

yellowness of the skin and mucous membranes;
bright yellow color of urine or increased concentration of bile pigments in it;
increased levels of bilirubin in plasma;
deviation of transaminase levels in the blood;
dull pain or discomfort in the right hypochondrium;
assumption of the presence of neoplasms;
clarification of the presence of metastases in the organ, their location, number;
differential diagnosis of lesions of the gland and gallbladder;
abdominal trauma;
Ultrasound control during operations;
preventive examination;
assessment of treatment adequacy.

Contraindications

Ultrasound is not indicated if there is:

purulent skin damage;
burns in the area being examined;
patient refusal.

Emergency liver ultrasound has no contraindications.

Preparation

In order for the examination to show reliable results, it is necessary to follow the preparation rules:

Avoid eating cabbage, fruit, dairy, brown bread, yeast products and carbonated drinks 2-4 days before the examination.
A fractional diet with a frequency of eating 4-6 times a day is shown.
The volume of fluid consumed is recommended to be kept to 1.5 liters per day.
You need to take enzymes for chronic digestive dysfunction.
An hour before the examination, in case of constipation or bloating, give an enema.
The procedure is carried out on an empty stomach.
Emergency examination does not require preparation.
The procedure is not performed within 2 days after X-ray contrast or endoscopic examination of the stomach.
After laparoscopy, examination is carried out 2-6 days later.
It is not recommended to stop taking any medications.

Decoding

The size and boundaries of the liver are one of the main characteristics of the organ. Indicators depend on age, gender, body composition. Men have larger volumes, weight and parameters than women. The right and left lobes are measured separately. In the process of performing ultrasound, the structure of the organ, which is normally homogeneous, the homogeneity of tissues, bile ducts, vascular pattern, and the size of the lobes are studied.

What does it show?

Ultrasound results and signs show the presence of pathologies:

Spots on the liver are areas of increased echogenicity. They may be a consequence of enzyme dysfunction, a sign of cysts, hepatosis or hemangiomas, or Giardia lesions.
An echo-positive formation in the liver is a sign of hemangiomas, cancer, metastases, abscess, cysts, fatty inclusions, adenoma, focal hyperplasia.
Acute and chronic hepatitis. Ultrasound of the liver with hepatitis does not have characteristic changes. Possible: inhomogeneity of the structure, areas of reduced echogenicity due to tissue edema, enlargement of the organ, increase in parameters, medium-grained structure of the liver, impoverishment of the vascular pattern. The progression of the disease changes the echogenicity of the tissue.
Cirrhosis. An ultrasound will show a violation of the structure of blood vessels and gland tissue, the processes of cell restoration and sclerosis. The organ increases in volume in the early phases of the disease and decreases in the latter. The correlation between the sizes of the lobes changes: the left and tail parts increase, the right part decreases. The contour becomes uneven and lumpy, regeneration nodes of more than 5-15 mm are identified. The parenchyma is heterogeneous, the vascular pattern is depleted, and criteria for increased pressure in the portal vein system appear.
Portal hypertension. The criteria include: a change in organ parameters towards an increase, restoration of the permeability function of the umbilical vein, an increase in the lumen of the portal vein, a change in the caliber of the splenic vein, splenomegaly. Hepatosis or fatty infiltration is accompanied by a diffuse increase in tissue echogenicity, an increase in size, and a softening of the vascular pattern. Areas of reduced echogenicity, distal attenuation of the echo signal, and changes in the oblique vertical dimension also appear. A “white liver” is visualized on ultrasound.
Budd-Chiari syndrome. Deficient image of veins, tortuosity and reduction in the diameter of vessels, enlargement of the caudate lobe, venous bypasses, absence of veins.
Metastases. The histological structure does not meet the echographic characteristics.
Hepatocellular carcioma. Hypo- or hyperechoic nodes are detected.
Hemangiomas. The small size of the formation is up to 4 cm, a uniform increase in the echogenicity of the structure, clear contours, typically located under the capsule of the right lobe.
Cysts and cyst-like structures. Single formations with the inclusion of liquid of various locations are observed. Single cysts have a round shape. Sizes range from a couple of millimeters to many centimeters.
Calcifications. On ultrasound they are presented as dense single or numerous formations surrounded by sound tissue.

Assessing the liver using ultrasound requires skill and experience. When a patient seeks advice, every doctor must be able to understand the meaning of terms and their interpretation. Only after a complete clinical examination, taking into account the patient’s complaints and condition, and obtaining the results of additional examination methods, an appropriate treatment regimen and lifestyle correction is prescribed.

Indications for ultrasound examination of the hepatobiliary system are:

Abnormal liver tests (indicates decreased function). Jaundice (yellowing of the skin and mucous membranes). Injuries and diseases of the abdominal cavity. Gallbladder problems. Suggestion of an oncological process. Feverish state of unknown origin.

Ultrasound helps identify various abnormalities

What are the ultrasound signs of hepatitis and is one ultrasound examination always enough to make a diagnosis?

The acute form of the disease occurs with typical bright symptoms: fever, pain in the right hypochondrium, dysfunction.

Is it possible to see acute hepatitis C on an ultrasound of the liver?

The diagnosis of acute hepatitis C is made on the basis of clinical complaints, examination of the patient, medical history and results of biochemical tests.

What does chronic hepatitis C look like on ultrasound?

Additional tests are needed to accurately diagnose the disease.

The chronic form often has a latent course and appears when changes in the structure are already quite clearly expressed and noticeable on ultrasound.

For what purpose is ultrasound prescribed for viral hepatitis?

In order to determine the state of the organ at the moment, the progression of the disease or make a conclusion about the effectiveness of treatment.

If focal compaction is noted, fibrotic areas of tissue, unevenness and tuberosity of the liver suggest the onset of cirrhosis.

An increase in echogenicity (light-colored liver) indicates fatty degeneration of the hepatic parenchyma. Fatty hepatosis.

During the study, the following parameters are assessed: shape, size, structure and condition of the ducts and hepatic collaterals.

The results obtained are compared with standards and a conclusion is drawn.

Let us list the main ultrasound moments that suggest hepatitis.

Increase in size.

One of the signs of hepatitis is an enlarged liver

Reduced echogenicity.

Heterogeneity of the liver parenchyma.

Does not always indicate viral hepatitis; such changes may indicate sclerosing cholangitis, fatty transformation of liver tissue, cirrhosis and autoimmune hepatitis.

Pronounced vessels.

A consequence of swelling of inflamed tissues, against a “dark” background of which the vessels become clearly visible, this is a frequent, but not constant indicator.

The appearance of visible signs of chronicity is observed with further progression of the viral infection. A cause for concern is the identification during an ultrasound examination of:

A noticeable increase in the size of the liver (both lobes). The appearance of uneven edges and blurred outline (a characteristic sign of cirrhosis). Rounding of the lower edge, increased echogenicity of the tissue (progression). Heterogeneity. Gradual depletion of the vascular pattern. A decrease in sound conductivity indicates the growth in the parenchyma of dense connective tissue that does not conduct ultrasound waves well.

Deciphering a liver ultrasound will help you understand what certain terms mean, written by the doctor who examined your liver. A complete interpretation of the results, taking into account your symptoms and objective data, the prognosis and treatment is determined by the doctor.
This could be an infectious disease specialist, oncologist, gastroenterologist, therapist or surgeon).

How preparation for liver ultrasound is carried out is described in detail in the corresponding section; it is not very difficult.

