UNI VERSI DAD NACI ONAL PEDR O R U I Z O F AC U L T AG DALL DE ME MEDI CI NA HUMA MANA
Marcadores DOCENTE:
Dra. Ingrid Quezada Nepo.
INTEGRANTES:
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Seminario Ruiz Kristel. 0123
Silva Agapito Solange. Silva Gutierrez Anton! Sip"n #apata $riss. Suárez N%&ez 'risett. (apia $a)anillas $ a)anillas Ale*ander. (ávara Saavedra $rist")al. (rigoso Mi*an +on. ,argas Marcena $ristian. ,eliz Sandoval Diana $arolina. ,idaurre $ávez Ale*. -ampagit $arrasco /uen.
2016-
Marcadores Marcadore s Hepáticos
Marcadores Hepáticos
Contenido INTRODUCCIÓN......... INTRODUCCIÓN................... ..................... ..................... ..................... ..................... ........................................... ................................. 3 OBJETIVOS:.......... OBJETIVOS:..................... ..................... ..................... ..................... ..................... ...................... ..................... ........................... ................. 5 MARCO MARCO TEÓRICO:............. TEÓRICO:........................ ..................... ..................... ..................... ..................... .................................... ......................... 6 CARACTERÍSTIC CARACTERÍSTICAS AS ESTRUCTURALES:........ ESTRUCTURALES:.................. ..................... ........................................6 .............................6 PATOGENIA:...............................................................................................10 MANIFESTACIONES CLÍNICAS.....................................................................17 MARACDORES MARACDORES EP! EP!TICOS SEROLÓGICOS.......... SEROLÓGICOS.................... ....................................... ............................. 1" CASO CLÍNICO 1:.................... 1:............................... ...................... ..................... ..................... ................................... ........................ ## CASO CLINICO #:.................... #:............................... ...................... ..................... ..................... ................................... ........................ #3 CONCLUSIONES:.... CONCLUSIONES:.............. ..................... ..................... ..................... ..................... ..................... ................................... ........................ #$ BIBLIOGRAFÍA:.... BIBLIOGRAFÍA:.............. ..................... ...................... ..................... ..................... ..................... ..................................... ...........................#5 #5
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Marcadores Hepáticos
INTRODUCCIÓ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
3
Marcadores Hepáticos
L% &'(%)*)*+ E %(%/'2' 2 /)'+ '(*9*2+ '- =-%+ )/(*2%4'+ ; +,)/(*2%4'+. E4 >*/,+ ' 4% &'(%)*)*+ E VE +' )/%+*)' (/ ><% '-)9/*2% ; (/,2' ,-% &'(%)*)*+ %,% %,)4**)%%. F,' 2,'-)% (/ >'= (/*'/% '- 4% I-*% '- 1"55. E- ,'/'+ '+)%-)'+ (,'' '>4,2*-%/ % ,-% &'(%)*)*+ ,4*-%-)'. N '>4,2*-% % 4% 2/-*2*%. U- %+('2) ' 2*'/)% *(/)%-2*% 24<-*2% 2- /'+('2) %4 >*/,+ ' 4% &'(%)*)*+ G VG '+ '4 (+*4' ''2) (/)'2)/ 8,' ''/2' '- (%2*'-)'+ 2*-'2)%+ (/ >*/,+ ' 4% *-,-'?2*'-2*% &,%-% VI. E- >%/*+ '+),*+ 4+ (%2*'-)'+ 2*-'2)%+ VIVG (/'+'-)%/- '-/ (/2'-)%' ' (//'+*- % +*% ; '-/ /)%4*% 8,' 4+ (%2*'-)'+ VI - 2*-'2)%+. E- 4% %2),%4*% +' 2-2'- 7 >*/,+ &'(%))/(+: VA VB VD VC VE &'(%)*)*+ G VG ; &'(%)*)*+ TT VTT. L+ VB VC ; VD +' )/%-+*)'- (/''/'-)''-)' (/ ><% (%/'-)'/%4 ; (,''- %/ 4,%/ % &'(%)*)*+ %,% 2/-*2% *'-)/%+ 8,' 4+ VA ; VE +- ' )/%+*+*'-)9/*2% ; (/,2'- &'(%)*)*+ %,% +*- 8,' +' &%;%- '+2/*) 2%++ ' 2/-*?2%2*-.
