Specific liver tests
Chronic hepatitis D (HDV) can have serious and irreversible consequences for your health. In order to be able to adequately monitor the course of your disease, your doctor, a specialist in hepato-gastroenterology, will carry out targeted examinations. Below is information to help you better understand these different tests.
It is important to keep an eye on the extent to which your liver has already been damaged and how this develops as the disease progresses.
What are fibrosis and cirrhosis?
When the liver becomes diseased, its cells are destroyed and gradually replaced with fibres (mainly collagen fibres). This change is called liver fibrosis.
When fibrosis is in an advanced stage, it develops into cirrhosis. Liver cirrhosis is a chronic (long-term and progressive) disease that can lead to serious complications.
Cirrhosis is characterised by disorganisation of the structure of the liver characterised by but not limited to persistent inflammation. This inflammation can be due to viral hepatitis, such as HDV. Contrary to popular belief, cirrhosis of the liver is not exclusively associated with excessive alcohol consumption.
What examinations are done?
Today, most tests are non-invasive, meaning they do not require hospitalisation and are not dangerous. However, in some cases, a liver biopsy may be necessary.
Non-invasive methods
Various tests (FibroTest® or FibroMeter®) can be performed with a simple blood sample.
There are other non-invasive methods, so-called physical methods, that allow for assessment of the condition of the liver
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Abdominal ultrasound is an easy-to-perform radiological exam that provides information such as the size or general appearance of the liver
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Elastography (e.g. FibroScan®) measures the stiffness of the liver, also known as liver elasticity. Liver stiffness can also be measured with an abdominal ultrasound device. The more severe the damage to the liver, the stiffer the liver.
Liver biopsy
In certain circumstances, your doctor may prescribe a liver biopsy.A small piece of the liver is removed with a needle under local anaesthesia and examined under a microscope.
Laboratory analysis of this sample determines the degree of liver damage. This is also known as the METAVIR Score.
Assessing the severity of cirrhosis
Child-Pugh-Score
The Child-Pugh score is used to assess the severity of the disease and provide a prognosis. It is used for the uniform description and classification of liver cirrhosis according to the severity of the symptoms at different stages.
MELD-Score
The MELD (Model for End-Stage Liver Disease) score is calculated in the advanced stages of chronic liver disease and used to predict patients' vital prognosis. This score, which is calculated from blood data, is used, among other things, to determine whether the patient can benefit from a liver transplant.
Sources
http://dasgastroenterologieportal.de/Hepatitis_D.html. Juni 2020
https://www.leber-ratgeber.de/die-leber/diagnose-einer-lebererkrankung-leber-ratgeber/index.html Juni 2020
https://gastropraxis-osnabrueck.de/untersuchungen/leberpunktion-biopsie/. Juni 2020.
https://www.praktischarzt.de/untersuchungen/biopsie/leberbiopsie/. Juni 2020.
Bedossa P, Poynard T. METAVIR cooperative study group. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289-93.
https://www.hepatitisandmore.de/archiv/2012-1/invasive-fibrosediagnostik.shtml . Juni 2020
Child CG, Turcotte JG Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
https://www.mdcalc.com/meld-score-model-end-stage-liver-disease-12-older. Juni 2020
LADR. Model of end stage liver disease (MELD) Score. https://ladr.de/service/rechenprogramme/meld-score . Juni 2020
Important stages from diagnosis to therapy
It is difficult to distinguish the symptoms of acute viral hepatitis D from another form of acute hepatitis.
If you have not been vaccinated against hepatitis B (HBV) and are at risk of contracting HBV or HDV , see your doctor for clarification and guidance. If you knowingly become acutely infected with hepatitis B (HBV), there is the possibility of post-exposure prophylaxis, which must be initiated within forty-eight hours
To find out whether you have contracted HBV or HDV, your blood will be tested in a laboratory.
If a HBV infection is confirmed, testing for hepatitis delta (HDV) should then take place immediately. Additionally, you should receive a referral to a liver specialist (hepato-gastroenterologist).
A hepatologist is a medicalspecialists for liver disease who will examine you in the hospital or in a doctor's office.
A HDV test should generally be performed in patients infected with HBV. More liver-specific tests can be done in the hospital.
Based on the results of the additional tests, your hepatologist, supported by a multidisciplinary medical team, will recommend and prescribe an appropriate HBV/HDV treatment.
Depending on the type of treatment prescribed, you will receive this directly at the hospital or you can obtain the medication from a pharmacy.
It is important to take your medication as directed and to read the patient information leaflets carefully.
Your hepatologist will monitor your treatment to check its effectiveness, as well as monitor the progression of the disease to detect any complications or signs of worsening.
Be assured that you are not alone on this journey or in dealing with this disease. It is very important to have someone to talk to. This can be a friend or family member. A patient organisation can also be a helpful contact point.