Therapy is not selected based solely on the results of an ultrasound scan of the liver.

A little about how this type of ultrasound diagnostics is done. You come to the office, lie down on the couch, and lift your clothes so that the chest area and abdominal wall are free for examination. A gel is applied to the hypochondrium area on the right, along which the sensor will move. This should not cause any discomfort at all.

The normal liver ultrasound includes the following indicators:

the size of each echogenic lobe of the contours of the liver and its structure.

For ease of inspection, 8 segments of the liver are distinguished based on some anatomical landmarks. They evaluate all the above parameters and compare them with the norm. If an organ pathology is detected, indicate in which segments it was found.

Let's talk about what the research shows. With its help, the following changes in organ tissue are detected:

Here is a breakdown of the most common terms that the sonologist indicates in the conclusion of the study.

Liver calcification. This word refers to a dense area in the parenchyma, saturated with calcium salts. Such formations can appear as a result of infectious diseases (malaria, amoebiasis, tuberculosis), which in the active phase did not affect the entire organ, but formed foci of inflammation in it.

First of all, it is a liver cyst, that is, a round benign formation in one of the lobes that contains liquid inside (usually transparent, but can be filled with blood, bile or pus).

There are single and multiple cysts (they fill 30% or less of the liver tissue), there is also a congenital disease called polycystic liver disease, when cysts fill about 60% or more of the organ tissue.

There is also the concept of “false cyst,” when the wall of the cyst is not a thin film, but scar tissue changed due to rupture, removal of the cyst or abscess.

These are the terms that ultrasound doctors use to describe the echo characteristics of changes, which “in real life” can be understood as several diagnoses:

Spots on the liver - this term means that there are foci in the tissue in which the echogenicity of the liver is increased. This may indicate areas of helminthic infestation (giardiasis). To clarify the diagnosis in this case, it is recommended to undergo a computed tomography. Lump in the liver is also a purely sonological diagnosis. This indicates that there are areas in the tissue that can be either nodes of incipient cirrhosis or tumors.

Signs of diffuse changes

Below we will briefly describe the signs of those diseases that cause changes not in individual areas, but throughout the entire surface of the liver.

The diagnosis of viral hepatitis, much less specific hepatitis (A, B, C), is not made by ultrasound. The following changes may be described with hepatitis C:

if an ultrasound was done in the acute period, there is an enlargement of the liver itself, an increase in its density, disruption and heterogeneity of the structure; signs of chronic hepatitis: enlargement of the liver, heterogeneity of its structure, unclear vascular pattern.

If an ultrasound describes diffuse changes in the liver, this means that the parenchyma of this organ along its entire length is changed due to fibrosis, hypertrophy, sclerosis, dystrophy or swelling. That is, this is not a diagnosis, but a symptom that can occur in the following diseases:

autoimmune hepatitis, sclerosing cholangitis, hepatitis of any etiology, cirrhosis.

The following signs of liver cirrhosis are identified on ultrasound:

the liver can be either larger or smaller (depending on the stage of the disease): first the left lobe increases, then the caudate lobe, then the liver begins to shrink; there are regeneration nodes inside, which is why the structure is mosaic; in cirrhosis, both the spleen and the diameter of the portal vein and the edges of the organ become larger rounded, tuberous structure, the corners of the liver are expanded.

The diagnosis is made not only by the echographic picture, but also by the symptoms presented by the patient. For the first time, cirrhosis of the liver can be suspected (and confirmed by ultrasound) by the presence of ascites, that is, free, uninfected fluid in the abdomen.

A light liver is an increase in the echogenicity of the organ. This picture suggests that areas have appeared in the tissue that do not transmit ultrasound well (usually fat cells). If fatty degeneration of an organ occurs, the ultrasound doctor may write “white liver” in the conclusion.

Q: What is liver screening?

A: This is the detection of people at risk of developing cancer, based on the results of tests for alpha-fetoprotein, as well as ultrasound data. It is carried out in patients with chronic forms of hepatitis B and C, with cirrhosis of the liver, as well as in countries where there are a large number of patients with liver cancer.

Q: What does “liver laboratory screening” mean?

A: This is what is colloquially called liver tests - that is, an analysis of venous blood, in which the following substances are determined:

total and direct bilirubin fractions, ALT and AST enzymes, gamma-glutamyl transferase alkaline phosphatase.

Q: What does screening for autoimmune liver disease mean?

A: This is also a type of analysis from a vein, which helps to determine autoimmune hepatitis and a second autoimmune disease - primary biliary cirrhosis. The following types of antibodies are determined in the blood:

to smooth muscles, to parietal cells of the stomach, to liver microsomes and kidney mitochondria.

Elevated levels of these tests indicate that autoimmune hepatitis is present in this case. It is also possible to determine the type of disease using some specific levels.

Q: When and why is liver puncture performed under ultrasound guidance?

A: Ultrasound determines where to insert the needle to collect cellular material suspicious for a malignant tumor. When the needle enters the node, they look at how the ultrasound picture changes (hemangiomas, that is, benign formations, tend to disappear during puncture).

An ultrasound of the liver can be performed at a clinic or public hospital at your place of residence at a low cost or even free. To do this, you must obtain a referral from your attending physician.

You can also undergo this type of diagnosis in a multidisciplinary center or a private ultrasound diagnostic room. Its price ranges from 700 to 1200 rubles, while in reviews people write that where the research is more expensive, it will not necessarily be better: it all depends on the specialist performing it.

Thus, interpretation of liver ultrasound is an important step in conducting this study. It is on this that the further tactics of examination, treatment and evaluation of the effectiveness of the prescribed therapy depend.

ATTENTION! The information on the site is for reference or popular information only. Correct treatment and prescription of medications can only be carried out by a qualified specialist, taking into account the diagnosis and medical history.

Successful diagnosis and treatment, health and well-being! Your uzilab.ru.

Hepatitis C is a viral disease transmitted by contact. The disease is characterized by a mild or acute form, which can provoke the development of a chronic form, as well as severe incurable consequences.

Diagnosis of this complex disorder is based not only on blood testing for the presence of markers, antibodies, and determining the level of bilirubin, but also requires mandatory ultrasound and computer examination.

In more severe cases, direct examination of the patient's liver tissue is required.

HBCAg is the main marker of hepatitis C. But in addition to this marker, a number of corresponding antibodies can be detected, the presence of which may indicate the exact likelihood of developing the disease.

It is worth noting that even if in a single case markers of hepatitis C were identified during diagnosis, this does not indicate the presence of an acute or chronic disease.

To get a more detailed picture, you need to contact an infectious disease doctor, who, after prescribing the appropriate tests, samples and examinations, will be able to establish an accurate diagnosis.

Before starting a diagnosis, you should take into account all the symptoms and the general condition of the body.

If jaundice is noted on the body, this is the first sign of a malfunction of the liver (yellowness of the skin and sclera). This is due to the fact that the level of bilirubin (yellow pigment) occurs due to the breakdown of red blood cells. A normally functioning liver independently utilizes bilirubin from the body, but if its function is impaired, it cannot fully perform its function, and, therefore, the yellow pigment is not filtered out. Darkening of urine as the kidneys try to utilize excess bilirubin. The disease is accompanied by ailments, fatigue, pain in the right side, hypochondrium, abdomen, fever and poor appetite. Skin itching is often observed, which appears due to intoxication of the body, i.e. the liver cannot cope with incoming toxic substances. Diseases that the patient previously suffered from, especially hepatitis, are also taken into account. The hereditary factor is checked. Alcohol abuse and uncontrolled use of certain medications are also taken into account.