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Marcadores Hepáticos
OBJETIVOS: D'+2/**/ 4+ *'/'-)'+ )*(+ ' &'(%)*)*+ >*/%4'+ + 2,-'+ %- % /'+%4)%/ ,-%'-)%4'-)' +,+ 2%/%2)'/<+)*2%+ '+)/,2),/%4'+ (%)'-*% %-*'+)%2*-'+ 24<-*2%+ ; +,+ %/2%/'+ + *(/)%-)'+ (%/% ')'/*-%/ '4 *%-+)*2. C-2'/ 4+ *'/'-)'+ )*(+ ' &'(%)*)*+ >*/%4'+ ; 4% *(/)%-2*% ' 4% +'/4<% '- 2%% ,-% ' 4%+ &'(%)*)*+ >*/%4'+. C(/'-'/ '4 '%'- *%-+)*2 ' 4+ *'/'-)'+ )*(+ ' &'(%)*)*+ >*/%4 '- %+' % +,+ %/2%/'+ +9/*2+.
5
Marcadores Hepáticos
MARCO TEÓRICO: CARACTERÍSTICAS ESTRUCTURALES: HEPATITIS A
E4 >*/,+ ' 4% &'(%)*)*+ A ('/)'-'2' % 4% %*4*% P*2/-%>*/*%' '+ ,- >*/,+ RNA ' 2%'-% +'-2*44% (+*)*>% ' 75 *4%+'+ ' 4-*), '+-, ; +, 2(+*' '+) 2(,'+)% (/ *'/'-)'+ (/)'<-%+ %-)*9-*2%+ '-*-%%+ 2- 4%+ +*4%+ VP1 VP# VP3 ; VP$. S, '+)/,2),/% (/'+'-)% ,-% /4<% *2+%9/*2% % '4 *2/+2(* '4'2)/-*2. S, '-% +' *>*' '- )/'+ (%/)'+: 1 4% /'*- 5 8,' )*'-' ,-*% ' /% 2>%4'-)' 4% (/)'<-% >*/%4 ' #5 VP # '4 +''-) '-*2 8,' 2*?2% (%/% )%+ 4%+ (/)'<-%+ >*/%4'+ 2- /'*-'+ '-*-%%+ P1 P# ; P3 ; 3 ,-% 24% 2/)% ' (4;A ' $0 % 0 -,24')*+ '- '4 ')/' 3 2 +' +'/>% '- 4% ?,/%.
HEPATITIS B
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
6
Marcadores Hepáticos
(/'S +,('/?2*' 2/' 2 (/)'<-%+ ' /'(4*2%2*- (4*'/%+% ; 4% (/)'<-% Q. E4 %-)<'- ' ' A 2-+*+)' '- ,-% (/)'<-% ' %(/*%%'-)' 15000 %4)-'+ %+2*%% %4 B2A ; +*-)')*=%% (/ *-/%2*- -,24')<*2% -,24')*+ 11$ 1"01 2-)'-*% '- 4% /'*(/'2/' (/'C 8,' +' '-2,'-)/% %4 *-*2* ' 4% /'*- C. L% 2(+*' '4 BV '+) /%% ' 10 2(*%+ ' ,-% (/)'<-% (/*-2*(%4 '-*-%% 2B 4%+ (%/)<2,4%+ 2'-)/%4'+ '4 BV +- ,- ()'-)' *-,-'- ;% 8,' *-,2'4% (/,22*- ' )<),4+ '4'>%+ ' %-)*2,'/(+ A22B ,/%-)' 4% *-'22*-%),/%4 (/ BV. E4 %-)<'- 'B A'B +' '-2,'-)/% '- 4% +%-/' ' 4+ (/)%/'+ '4 BV ; ,%/% /'4%2*- 2- 4% >*/'*% %+*>% 4% ,-2*- ' '+)% (/)'<-% %@- '+ '+2-2*% '+ ,-% (/)'<-% - '+)/,2),/%4 - -'2'+%/*% (%/% 4% *-'2)*>*% '4 BV. L% (/)'<-% Q '+ ,-% (/)'<-% /',4%/% 8,' *- >*)/ %2)@% 2 %2)*>%/% ' 4% )/%-+2/*(2*-. E4 BV (,'' (/'+'-)%/ ,)%2*-'+ 4%+ 2,%4'+ (,''- 2%)'/*=%/+' '- + /%-'+ /,(+: >%/*%2*-'+ '-9)*2%+ ' >%4/ *-2*'/) ; ,)%2*-'+ 8,' 2%,+%- *?2%2*-'+ '+('2*/%4 '- '4 +',- /,( +' &%- *'-)*?2% + ,)%2*-'+ (/*-2*(%4'+ *?2%2*-'+ '4 B+A 8,' (,''- %4)'/%/ '4 /'2-2**'-) *-,-4*2 '4 >*/,+ 2/'%- ,)%2*-'+ ' '+2%(' ; *?2%2*-'+ ' 4% /'*- (/'C '4 BVDNA *-2%(%2'+ ' '(/'+%/ '4 (9()* 8,' /',4% 4% +'2/'2*- '4 B2A.3# E+ '4 "5H ' 4+ 2%++ 4% ,)%2*- (/'C *->4,2/% % ,-% %+' -*)/'-%% GA '- '4 -,24')* 1"6 8,' 2%*% ,- 2- ' )/*()%- (/ ,- 2- ' %4).