Due to the fact that the virus of the disorder was discovered recently, the diagnosis of hepatitis C, namely the virus that provokes its development, has not been thoroughly developed, therefore the main diagnostic factor is the presence of antibodies belonging to group C.

The presence of antibodies can currently be determined using an immunosorbent test and a RIBA test (immune recombinant spots). Basically, in medicine, the first test is used, since the second one requires large expenses.

To get a more accurate picture of what is happening, the doctor must prescribe a blood test and a number of examinations (ultrasound, CT scan of the liver, radioisotope scanning, liver tests, determination of serum enzymes, sometimes a biopsy), which are discussed further.

Ultrasound of the liver for hepatitis C is one of the main instrumental examinations prescribed by the doctor, thanks to which it is possible to examine the condition of the liver and bile ducts.

Ultrasound is a painless procedure that takes little time, but can show even minor organ abnormalities and, based on the results of which, a decision is made on further manipulations.

On the eve of this diagnostic procedure, it is recommended not to eat for six hours, because this is exactly the time needed to fill the gallbladder, which is the only way to examine it.

The study shows the size of organs and bile ducts, their location, the presence of stones and blockages. Also thanks to this, it is possible to determine the blood flow of the liver, examine the kidneys, bile and spleen.

CT is a widely used diagnostic method, with which you can obtain a three-dimensional view of the liver, blood vessels adjacent to it, the gallbladder and its canals, kidneys, pancreas, and spleen.

This simple examination, which takes a little more than half an hour, allows you to instantly determine the presence of tumors, cysts, and mechanical damage.

Before the procedure, it is forbidden to eat food for 12 hours.

Before starting, you should drink a special solution with a radiopaque substance, which improves visibility of organs.

To date, this is the most informative procedure in which the subject is injected with radioactive isotopes, which help to examine the bladder and track the movement of bile.

Thanks to a special device, you can obtain a picture resembling an x-ray image, in which you can determine the condition of the organ, as well as its diseases, such as cirrhosis or malignant neoplasms.

The dosage of isotopes introduced into the body is very small and cannot cause harm.

Liver tests show the adequacy of treatment, make a prognosis of the disease, and also determine liver disorders.

The level of alkaline phosphatase, bilirubin, serum enzymes, transaminases, albumin, as well as factors of the blood coagulation system are determined, this allows us to determine the degree of liver damage.

Liver tests can also help detect cancer of the pancreas, bile ducts, stones, or damage to the ducts.

Biopsy

A biopsy is an effective method for diagnosing hepatitis C, which is carried out exclusively by a specialist in a hospital.

A small piece of liver tissue is removed with a special needle and sent for histological examination in a special laboratory.

Before starting the procedure, the patient must be given an anesthetic to minimize discomfort and eliminate pain. Upon completion, the patient must remain in the hospital for several more hours for medical observation.

As a rule, an ultrasound and CT scan are performed with a biopsy so that the doctor can see the place where the needle was inserted, this eliminates complications.

A biopsy is used to diagnose chronic hepatitis, which can be distinguished from other liver disorders that are provoked by excessive consumption of alcoholic beverages, uncontrolled use of certain medications, and impaired metabolism.

Using this procedure, it is possible to determine primary (occurs directly in the organ) and secondary (introduced into the organ from others) liver cancer, the chronic form of hepatitis, hemochromatosis and other liver diseases. It can also be used as a control of the organ after treatment and to make a prognosis.

The development of medicine is so rapid that ultrasound has long been considered commonplace. But ultrasound scanning is truly one of the best inventions among methods for diagnosing various diseases. It’s hard to believe, but medical ultrasound, respected by all doctors, did not exist 80 years ago. An ultrasound machine is good because the sound vibrations it reads are not accessible to human hearing, but it is ideal for examining internal organs and obtaining accurate results about their condition. It was the internal organs that were inaccessible for a long time, which once again proves the usefulness of this method. Today we will talk about, namely, an ultrasound of the liver: why and when to undergo it, how to prepare for such an ultrasound, what liver diseases can be learned about with its help and how to decipher all these images.

Why and when should you go for an ultrasound of the liver?

Typically, an ultrasound of the liver is prescribed if test results indicate damage to this organ or disruption of its functions. Ultrasound is also often used as a safety net: to ensure the accuracy of an already made diagnosis. Sometimes ultrasound is used even for minor surgery (if a tumor has formed on the liver). In case of cancer, an ultrasound is often necessary to understand whether there is. If a person received it, it would be much more difficult to assess whether the internal organs in the abdominal cavity, including the liver, are damaged without an ultrasound.

When treating liver diseases, more than one ultrasound visit is usually required. The doctor needs to monitor changes during therapy; if progress is not noticeable, the examination helps to change treatment in time.

Preparation for liver ultrasound

Almost all methods of diagnosing internal organs are carried out on an empty stomach. If a liver ultrasound is scheduled in the morning, you should skip breakfast. If after lunch, you need to give up food 5-10 hours before. Not because “doctors will swear,” this is in the interests of the patient himself: intestinal gases distort the image. Moreover, there is a possibility that doctors may misread the image: gas bubbles may even resemble a tumor. Sooner or later the false signal will be refuted, but the nerves cannot be returned.

It is most difficult for people with a high degree of obesity, since the fat layer dampens the signal and makes it difficult to see the outlines of the organ. That is why such patients are entitled to a cleansing enema.

How to decipher an ultrasound image of the liver

It is clear that deciphering an ultrasound is not the patient’s business. But a general understanding of the basic principles of this process certainly won’t hurt.

An ultrasound shows the condition of the liver down to the smallest detail, but most carefully the doctor will study the structure and size of the entire organ, its lobes (if, remember, the liver is divided into “halves”, and in addition to the right and left, they also distinguish the caudate and quadrate), as well as the bile ducts ducts, small and large vessels.

It will be difficult to independently analyze whether your liver size is within the normal range. But a table of average liver parameters still exists: the right lobe of the liver should be within 12.5 cm, the smaller left lobe - up to 7 cm. The normal size of the bile ducts is 6-8 mm, and the diameter of the so-called portal vein - up to 1.3 cm.

What you can definitely evaluate personally is the evenness of the edges and the uniformity of the liver structure. “Visibility” depends on the position in which you will have the ultrasound. Each specialist has his own techniques, which also depend on the tasks (which part of the liver needs to be examined in more detail), but usually the examination begins with the upper abdomen. Don't worry that you won't get enough information: as practice shows, ultrasound specialists are commentators. But seriously, the doctor is obliged to provide advice after the procedure.

What you can definitely evaluate personally is the evenness of the edges and the uniformity of the liver structure. But the “visibility” of the process will depend on the position in which you will have the ultrasound. Each specialist has his own techniques, which also depend on the tasks (which part of the liver needs to be examined in more detail), but usually the examination begins with the upper abdomen. Don’t worry, as practice shows, ultrasound specialists are just commentators. But seriously, the doctor is obliged to give detailed advice after the procedure.

What liver diseases can be detected by ultrasound?

Ultrasound can detect or confirm almost all liver diseases. And even if any of the main diagnoses listed below are confirmed, this is better than not guessing about the disease or treating something “wrong.” An ultrasound examination can detect even small changes in the liver, which means it increases the chances of preventing or timely treating the disease.

Ultrasound of the liver will determine: hepatitis

Acute and chronic hepatitis is determined by the enlargement, heterogeneity of the structure and swelling of the liver. Ultrasound alone is not enough. It is usually prescribed after to assess the extent of liver damage. The specialist may also notice warning signs of inflammation, fibrosis and changes in organ tissue density, which are characteristic of chronic hepatitis.

Ultrasound of the liver will determine: cirrhosis of the liver

Ultrasound of the liver will determine: Budd-Chiari syndrome

Ultrasound of the liver will determine: hemangioma

If detected during the examination, it can save the patient’s life. Firstly, this is a fairly common disease (especially in women). Secondly, if it is not detected by ultrasound, this benign vascular formation can grow and even occupy most of the liver, without causing any discomfort. But its rupture at such a size is extremely dangerous; in 80% of cases people die from bleeding. Fortunately, once the diagnosis is confirmed with an MRI or CT X-ray, the hemangioma can be controlled. , if the formation increases and do not worry if it does not change in size. Don't worry, you won't even need surgery right away, but only if other treatment methods have been exhausted - for example, hormonal therapy.

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Hepatitis is the name given to acute and chronic inflammatory diseases of the liver that are not focal, but widespread. Different hepatitises have different methods of infection; they also differ in the rate of disease progression, clinical manifestations, methods and prognosis of therapy. Even the symptoms of different types of hepatitis are different. Moreover, some symptoms are stronger than others, which is determined by the type of hepatitis.

Main symptoms

Jaundice. The symptom occurs frequently and is due to the fact that bilirubin enters the patient’s blood when the liver is damaged. Blood, circulating throughout the body, carries it to organs and tissues, coloring them yellow.
The appearance of pain in the area of the right hypochondrium. It occurs due to an increase in the size of the liver, leading to pain that can be dull and prolonged or of a paroxysmal nature.
Deterioration of health, accompanied by fever, headaches, dizziness, indigestion, drowsiness and lethargy. All this is a consequence of the effect of bilirubin on the body.

Hepatitis acute and chronic

Hepatitis in patients has acute and chronic forms. In acute form, they appear in the case of viral liver damage, as well as if there has been poisoning with various types of poisons. In acute forms of the disease, the condition of patients quickly deteriorates, which contributes to the accelerated development of symptoms.

With this form of the disease, favorable prognosis is quite possible. Except for its transformation into chronic. In its acute form, the disease is easily diagnosed and easier to treat. Untreated acute hepatitis easily develops into a chronic form. Sometimes, with severe poisoning (for example, alcohol), the chronic form occurs independently. In the chronic form of hepatitis, the process of replacement of liver cells with connective tissue occurs. It is weakly expressed, progresses slowly, and therefore sometimes remains undiagnosed until cirrhosis of the liver occurs. Chronic hepatitis is less treatable, and the prognosis for its cure is less favorable. In the acute course of the disease, health deteriorates significantly, jaundice develops, intoxication appears, the functional functioning of the liver decreases, and the bilirubin content in the blood increases. With timely detection and effective treatment of acute hepatitis, the patient most often recovers. When the disease lasts more than six months, hepatitis becomes chronic. The chronic form of the disease leads to serious disorders in the body - the spleen and liver enlarge, metabolism is disrupted, complications arise in the form of cirrhosis of the liver and cancer. If the patient has reduced immunity, the treatment regimen is chosen incorrectly, or there is alcohol dependence, then the transition of hepatitis to a chronic form threatens the patient’s life.

Types of hepatitis

Hepatitis has several types: A, B, C, D, E, F, G, they are also called viral hepatitis, since they are caused by a virus.

Hepatitis A

This type of hepatitis is also called Botkin's disease. It has an incubation period lasting from 7 days to 2 months. Its causative agent, an RNA virus, can be transmitted from a sick person to a healthy person through poor-quality food and water, or contact with household items used by the sick person. Hepatitis A is possible in three forms, they are divided according to the severity of the disease:

in the acute form with jaundice, the liver is seriously damaged;
with subacute without jaundice, we can talk about a milder version of the disease;
in the subclinical form, you may not even notice symptoms, although the infected person is the source of the virus and is capable of infecting others.

Hepatitis B

This disease is also called serum hepatitis. Accompanied by an enlarged liver and spleen, joint pain, vomiting, fever, and liver damage. It occurs either in acute or chronic forms, which is determined by the state of the patient’s immunity. Routes of infection: during injections in violation of sanitary rules, sexual contact, during blood transfusions, and the use of poorly disinfected medical instruments. The duration of the incubation period is 50 ÷ 180 days. The incidence of hepatitis B decreases with vaccination.

Hepatitis C

This type of disease is one of the most serious diseases, as it is often accompanied by cirrhosis or liver cancer, which subsequently leads to death. The disease is difficult to treat, and moreover, having had hepatitis C once, a person can be infected with the same disease again. It is not easy to cure HCV: after contracting hepatitis C in an acute form, 20% of patients recover, but in 70% of patients the body is not able to recover from the virus on its own, and the disease becomes chronic. It has not yet been possible to establish the reason why some heal on their own and others do not. The chronic form of hepatitis C will not disappear on its own and therefore requires therapy. Diagnosis and treatment of the acute form of HCV is carried out by an infectious disease specialist, and the chronic form of the disease is carried out by a hepatologist or gastroenterologist. You can become infected during a plasma or blood transfusion from an infected donor, through the use of poorly processed medical instruments, through sexual contact, and a sick mother transmits the infection to her child. The hepatitis C virus (HCV) is rapidly spreading throughout the world; the number of patients has long exceeded one and a half hundred million people. Previously, HCV was difficult to treat, but now the disease can be cured using modern direct-acting antivirals. But this therapy is quite expensive, and therefore not everyone can afford it.

Hepatitis D

This type of hepatitis D is possible only with coinfection with the hepatitis B virus (coinfection is the case of infection of one cell with viruses of different types). It is accompanied by massive liver damage and an acute course of the disease. The route of infection is the entry of the disease virus into the blood of a healthy person from a virus carrier or a sick person. The incubation period lasts 20 ÷ 50 days. Externally, the course of the disease resembles hepatitis B, but its form is more severe. It can become chronic, later turning into cirrhosis. It is possible to carry out vaccination similar to that used for hepatitis B.

Hepatitis E

It is slightly reminiscent of hepatitis A in its course and transmission mechanism, since it is also transmitted through the blood. Its peculiarity is the occurrence of lightning-fast forms that cause death in a period not exceeding 10 days. In other cases, it can be effectively treated, and the prognosis for recovery is most often favorable. An exception may be pregnancy, since the risk of losing a child is close to 100%.

Hepatitis F

This type of hepatitis has not yet been studied enough. It is only known that the disease is caused by two different viruses: one was isolated from the blood of donors, the second was found in the feces of a patient who received hepatitis after a blood transfusion. Signs: the appearance of jaundice, fever, ascites (fluid accumulation in the abdominal cavity), an increase in the size of the liver and spleen, an increase in the levels of bilirubin and liver enzymes, the occurrence of changes in urine and feces, as well as general intoxication of the body. Effective methods of treating hepatitis F have not yet been developed.

Hepatitis G

This type of hepatitis is similar to hepatitis C, but is not as dangerous because it does not contribute to the development of cirrhosis and liver cancer. Cirrhosis can only appear in cases of co-infection with hepatitis G and C.