HEPATITIS C
D'-*-%% %-)'/*/'-)' &'(%)*)*+ - A- B '+ 2%,+%% (/ '4 >*/,+ ARN 4*-'%4 8,' *' 3# - 2- '->4),/% 4*(<*2% +' *-%2)*>% 2- +4>'-)'+ 4*(<*2+ 2%4'-)%*'-) )/%)%*'-) 2- /4 ; '(+*2*- % 4,= ,4)/%>*4')% '+ -2%)'-%/* ' (4%/*% (+*)*>% 2-+)*),* (/ "$00 -,24')*+ 8,' (+'' ,-% @-*2% '+)/,2),/% '- ' 4'2),/% %*'/)% 8,'
7
Marcadores Hepáticos
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
HEPATITIS D
E4 >*/,+ ' 4% &'(%)*)*+ D '+ ,- >*/,+ ''2),+ ' )*( RNA 8,' +4%'-)' +' /'(4*2% '- &+(''/+ 8,' +*,4)-'%'-)' '+)- *-'2)%+ (/ >*/,+ ' 4% &'(%)*)*+ B '4 >*/- '+ ,-% (%/)<2,4% '+9/*2% ' 36 - 2(,'+)% (/ ,-% 2%(% ' 4*((/)'<-%. D'-)/ ' 4% 2,*'/)% '+) 4% '+)/,2),/% ' 4% -,24'2(+*' ' /% '+9/*2% )*'-' 1 - ' *')/ '4 '-% '4 VD '+ ,-% 492,4% ' RNA ' 1.7 4% -,24'2(+*' 2-)*'-' '4
Marcadores Hepáticos
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
HEPATITIS E
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
E- (%<+'+ '+%//44%+ %(/*%%'-)' '4 $ %4 5H ' 4%+ &'(%)*)*+ %8,*/*%+ - )*'-'- ')*4<% >*/%4 '+('2'/++ -/'+ (%/% +'%4%/ % '+)+ >*/,+: &'(%)*)*+ F &'(%)*)*+ - AE '4 ' &'(%)*)*+ - A - B - C - D - E. HEPATITIS G
S' )/%)% ' ,- RNA >*/,+ GV ' (4%/*% (+*)*>% 2,;% +'2,'-2*% ' -,24')*+ &% +* 2(4')%'-)' ')'/*-%%. L+ >*/,+ + /'4%2*-%+ +- 4+ %>*>*/,+ '4 >*/,+ C ; 4+ /'2*'-)''-)' '+2/*)+ GBVA GBVB '4 >*/,+ GV +' &% '+2/*) 2 ,- -,'> >*/,+ ' 4% %*4*% %>*>*/*%'. S, (/'>%4'-2*% '+ ' 1 % #H '- (4%2*- +%-% ' -%/'+
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Marcadores Hepáticos
>4,-)%/*+ ' +%-/' '+)' %'-)' '' +'/ 2-+*'/% '- '4 *%-+)*2 *'/'-2*%4 ' &'(%)(%)<%+ 2/-*2%+ ; %,%+ ' ')*4<% '+2-2*% ;% 8,' '- ,- '+),* /'2*'-)' +' '-2-)/ ,- "0H ' GV RNA '- ,-% (4%2*- ' (%2*'-)'+ 2- &'(%)(%)<% 2/*()9-*2%
10
Marcadores Hepáticos
PATOGENIA: HEPATITIS VIRAL
L% &'(%)*)*+ &%2' /''/'-2*% % 4% *-%%2*- '4 &<%. P,'' +'/ 2%,+%% (/ >*/,+ &'(%))/(*2+ 8,' %'2)%- ' %-'/% (/*/*%4 4%+ 294,4%+ &'()*2%+ &'(%)2*)+ (/ '2%-*++ %,)*-,-*)%/*+ /'%22*-'+ (/ /%2+ ; )*-%+ *'- +'/ +'2,-%/*% % )/+ )/%+)/-+ +*)+)9*2+. L+ >*/,+ 8,' *-,2'- '-'/'% +*+)9*2% ; (,''- %'2)%/ %4 &<% *-24,;'- %4 >*/,+ E(+)'*-B%// --,24'+*+ *-'22*+% 2%(%= ' '-'/%/ &'(%)*)*+ 4'>' ,/%-)' 4% %+' %,% '4 2*)'%4>*/,+ '- (%/)*2,4%/ '-'-%)+ ; ('/+-%+ 2- *-,-+,(/'+*- 4+ &'/('+>*/,+ ; 4+ '-)'/>*/,+. L+ >*/,+ &'(%))/(*2+ 2-2*+ *-24,;'- %4 >*/,+ ' 4% &'(%)*)*+ A VA %4 >*/,+ ' 4% &'(%)*)*+ B VB %4 >*/,+ %+2*% 2- '4 >*/,+ ' 4% &'(%)*)*+ B VD %4 >*/,+ ' 4% &'(%)*)*+ C VC ; %4 >*/,+ ' 4% &'(%)*)*+ E VE. S* *'- )+ 9+)+ (,''- *-,2*/ &'(%)*)*+ %,% *?'/'- '- 2,%-) %4 ' )/%-+*+*- ; ('/< ' *-2,%2*- '4 '2%-*+ /% ; 2/-*2*% '4 % &'()*2 ; 4% 2%(%2*% (%/% '>4,2*-%/ %4 '+)% ' (/)%/. L% (/'+'-2*% ' %-)<'-+ >*/%4'+ ; +,+ %-)*2,'/(+ (,'' ')'/*-%/+' '*%-)' (/,'%+ ' 4%/%)/*. L+ '+),*+ '(*'*4*2+ &%- *-*2% 8,' %4,-+ 2%++ ' &'(%)*)*+ *-'22*+% +' ''- % )/+ %2)/'+. U- %'-)' >*/%4 +**4%/ %4 VC +' 24- ' *'-)*?2 2 >*/,+ ' 4% &'(%)*)*+ G VG )%*9- '-*-% GBV C#3. S' &% *'-)*?2% '>*'-2*% ' VG '- '4 #H ' 4+ -%/'+ ' +%-/' '- E+)%+ U-*+. S*- '%/ '4 VG - +' >*-2,4% 2- %4,-% &'(%)(%)<% 2- '%2'/%2*-'+ ' 4% '-'/'% &'()*2%. ETIOLOGÍA Y PATOGNESIS
E*+)'- # '2%-*++ ' 4'+*- &'()*2% '- 4% &'(%)*)*+ >*/%4: 4% !e"i#n $e!%!&' di'e$t& ; 4% ind%$$i#n de 'e"(%e"t&" in)%nit&'i&" $ont'& !o" &nt*+eno" ,i'&!e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
11
Marcadores Hepáticos
L% '>4,2*- 24<-*2% ' 4% &'(%)*)*+ >*/%4 ')'/*-% *+)*-)+ +<-/'+ 4 8,' *-24,;' 4% *-'22*- %+*-))*2% 2- +4 '>*'-2*% +'/4*2% '4 )/%+)/- 4% &'(%)*)*+ %,% '4 '+)% ' (/)%/ +*- '-'/'% 24<-*2% %(%/'-)' 2- &'(%)*)*+ 2/-*2% 4% &'(%)*)*+ 2/-*2% 2- +*- '>4,2*- % 2*//+*+ % 4% '-'/'% ,4*-%-)' 2- '+%//44 )'(/%- ' *-+,?2*'-2*% &'()*2%. N )+ 4+ >*/,+ &'(%))/(*2+ (/>2%- 2%% ,- ' 4+ +<-/'+ 24<-*2+. HEPATITIS A PATOGENIA
E4 >*/,+ ' 4% &'(%)*)*+ A ('/)'-'2' % 4% %*4*% P*2/-%>*/*%' 8,' *-24,;' % 4+ '-)'/>*/,+ ; /*->*/,+. E+ ,- >*/,+ ' 2%'-% +*(4' ARN 8,' *' '-)/' #7 ; # -. S' )/%-+*)' (/ 4% ><% '2%4/%4 2- ,- ('/* ' *-2,%2*- ' 1$ % # <%+ /'(4*2-+' '- '4 *-)'+)*- 4,' ' 4 2,%4 44'% %4 &<% % )/%>9+ ' 4% 2*/2,4%2*- (/)%4. E4 &<% '+ '4 (/*-2*(%4 +*)* ' /'(4*2%2*- 8,' 2,//' '+('2*/'*% *-*2*%4 ; '2/'2*- '2%4 '4 >*/,+. I-*2*%4'-)' +' (/,2' IM +',*% (/ IG ; %+ ,-2*-%2 %-)*2,'/(+ -',)/%4*=%-)'+ *- >*>. E4 %-)* AV IG ('/+*+)' (/ )% 4% >*% ;
2-?'/' (/)'22*- 2(4')% 2-)/% 4% /'*-'22*- (/ '4 >*/,+ ' &'(%)*)*+ A.