Diagnostics

Viral hepatitis is similar in its symptoms to one another, just like some other viral infections. For this reason, it can be difficult to accurately diagnose a sick person. Accordingly, to clarify the type of hepatitis and the correct prescription of therapy, laboratory blood tests are required to identify markers - indicators individual for each type of virus. By identifying the presence of such markers and their ratio, it is possible to determine the stage of the disease, its activity and possible outcome. In order to track the dynamics of the process, the examinations are repeated after a period of time.

How is hepatitis C treated?

Modern treatment regimens for chronic forms of HCV are reduced to combination antiviral therapy, including direct-acting antivirals such as sofosbuvir, velpatasvir, daclatasvir, ledipasvir in various combinations. Sometimes ribavirin and interferons are added to enhance effectiveness. This combination of active ingredients stops the replication of viruses, saving the liver from their destructive effects. This type of therapy has a number of disadvantages:

The cost of drugs to combat the hepatitis virus is high; not everyone can buy them.
Taking certain medications is accompanied by unpleasant side effects, including fever, nausea, and diarrhea.

The duration of treatment for chronic forms of hepatitis takes from several months to a year, depending on the genotype of the virus, the degree of damage to the body and the drugs used. Because hepatitis C primarily attacks the liver, patients are required to follow a strict diet.

Features of HCV genotypes

Hepatitis C is one of the most dangerous viral hepatitis. The disease is caused by an RNA virus called Flaviviridae. The hepatitis C virus is also called the “gentle killer.” He received such an unflattering epithet due to the fact that at the initial stage the disease is not accompanied by any symptoms at all. There are no signs of classic jaundice, and there is no pain in the area of the right hypochondrium. The presence of the virus can be detected no earlier than a couple of months after infection. Before this, the reaction of the immune system is completely absent and markers cannot be detected in the blood, and therefore genotyping is not possible. Another feature of HCV is that after entering the bloodstream during the process of reproduction, the virus begins to rapidly mutate. Such mutations prevent the infected person’s immune system from adapting and fighting the disease. As a result, the disease can proceed for several years without any symptoms, after which cirrhosis or a malignant tumor appears almost immediately. Moreover, in 85% of cases, the disease goes from an acute form to a chronic one. The hepatitis C virus has an important feature - a variety of genetic structure. In fact, hepatitis C is a collection of viruses, classified depending on their structural variants and divided into genotypes and subtypes. The genotype is the sum of genes encoding hereditary traits. So far, medicine knows 11 genotypes of the hepatitis C virus, which have their own subtypes. The genotype is designated by numbers from 1 to 11 (although genotypes 1 ÷ 6 are mainly used in clinical studies), and subtypes are designated using letters of the Latin alphabet:

1a, 1b and 1c;
2a, 2b, 2c and 2d;
3a, 3b, 3c, 3d, 3e and 3f;
4a, 4b, 4c, 4d, 4e, 4f, 4h, 4i and 4j;

In different countries, HCV genotypes are distributed differently; for example, in Russia, the most common genotypes are the first to the third. The severity of the disease depends on the type of genotype; they determine the treatment regimen, its duration and the result of treatment.

How are HCV strains distributed across the planet?

Hepatitis C genotypes are distributed heterogeneously across the globe, and genotypes 1, 2, 3 can most often be found, and in certain areas it looks like this:

in Western Europe and its eastern regions, genotypes 1 and 2 are most common;
in the USA - subtypes 1a and 1b;
in northern Africa, genotype 4 is the most common.

People with blood diseases (tumors of the hematopoietic system, hemophilia, etc.), as well as patients undergoing treatment in dialysis units, are at risk of possible HCV infection. Genotype 1 is considered the most common across the world - it accounts for ~50% of the total number of cases. In second place in prevalence is genotype 3 with an indicator of slightly more than 30%. The spread of HCV throughout Russia has significant differences from the global or European variants:

genotype 1b accounts for ~50% of cases;
for genotype 3a ~20%,
~10% of patients are infected with hepatitis 1a;
hepatitis with genotype 2 was found in ~5% of infected people.

But the difficulties of HCV therapy depend not only on the genotype. The effectiveness of treatment is also influenced by the following factors:

age of patients. The chance of cure is much higher in young people;
It is easier for women to recover than for men;
the degree of liver damage is important - the favorable outcome is higher with less damage;
the magnitude of the viral load - the fewer viruses in the body at the time of treatment, the more effective the therapy;
the patient’s weight: the higher it is, the more complicated the treatment becomes.

Therefore, the treatment regimen is chosen by the attending physician, based on the above factors, genotyping and recommendations of the EASL (European Association for Liver Diseases). EASL constantly keeps its recommendations up to date and, as new effective drugs for the treatment of hepatitis C become available, it adjusts the recommended treatment regimens.

Who is at risk for HCV infection?

As you know, the hepatitis C virus is transmitted through blood, and therefore the following are most likely to become infected:

patients receiving blood transfusions;
patients and clients in dental offices and medical institutions where medical instruments are improperly sterilized;
visiting nail and beauty salons can be dangerous due to unsterile instruments;
piercing and tattoo enthusiasts can also suffer from poorly processed tools,
there is a high risk of infection for those who use drugs due to repeated use of unsterile needles;
the fetus can become infected from a mother infected with hepatitis C;
During sexual intercourse, the infection can also enter the body of a healthy person.

How is hepatitis C treated?

It was not for nothing that the hepatitis C virus was considered a “gentle” killer virus. It can remain silent for years, and then suddenly appear in the form of complications accompanied by cirrhosis or liver cancer. But more than 177 million people in the world have been diagnosed with HCV. The treatment that was used until 2013, combining injections of interferon and ribavirin, gave patients a chance of healing that did not exceed 40-50%. Moreover, it was accompanied by serious and painful side effects. The situation changed in the summer of 2013 after the US pharmaceutical giant Gilead Sciences patented the substance sofosbuvir, produced in the form of a drug under the Sovaldi brand, which included 400 mg of the drug. It was the first direct acting antiviral drug (DAA) to combat HCV. The results of clinical trials of sofosbuvir pleased doctors with the effectiveness, which reached 85 ÷ 95% depending on the genotype, while the duration of the course of therapy was more than halved compared to treatment with interferons and ribavirin. And, although the pharmaceutical company Gilead patented sofosbuvir, it was synthesized in 2007 by Michael Sophia, an employee of Pharmasett, which was later acquired by Gilead Sciences. From Michael’s last name, the substance he synthesized was named sofosbuvir. Michael Sofia himself, together with a group of scientists who made a number of discoveries that revealed the nature of HCV, which made it possible to create an effective drug for its treatment, received the Lasker-DeBakey Award for Clinical Medical Research. Well, almost all of the profit from the sale of the new effective product went to Gilead, which set monopoly high prices for Sovaldi. Moreover, the company protected its development with a special patent, according to which Gilead and some of its partner companies became the owners of the exclusive right to manufacture the original DPP. As a result, Gilead's profits in just the first two years of sales of the drug many times covered all the costs that the company incurred to acquire Pharmasett, obtain a patent and subsequent clinical trials.

What is Sofosbuvir?

The effectiveness of this drug in the fight against HCV has proven to be so high that now almost no treatment regimen can do without its use. Sofosbuvir is not recommended for use as monotherapy, but when used in combination it shows exceptionally good results. Initially, the drug was used in combination with ribavirin and interferon, which made it possible to achieve a cure in just 12 weeks in uncomplicated cases. And this despite the fact that therapy with interferon and ribavirin alone was half as effective, and its duration sometimes exceeded 40 weeks. After 2013, each subsequent year brought news of the emergence of more and more new drugs that successfully fight the hepatitis C virus:

daclatasvir appeared in 2014;
2015 was the year of birth of ledipasvir;
2016 pleased with the creation of velpatasvir.