1#
Marcadores Hepáticos
HEPATITIS B PATOGENIA
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epadnaviridae. L+ &'(%-%>*/,+ +- ,-% %*4*% ' >*/,+ &'(%))/(*2+ DNA 8,' *-24,;'(%/)<2,4%+ *-)%2)%+ ' $# - ' *')/ 2- DNA W(%/)<2,4%+ ' D%-'X ;
13
Marcadores Hepáticos
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tolerancia immune ,/%-)' 4% 2,%4 4% /'(4*2%2*- - +' %+2*% % '-'/'% &'()*2% %2)*>%. E- '+)+ (%2*'-)'+ 4% %+' *-*2*%4 +' 2%/%2)'/*=% (/ -*>'4'+ %4)+ ' >*/'*% BV DNA ; (/'+'-2*% ' B'A ('/ -*>'4'+ -/%4'+ ' ALT ' &*+)4<% -/%4. E+)% %+' ,/% '-)/' 10 ; 30 %+ 2,-% )%+% ,; %% ' %24%/%*'-) ' B'A. E4 %24%/%*'-) '+(-)-' ' B'A '- %4,-+ (%2*'-)'+ (,'' 2,//*/ 4,' ' # % 3 92%%+ ' */ %+2*% % ,- %,'-) ' ALT +<-)%+ ' &'(%)*)*+ %,% 8,' (,'' 44'%/ % 2-,-*/+' 2- &'(%)*)*+ B %,% '- (%2*'-)'+ '- 8,*'-'+ - +' 2-2' '4 '+)% ' &'(%)*)*+ B 2/-*2%.
1$
Marcadores Hepáticos
Se$%en$i& de !o" $&)-io" de !o" &nt*+eno" ,i'&!e" de! VHB .HB"A+/ HBeA+0/ ADN de! VHB 1 &nti$%e'(o" $ont'& VHB .I+M/ I+G/ &nti2HB$ 1 &nti2HB"0 en !& 3e(&titi" B &+%d& en 'e"o!%$i#n4
HEPATITIS C PATOGENIA
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
15
Marcadores Hepáticos
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
16
Marcadores Hepáticos
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
17
Marcadores Hepáticos
/&'+,+ )%%/*-+ ; -+ >'/'+ %/*2%-+ 4+ 2,%4'+ +- +,+2'()*4'+ % 4% *-'22*- -%),/%4 2- 2'(%+ &,%-%+ '4 VE. A4 *,%4 8,' 4% &'(%)*)*+ % >*/,+ A 4% &'(%)*)*+ E - '>4,2*-% % 4% 2/-*2*% -* '% +'2,'4%+. P/'+'-)% ,- ('/< ' *-2,%2*- '+' 4% '(+*2*- &%+)% '4 2*'-= ' 4% '-'/'% 24<-*2% ' %4/''/ ' #$0 <%+. L% >*/'*% ; 4% '2/'2*' 4%+ (%/)<2,4%+ >*/%4'+ '- 4%+ &'2'+ +' %- %4 *+ )*'( (/'*-%-)''-)' ,/%-)' '4 ('/* ' *-2,%2*- ; 4% %+' %,% )'(/%-% ; ,+,%4'-)' % ,; %%+ 2-2'-)/%2*-'+. L% (/,22*- ' %-)*2,'/(+ %-)*VE ; 4% &'(%)*)*+ +' %2-2*)%-)''-)' (/ 4 8,' +' 2-+*'/% 8,' 4% &'(%)*)*+ E '+ ,-% '-'/'% *-,-(%)4*2% '- 4% 2,%4 '4 % % 4+ &'(%)2*)+ +'/<% <-* ; 4% /'+(,'+)% *-,-' '4 &,9+(' 2-,2*/<% % 4% &'(%)*)*+. HEPATITIS G PATOGENIA L% )/%-+*+*- '+ %(%/'-)''-)' (%/'-)'/%4. S' )/%-+*)' 2- %2*4*% '*%-)' 4%+ )/%-+,+*-'+ ' +%-/' ; /'2,'-)''-)' (/,2' >*/'*% ('/+*+)'-)' '- '4 /'2'()/ *-'2)%. E*+)' '- ,-% '4'>%% (/'>%4'-2*% '-)/' 4%+ (/+)*),)%+ (/ 4 8,' )%*9- (/<% )/%-+*)*/+' (/ ><% +',%4. T%*9- '*+)'- *-*2*+ ' 8,' +' (,'' )/%-+*)*/ ' %/' % &*. E%8,'44%+ %/'+ 2- %4)% 2%/% >*/%4 ; '('-*'- '4 '4 (%/) (,''- )'-'/ &*+ 2- ,-% *-'22*- ('/+*+)'-)'. S' 4 &% '-2-)/% '('/+-%+ 2*-'2)%%+ 2- BV CV ; VI. E4 &<% - +'/<% '4 +*)* (/*%/* ' /'(4*2%2*- ; - '*+)' ,-% '-'/'% +*-*?2%)*>% %+2*%% %4 GV. N +' &% '+)/% 4% %+2*%2*- '4 >*/,+ 2- 4% (/,22*- ' &'(%)*)*+ ,4*-%-)' ; 2%/2*-% &'(%)2'4,4%/. L% %;/<% ' 4%+ ('/+-%+ *-'2)%%+ - '+%//44%+<-)%+ %,-8,' +' &%- /'(/)% 2%++ ' &'(%)*)*+ (+) )/%-+,+*- ; 2%++ ' &'(%)*)*+ ,4*-%-)'+ % GV. C +' '-2*- %-)'/*/'-)' +' &% '-2-)/% '4 GV '- ('/+-%+ 2*-'2)%%+ 2- )/+ >*/,+ &'(%))/(+. N +)%-)' '- 4+ (%2*'-)'+ *-'2)%+ (/ '4 VC 4% 2*-'22*- (/ VG %'2)% 4% '(/'+*- 24<-*2% ' 4% '-'/'% 4% &*+)(%)4<% &'()*2% 4% /'+(,'+)% %4 )/%)%*'-) 2- *-)'/'/- ; '4 /*'+ ' &'(%)2%/2*-%. E+)+ &%44%=+ ')'/*-%/- 8,' '- 4% %2),%4*% (/ 4 '-'/%4 +'% 2-+*'/% ,- >*/,+ - 2%,+%4 ' &'(%)*)*+ 8,' 2(%/)' ><%+ ' )/%-+*+*- (%/'-)'/%4 2,-'+ % )/+ >*/,+ 2%,+%-)'+ ' &'(%)*)*+. D' )+ + '4 (%('4 (%)'- '+'('% (/ '4 VG %@- - &% +* '4,2*% 2- 2'/)'=%.
1
Marcadores Hepáticos
MANIFESTACIONES CLÍNICAS HEPATITIS A
L+ +<-)%+ ' 4% &'(%)*)*+ A +,'4' 2'-=%/ '- /% /,+2% ' *-24,*/ ?'/' %4'+)%/ '-'/%4 -,+'%+ %-/'*% 4'+)*%+ %*-%4'+ /*-% +2,/% ' *2)'/*2*%. L% (/%*4*% ' (/'+'-)%/ +<-)%+ +' /'4%2*-% 2- 4% '%. L+ -*+ '-/'+ +,'4'- ('/%-'2'/ %+*-))*2+. E- -*+ %;/'+ ; '- %,4)+ 4% '-'/'% 2%+* +*'(/' +' %+2*% 2- +<-)%+ ; '- ,- "0H ' 4+ 2%++ &%; *2)'/*2*%. L+ +<-)%+ (/ 4 '-'/%4 ,/%2'/2% ' + '+'+ ('/ (,''- (/4-%/+' (/ + )*'(. MANIFESTACIONES CLINICAS DE HEPATITIS B
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
L+ +<-)%+ 24<-*2+ ' 4' &'(%)*)*+ C %,% )*'-'- +'/ + 4'>'+ 8,' ')/+ )*(+ ' &'(%)*)*+ >*/%4. L+ -*+ ; 4+ %,4)+ 8,' %8,*'/'- 4% *-'22*- +,'4'- ('/%-'2'/ %+*-))*2+ (/'+'-)%/ ,-% '-'/'% 24<-*2% - '+('2*/,+ ' 4%+ &'(%)*)*+ A ; B 4% *-+,?2*'-2*% &'()*2% ,4*-%-)' '+ /%/% ; +4 +' &%- *-/% ,-+ (2+ 2%++. MANIFESTACIONES CLINICAS DE HEPATITIS D
L% ('/+-%+ 2- 2*-'22*- VB VD (,''- )'-'/ ,-% '-'/'% %,% + +'>'/% ; ,- %4) /*'+ ' &'(%)*)*+ ,4*-%-)' ##0H 2(%/%%+ 2- 4%+ *-'2)%%+ +4 2- VB. S*- '%/ 4% *-'22*2/-*2% VB 2,//' '-+ /'2,'-)''-)' '- ('/+-%+ 2- VB VD. L% *-'22*- VD (,'' %-*'+)%/+' 2 ,-% 2*-'22*- %,% 2- VB 2 +,('/*-'22*- %,% '- ,- (/)%/ VB 2 *-'22*- VB 2/-*2%. HEPATITIS E
1"
Marcadores Hepáticos
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
L% *-'22*- +' '-2,'-)/% '- (/2'+ ' 2%/%2)'/*=%2*- '- M9*2 - &%; /'(/)'+ ' /'2,'-2*% *-2*'-2*% ' 4% *-'22*- (/ '+)' >*/,+. E- J%(- '4 GVRNA - ,' ')'2)% '- &'(%)*)*+ %,% '+(/*2% ('/ ,' (+*)*> '- 2'/2% '4 3H ' 2%++ 2- &'(%)*)*+ - A -E 2/-*2%. S' '-2-)/ 2*-'2)% +,('/*-'2)% '- " % 15H ' &'(%)*)*+ C ; 5H ' &'(%)*)*+ B ; '- ,- "H ' -%/'+ ' +%-/'. E4 >*/,+ G &% +* '-2-)/% '- (%2*'-)'+ '- '4 ('/* (/')/%-+(4%-)' &'()*2. F/'2,'-)''-)' +' %+2*% % &'(%)*)*+ C ; '- '-/ /'2,'-2*% % &'(%)*)*+ B: +' ')'2)% '- 4%/%)/*+ ' *->'+)*%2*- 2- %-)*2,'/(+ %-)*GV 2GVRNA. L% &'(%)*)*+ (/ >*/,+ G )*'-' '+2%+% /'('/2,+*- 24<-*2% +' '-2,'-)/% '- %+' ' 2%/%2)'/*=%2*- - +' &% ')'/*-% 2- (/'2*+*- +* '*+)' ,-% %+' 2/-*2% - &%; /'2'-%2*- )'/%(9,)*2% '- 4% %2),%4*%.