Daclatasvir was released by Bristol-Myers Squibb in the form of Daklinza, containing 60 mg of the active substance. The next two substances were created by Gilead scientists, and since neither of them was suitable for monotherapy, the drugs were used only in combination with sofosbuvir. To facilitate therapy, Gilead prudently released the newly created drugs immediately in combination with sofosbuvir. This is how the drugs appeared:

Harvoni, combining sofosbuvir 400 mg and ledipasvir 90 mg;
Epclusa, which included sofosbuvir 400 mg and velpatasvir 100 mg.

During therapy with daclatasvir, two different drugs had to be taken: Sovaldi and Daklinza. Each paired combination of active ingredients was used to treat specific HCV genotypes according to treatment regimens recommended by EASL. And only the combination of sofosbuvir with velpatasvir turned out to be a pangenotypic (universal) drug. Epclusa cured all genotypes of hepatitis C with almost equally high effectiveness of approximately 97 ÷ 100%.

The emergence of generics

Clinical trials confirmed the effectiveness of the treatment, but all these highly effective drugs had one significant drawback - too high prices, which prevented the majority of patients from purchasing them. Monopoly high prices for products set by Gilead caused outrage and scandals, which forced patent holders to make certain concessions, granting some companies from India, Egypt and Pakistan licenses to produce analogues (generics) of such effective and popular drugs. Moreover, the fight against patent holders offering drugs for treatment at biasedly inflated prices was led by India, as a country where millions of chronic hepatitis C patients live. As a result of this struggle, Gilead issued licenses and patent developments to 11 Indian companies to independently produce first sofosbuvir, and then its other new drugs. Having received licenses, Indian manufacturers quickly began producing generics, assigning their own trade names to the drugs they produced. This is how generics Sovaldi first appeared, then Daklinza, Harvoni, Epclusa, and India became the world leader in their production. Indian manufacturers, under a licensing agreement, pay 7% of earnings to patent holders. But even with these payments, the cost of generics produced in India turned out to be tens of times less than the originals.

Mechanisms of action

As already reported above, the new HCV therapy products that have emerged are classified as DAAs and act directly on the virus. Whereas interferon with ribavirin, previously used for treatment, strengthened the human immune system, helping the body resist the disease. Each substance acts on the virus in its own way:

Sofosbuvir blocks RNA polymerase, thereby inhibiting viral replication.

Daclatasvir, ledipasvir and velpatasvir are NS5A inhibitors that interfere with the spread of viruses and their entry into healthy cells.

This targeted effect makes it possible to successfully combat HCV using sofosbuvir for therapy in combination with daklatasvir, ledipasvir, velpatasvir. Sometimes, to enhance the effect on the virus, a third component is added to the pair, which most often is ribavirin.

Manufacturers of generics from India

Pharmaceutical companies in the country have taken advantage of the licenses granted to them, and now India produces the following generic Sovaldi:

Hepcvir - manufactured by Cipla Ltd.;
Hepcinat - Natco Pharma Ltd.;
Cimivir - Biocon ltd. & Hetero Drugs Ltd.;
MyHep is manufactured by Mylan Pharmaceuticals Private Ltd.;
SoviHep - Zydus Heptiza Ltd.;
Sofovir - manufactured by Hetero Drugs Ltd.;
Resof - produced by Dr Reddy's Laboratories;
Virso - produced by Strides Arcolab.

Analogs of Daklinza are also made in India:

Natdac from Natco Pharma;
Dacihep by Zydus Heptiza;
Daclahep from Hetero Drugs;
Dactovin by Strides Arcolab;
Daclawin from Biocon ltd. & Hetero Drugs Ltd.;
Mydacla from Mylan Pharmaceuticals.

Following Gilead, Indian drug manufacturers also mastered the production of Harvoni, resulting in the following generics:

Ledifos - released by Hetero;
Hepcinat LP - Natco;
Myhep LVIR - Mylan;
Hepcvir L - Cipla Ltd.;
Cimivir L - Biocon ltd. & Hetero Drugs Ltd.;
LadyHep - Zydus.

And already in 2017, the production of the following Indian generics of Epclusa was mastered:

Velpanat was released by the pharmaceutical company Natco Pharma;
the release of Velasof was mastered by Hetero Drugs;
SoviHep V was launched by Zydus Heptiza.

As you can see, Indian pharmaceutical companies do not lag behind American manufacturers, quickly mastering their newly developed drugs, while observing all qualitative, quantitative and medicinal characteristics. Maintaining, among other things, pharmacokinetic bioequivalence in relation to the originals.

Requirements for generics

A generic is a drug that, based on its basic pharmacological properties, can replace treatment with expensive original drugs with a patent. They can be produced either with or without a license; only its presence makes the produced analogue licensed. In the case of issuing a license to Indian pharmaceutical companies, Gilead also provided the production technology for them, giving the license holders the right to an independent pricing policy. In order for a drug analogue to be considered a generic, it must meet a number of parameters:

It is necessary to observe the ratio of the most important pharmaceutical components in the drug according to qualitative as well as quantitative standards.

Compliance with relevant international standards should be adhered to.

Proper production conditions are required.

The preparations should maintain the appropriate equivalent absorption parameters.

It is worth noting that the WHO is guarding the availability of medicines, seeking to replace expensive branded medicines with the help of budget generics.

Egyptian generics of sofosbuvir

Unlike India, Egyptian pharmaceutical companies have not become world leaders in the production of generic drugs for hepatitis C, although they have also mastered the production of sofosbuvir analogues. True, the bulk of the analogues they produce are unlicensed:

MPI Viropack, produces the drug Marcyrl Pharmaceutical Industries - one of the very first Egyptian generics;

Heterosofir, produced by Pharmed Healthcare. Is the only licensed generic in Egypt. There is a code hidden on the packaging under the hologram that allows you to check the originality of the drug on the manufacturer’s website, thereby eliminating its counterfeit;

Grateziano, manufactured by Pharco Pharmaceuticals;

Sofolanork produced by Vimeo;

Sofocivir, manufactured by ZetaPhar.

Generics to fight hepatitis from Bangladesh

Another country producing large volumes of generic anti-HCV drugs is Bangladesh. Moreover, this country does not even require licenses for the production of analogues of branded medicines, since until 2030 its pharmaceutical companies are allowed to produce such medications without having the appropriate licensing documents. The most famous and equipped with the latest technology is the pharmaceutical company Beacon Pharmaceuticals Ltd. The design of its production capacity was created by European specialists and meets international standards. Beacon produces the following generics for the treatment of hepatitis C virus:

Soforal is a generic version of sofosbuvir, containing 400 mg of active substance. Unlike traditional packaging in bottles of 28 pieces, Soforal is produced in the form of blisters of 8 tablets in one plate;
Daclavir is a generic version of daclatasvir, one tablet of the drug contains 60 mg of the active substance. It is also produced in the form of blisters, but each plate contains 10 tablets;
Sofosvel is a generic version of Epclusa, containing sofosbuvir 400 mg and velpatasvir 100 mg. A pangenotypic (universal) drug, effective in the treatment of HCV genotypes 1 ÷ 6. And in this case, there is no usual packaging in bottles, the tablets are packaged in blisters of 6 pieces in each plate.
Darvoni is a complex drug that combines sofosbuvir 400 mg and daclatasvir 60 mg. If it is necessary to combine sofosbuvir therapy with daklatasvir, using drugs from other manufacturers, you must take a tablet of each type. And Beacon combined them into one pill. Darvoni is packaged in blisters of 6 tablets in one plate and sent for export only.