#0
Marcadores Hepáticos
MARACDORES HEP5TICOS SEROLÓGICOS VIRUS DE LA HEPATITIS A: MARCADORES SEROLOGICOS .Di&+n#"ti$o "e'o!#+i$o0
L% '/ /% ' *'-)*?2%/ ,-% *-'22*- %,% (/ '4 VA 2-+*+)' '- 4% ')'22*- ' 4% *-,-4,4*-% M IM %-)*VA '*%-)' ,- *-,- %-4*+*+ ' %+/2*- 4*% % '-=*%+ ELISA /%**-,-%-4*+*+. E4 %*+4%*'-) '4 >*/,+ - +' *-)'-)% '* % 8,' - '*+)'- +*+)'%+ '?2%2'+ ' 2,4)*>+ )*+,4%/'+ (%/% '44. E- '4 *-*2* ' 4% '-'/'% +' ')'2)%- %-)*2,'/(+ +9/*2+ /'-)' %4 VA. A4 2*'-= +' *'-)*?2%- IM ' IG '+('2*% . E4 *%-+)*2 ' *-'22*- %,% (/ VA +' /'%4*=% %-)' '4 &%44%= ' IM %-)* VA '- ,-% ('/+-% 2- +<-)%+ ; +*-+ *8,<*2+ ' &'(%)*)*+.
4ig.2. 5voluci"n cronol"gica de la in6ecci"n por el virus de la epatitis A
#1
Marcadores Hepáticos
VIRUS DE LA HEPATITIS B MARCADORES SEROLOGICOS
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do'e" de !& 3e(&titi" B
##
Marcadores Hepáticos
B+A %-)*'- ' +,('/?2*'.
A-)*B+ %-)*2,'/( 2-)/% %-)*. D' +,('/?2*'.
B2 A %-)*'- '4 2/'.
A-)* B2 %-)*2,'/( 2-)/% '4 2/' Z2/' ))%4[
B' A %-)*'- Z'[.
A-)* ' %-)*2,'/( 2-)/% '4 %-)*'-* Z'[.
BU DNA DNA '4 >*/,+ ' &'(%)*)*+ B. DNA (4*'/%+%.
Pe'6!e" "e'o!#+i$o" en !& in7e$$i#n (o' VHB A+HB"
Anti2HB"
I+M HB$
HB$
8 2
2 2
8 8
tot&! 8 8
8 2 2
2 8 2
2 2 2
8 8 8
2
8
2
2
Sit%&$i#n
I-. A,% I-. A,% ('/< >'-)%-% I-. C/-*2% I-. P%+%% I-. P%+%% 2/-*2%\ %4+ . V%2,-%2*-
HEPATITIS C MARCADORES SEROLOGICOS
ANTI2VHC: 2*'-=% % ')'2)%/+' %(/*%%'-)' % 4%+ 11
+'%-%+ 6#$ +'%-%+ )/%+ 4% '(+*2*- %4 >*/,+. S* 4% *-'22*- +' %,)4**)% '+%(%/'2' /%,%4'-)' %,-8,' (,'' ('/+*+)*/ &%+)% 5 %+ '+(,9+ ' 4% 2,/%2*-. S* 4% *-'22*- +' 2/-*?2% ('/+*+)'(+*)*>+. L% (/'+'-2*% ' %-)* VC *(4*2% 2-)%2) 2- '4 >*/,+ ; (,'' +'/ *-)'/(/')% 2 %/2%/ ' *-'22*- (%+%% ; 2,/%% ,- %4+ (+*)*> ,-% *-'22*- 2/-*2%. P%/% *+)*-,*/ '-)/' '+)%+ '-)*%'+ '4 +*,*'-)' (%+ *%-+)*2 '+ 4% ')'/*-%2*- '4 ARN >*/%4
#3
Marcadores Hepáticos
ARN2VHC: +, ')'/*-%2*- )%-) '- +,'/ 2 '- (4%+% 2-?/%
4% *-'22*- %2)*>%. S' (,'' ')'2)%/ )/%+ + +'%-%+ '+' '4 *-*2* ' 4% *-'22*-. L% 2%/% >*/%4 '+ %/2%/ (/-+)*2 ' /'+(,'+)% %4 )/%)%*'-).