When purchasing medications from Beacon for a course of therapy, you should take into account the originality of their packaging in order to purchase the quantity required for treatment. The most famous Indian pharmaceutical companies As mentioned above, after the country's pharmaceutical companies received licenses to produce generics for HCV therapy, India has become a world leader in their production. But among the many companies, it is worth noting a few whose products are the most famous in Russia.

Natco Pharma Ltd.

The most popular pharmaceutical company is Natco Pharma Ltd., whose drugs have saved the lives of several tens of thousands of people with chronic hepatitis C. It has mastered the production of almost the entire line of direct-acting antiviral drugs, including sofosbuvir with daclatasvir and ledipasvir with velpatasvir. Natco Pharma appeared in 1981 in Hyderabad with an initial capital of 3.3 million rupees, then the number of employees was 20 people. Now in India, 3.5 thousand people work at five Natco enterprises, and there are also branches in other countries. In addition to production units, the company has well-equipped laboratories that allow it to develop modern medications. Among her own developments, it is worth noting drugs to combat cancer. One of the most well-known drugs in this area is Veenat, produced since 2003 and used for leukemia. And the production of generics for the treatment of hepatitis C virus is a priority area of activity for Natco.

Hetero Drugs Ltd.

This company has set its goal to produce generics, subordinating its own network of production facilities, including factories with branches and offices with laboratories. Hetero's production network is designed to produce medicines under licenses received by the company. One of its areas of activity is medications that help fight serious viral diseases, the treatment of which has become impossible for many patients due to the high cost of original drugs. The acquired license allows Hetero to quickly begin producing generics, which are then sold at a price affordable for patients. The creation of Hetero Drugs dates back to 1993. Over the past 24 years, a dozen factories and several dozen production units have appeared in India. The presence of its own laboratories allows the company to carry out experimental work on the synthesis of substances, which contributed to the expansion of the production base and the active export of drugs to foreign countries.

Zydus Heptiza

Zydus is an Indian company that has set as its goal the creation of a healthy society, which, according to its owners, will be followed by a positive change in the quality of life of people. The goal is noble, and therefore, to achieve it, the company conducts active educational activities that affect the poorest segments of the country's population. Including through free vaccination of the population against hepatitis B. Zidus is in fourth place in terms of production volumes on the Indian pharmaceutical market. In addition, 16 of its drugs were included in the list of 300 most important drugs of the Indian pharmaceutical industry. Zydus products are in demand not only on the domestic market; they can be found in pharmacies in 43 countries on our planet. And the range of drugs produced at 7 enterprises exceeds 850 drugs. One of its most powerful production facilities is located in the state of Gujarat and is one of the largest not only in India, but also in Asia.

HCV therapy 2017

Hepatitis C treatment regimens for each patient are selected by the doctor individually. To correctly, effectively and safely select a regimen, the doctor needs to know:

virus genotype;
duration of illness;
degree of liver damage;
presence/absence of cirrhosis, concomitant infection (for example, HIV or other hepatitis), negative experience of previous treatment.

Having received this data after a series of tests, the doctor, based on EASL recommendations, selects the optimal treatment option. EASL recommendations are adjusted from year to year, adding newly available drugs. Before new treatment options are recommended, they are submitted to Congress or a special session. In 2017, a special EASL meeting in Paris considered updates to the recommended schemes. The decision was made to completely stop using interferon therapy in the treatment of HCV in Europe. In addition, there is not a single recommended regimen left that uses one single direct-acting drug. Here are several recommended treatment options. All of them are given for informational purposes only and cannot become a guide to action, since the prescription of therapy can only be given by a doctor, under whose supervision it will then be carried out.

Possible treatment regimens proposed by EASL in case of hepatitis C monoinfection or concomitant HIV+HCV infection in patients who do not have cirrhosis and have not previously been treated:

for treatment genotypes 1a and 1b can be used:

- sofosbuvir + ledipasvir, without ribavirin, duration 12 weeks; - sofosbuvir + daclatasvir, also without ribavirin, treatment period is 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, course duration 12 weeks.

during therapy genotype 2 used without ribavirin for 12 weeks:

- sofosbuvir + dklatasvir; - or sofosbuvir + velpatasvir.

during treatment genotype 3 without the use of ribavirin for a period of therapy of 12 weeks, use:

- sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

during therapy genotype 4 You can use without ribavirin for 12 weeks:

- sofosbuvir + ledipasvir; - sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

EASL recommended treatment regimens for hepatitis C monoinfection or concomitant HIV/HCV infection in patients with compensated cirrhosis who have not previously been treated:

for treatment genotypes 1a and 1b can be used:

- sofosbuvir + ledipasvir with ribavirin, duration 12 weeks; - or 24 weeks without ribavirin; - and one more option - 24 weeks with ribavirin if the response prognosis is unfavorable; - sofosbuvir + daclatasvir, if without ribavirin, then 24 weeks, and with ribavirin, the treatment period is 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, 12 weeks.

during therapy genotype 2 apply:

- sofosbuvir + dklatasvir without ribavirin the duration is 12 weeks, and with ribavirin in case of poor prognosis - 24 weeks; - or sofosbuvir + velpatasvir without combination with ribavirin for 12 weeks.

during treatment genotype 3 use:

- sofosbuvir + daclatasvir for 24 weeks with ribavirin; - or sofosbuvir + velpatasvir, again with ribavirin, treatment period is 12 weeks; - as an option, sofosbuvir + velpatasvir is possible for 24 weeks, but without ribavirin.

during therapy genotype 4 apply the same schemes as for genotypes 1a and 1b.

As you can see, the result of therapy is influenced, in addition to the patient’s condition and the characteristics of his body, by the combination of prescribed medications chosen by the doctor. In addition, the duration of treatment depends on the combination chosen by the physician.

Treatment with modern drugs for HCV

Take tablets of direct antiviral drugs as prescribed by a doctor orally once a day. They are not divided into parts, not chewed, but washed down with plain water. It is best to do this at the same time, this way a constant concentration of active substances in the body is maintained. There is no need to be tied to the timing of meals, the main thing is not to do it on an empty stomach. When you start taking medications, pay attention to how you feel, since during this period it is easiest to notice possible side effects. DAAs themselves do not have very many of them, but drugs prescribed in combination have much less. Most often, side effects appear as:

headaches;
vomiting and dizziness;
general weakness;
loss of appetite;
joint pain;
changes in biochemical blood parameters, expressed in low hemoglobin levels, a decrease in platelets and lymphocytes.

Side effects are possible in a small number of patients. But still, all noticed ailments should be reported to the attending physician so that he can take the necessary measures. To avoid increased side effects, alcohol and nicotine should be avoided, as they have a harmful effect on the liver.

Contraindications

In some cases, taking DAAs is excluded, this applies to:

individual hypersensitivity of patients to certain drug ingredients;

patients under 18 years of age, since there is no accurate data on their effect on the body;

women carrying a fetus and breastfeeding babies;

Women should use reliable methods of contraception to avoid conception during therapy. Moreover, this requirement also applies to women whose partners are also undergoing DAA therapy.

Storage

Store direct-acting antiviral drugs in places inaccessible to children and out of direct sunlight. Storage temperature should be in the range of 15 ÷ 30ºС. When starting to take medications, check their production and storage dates indicated on the packaging. Expired medications should not be taken. How to purchase DAAs for residents of Russia Unfortunately, it will not be possible to find Indian generics in Russian pharmacies. The pharmaceutical company Gilead, having granted licenses to produce drugs, prudently banned their export to many countries. Including all European countries. Those wishing to purchase budget Indian generics to combat hepatitis C can use several options:

order them through Russian online pharmacies and receive the goods in a few hours (or days) depending on the delivery location. Moreover, in most cases, even an advance payment is not required;
order them through Indian online stores with home delivery. Here you will need an advance payment in foreign currency, and the waiting time will last from three weeks to a month. Plus there will be the need to communicate with the seller in English;
go to India and bring the drug yourself. This will also take time, plus the language barrier, plus the difficulty of checking the originality of the product purchased at the pharmacy. Added to this is the problem of self-export, which requires a thermal container, a doctor’s report and a prescription in English, as well as a copy of the receipt.

People interested in purchasing medicines decide for themselves which of the possible delivery options to choose. Just do not forget that in the case of HCV, a favorable outcome of therapy depends on the speed of its initiation. Here, in the literal sense, delay is like death, and therefore you should not delay the start of the procedure.

Using ultrasound diagnostics, you can evaluate the structure of the liver and gallbladder, as well as suspect diseases of the abdominal organs.

Diagnosis is performed with a special sensor that is applied to the stomach

To prepare for this procedure you need to:

three days before the study, avoid milk, cabbage, and carbonated drinks;
reduce the amount of liquid you drink to one and a half liters;
in the presence of flatulence (bloating), medications are recommended that reduce this undesirable symptom.

Indications for liver ultrasound:

With hepatitis B, there is a symptom of a diffuse decrease in hepatic echogenicity. The most common cause of hepatomegaly (organ enlargement) in this disease, which is characterized by a uniform decrease in the echogenicity of liver tissue, is acute hepatitis.

As a result of these changes, the walls of the portal vein branches look brighter - a symptom of the “starry sky”. Quite often you can find thickening of the walls of the gallbladder. Ultrasound is not the main diagnostic method for hepatitis B and is most often used to exclude other liver pathologies.

What does the organ look like during diagnosis?

Ultrasound signs of HCV

This disease is characterized by increased echogenicity of the organ. More often it occurs chronically and is accompanied by fibrosis and cirrhosis.

What does a liver ultrasound show for hepatitis C? The echographic picture of the disease and the early stages of cirrhosis is nonspecific. In some cases, the organ may appear without pathological changes.

Against the background of a severe long-term disease, hepatomegaly, a diffuse and uneven increase in the echogenicity of the liver parenchyma, can be detected. Its acoustic heterogeneity is also considered. It is caused by alternating areas of increased and decreased echogenicity.

The conclusion of the study may show an increase in the acoustic density of the portal vein. There may be a decrease in the diameter of the hepatic veins, a decrease in the structure of the vascular pattern of the liver due to deterioration in the visualization of small branches of the portal and hepatic veins, due to an increase in echogenicity and heterogeneity of the structure of the organ parenchyma.

A specific symptom complex describes the late stage of liver cirrhosis, which occurs in chronic hepatitis C. This includes the following echo signs:

a decrease in the size of the right lobe of the organ with an increase in the caudate;
uneven and lumpy contour of the liver;
pronounced heterogeneity of its structure, due to the alternation of areas of increased, medium and decreased echogenicity;
diffuse hyperechogenicity of the parenchyma;
deformations of the vascular pattern of varying degrees;
signs of portal hypertension (splenomegaly, increased diameter of the portal and splenic veins, portosystemic shunts - recanalized umbilical vein in the round ligament of the liver, splenorenal shunts, ascites).

In the video below, you can see what cirrhosis looks like on an ultrasound.

When diagnosing liver cirrhosis, the following picture is observed:

The organ is enlarged.
Its edge is uneven with a gradual decrease and deformation of the right lobe.
The appearance of splenomegaly.
The picture differs depending on the stage (acute and chronic).
With any course of hepatitis, a uniform enlargement of the liver is observed.
Contours: in acute cases - smooth, in chronic cases they can be lumpy.
The echogenicity of the parenchyma: reduced or normal in reactive cases, unchanged or moderately increased in chronic cases.
Disturbance of the hepatic veins: narrowed in the acute form or thickening of the walls and gradual narrowing in the chronic form. Echostructure: in the first case, homogeneous, in the second – inhomogeneous.
Condition of the branches of the portal vein: “emphasized” hyperechogenicity of the walls “starry sky” and normal or expanded structure.
Changes outside the liver: none for acute hepatitis, splenomegaly for chronic hepatitis.

Lecture on ultrasound: interesting and accessible in the following video.

Additional diagnostic methods: interpretation of results

Fibroscan or elastography is a new non-invasive research method. Using special ultrasound waves, he studies the elasticity of organ tissue. The procedure allows you to diagnose pathologies such as hepatitis, steatohepatitis and hepatic cirrhosis.

Markers of a viral disease that can determine the presence of pathogens or antibodies to them in the patient’s blood. There are several types of such specific proteins.

The following video provides brief information about pathology markers.

For hepatitis B:

HBsAg;
HBeAg;
Anti HBCIgM;
Anti HBc;
Anti HBe;
Anti HBs;
HBV DNA.

Markers for Hepatitis C are also used:

Anti-HCVIgM;
Anti-HCVcoreIgG;
Anti-HCVNSIgG;
RNAHCV.

Radionuclide diagnostics allows you to obtain images of the liver and biliary tract. With this method, the patient is administered a radiopharmaceutical drug (RP) intravenously. This substance is then transported by the blood to hepatocytes (hepatobiliscanography) or endothelial cells (hepatoscanography or hepatoscintigraphy).

In direct projection, a triangle is visualized, where the right and left lobes can be determined. In the lateral view, the shadow of the examined organ has the shape of an oval or diamond. In all positions, a special contrast agent is evenly distributed in the tissues of the hepatobiliary system.

Dopplerography is a study that makes it possible to determine the state of blood flow in such vital vessels: the pancreas, portal, inferior vena cava, hepatic vein and artery, as well as the branches of the latter.

The picture shows the fibrosis scale that is used when performing elastometry.

Organ fibrosis rating scale

Echoanatomy of the organ

Normal organ anatomy during examination

During an ultrasound, the liver is visualized in the right upper quadrant of the abdomen. In most cases, it is possible to determine all four of its anatomical lobes: right and left, quadrant and caudate. Eight segments of the liver are also studied using ultrasound.

The size of the organ is assessed based on determining the maximum oblique size of the right part along the midclavicular line (no more than 150 mm), the thickness, or anteroposterior size, of the left (up to 60 mm).

The liver capsule is clearly defined as a hyperechoic structure around its outline, which should be smooth and continuous.

Unchanged liver parenchyma appears fine-grained and homogeneous on ultrasound. Its echogenicity compared to the right kidney is slightly higher, but lower than that of the pancreas.

What a healthy organ should look like

Anechoic tubular formations, which are visualized against the background of a homogeneous echostructure of the liver, correspond to the branches of the portal and hepatic veins. They are distinguished based on the anatomical location and definition of echogenic walls in the branches of the portal vein.