CASO CLÍNICO 9: P%2*'-)' ''-*-% ' 61 %+ +*- %-)'2''-)' ' *(/)%-2*% 8,*'(/'+'-)% 2,%/ ' %4'+)%/ '-'/%4 *2)'/*2*% 4'>' ; 24,/*% &%2*9-+' '4 *%-+)*2 ' &'(%)*)*+ >*/%4 %,% )*( A 2- %/2%/ +'/4*2 IM %-)* AV (+*)*>. E4 '%'- 24<-*2 +' '-2-)/%% '-)/ ' 4<*)'+ -/%4'+ '2'() (/ *+2/')% *2)'/*2*%. E- '+' '-) 4+ %/2%/'+ +'/4*2+ (%/% &'(%)*)*+ B ; C ,'/- -'%)*>+ ; 4+ %-4*+*+ *-*2*%4'+ ,'/- 4+ +*,*'-)'+: : 1$.# L L',22*)+: 53003 B*4*//,*-% ))%4: #.6 L % (/'*-* */'2). ALT: 1#00 UIL AST: 1530 UIL F+%)%+% %42%4*-% ; )*'( ' (/)/*-% '-)/ ' 4+ 4<*)'+ -/%4'+. L% (%2*'-)' (/'+'-) /(*% /'2,('/%2*- 24<-*2% ; *8,<*2% ' +, 2,%/ ; ,- '+ '+(,9+ 4+ 2-)/4'+ *8,<*2+ +)/%/- ,-% AST ' #1" UIL ALT ' 0 UIL ; B*4*//,*-% ))%4 ' 1.$5 L. S*- '%/ 4+ 2-)/4'+ ('/**2+ ' %*-)/%-+'/%+%+ +)/%%- +*'(/' ,-% '4'>%2*('/+*+)'-)' %,-8,' ' % /% +*'- 4+ >%4/'+ ' ALT 57 UIL ; AST 6" UIL % 4+ 6 '+'+ ; ALT "5 UIL ; AST 7 UIL % 4+ -,'>' '+'+. E-)/' '4 +9()* ; 2)%> '+ '4 *%-+)*2 *-*2*%4 4% (%2*'-)' 2*'-=% % (/'+'-)%/ 2*'/)% %)*%*4*% ; %/)/%4*%+ */%)/*%+ ' %+ &/+ ; 2+ +*- ')*>%/+' +*-+ ' +*+. E- '+)' '-) +' +4*2*)%%4,-+ %-4*+*+ ' 4%/%)/*: A-)*2,'/(+ %-)* -,24'%/'+ 1$0 A-)*2,'/(+ %-)* @+2,4 1#0 A4@*-% 3." L G4,4*-%+ ))%4'+ $.51 L *('/%%4,4*-'*% ' #.71 L.
#$
Marcadores Hepáticos
B*(+*% &'()*2%: 4'>' *-?4)/% 4*--2*)%/* '- '+(%2*+ (/)% +*-'2/+*+ '- +%2%2% '+2%++ *-?4)/%+ 4,4%/'+ '+)'%)+*+ 4'>'. Di&+n#"ti$o:
'(%)*)*+ %,)*-,-' '+'-2%'-%% (/ '(%)*)*+ A.
CASO CLÍ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i"$%"i#n:
L% &'(%)*)*+ A '+ ,-% '-'/'% *-'2)2-)%*+% 2,;% /'+(-+%4' '+ ,(*2/-%>*/,+ ' #7 - 8,' +' /'(4*2% '- '4 &<% +' '2/')% '- 4% *4*+ ; +' '4**-% '- 4%+ &'2'+ ' ('/+-%+ *-'2)%%+ %(/*%%'-)' # +'%-%+ %-)'+ '4 *-*2* ' 4% 24<-*2% ; &%+)% ,-% +'%-% '+(,9+. L% >*/'*% 2%,+% ,- /'('-)*- %4'+)%/ '-'/%4 2- +<-)%+ *-'+('2*)+ %-/'*% *-%(')'-2*% ; 4/ '- '(*%+)/* &*(2-/* '/'2& ; %2(%% ' *4*//,*-,/*% ; %+2'-+ ' '-=*%+ &'()*2%+. L% 24,/*% ; 4% %24*% (/'2''- '- 15 <%+ ' 4% %(%/*2*- '
#5
Marcadores Hepáticos
*2)'/*2*%. A4 '%'- <+*2 /'>'4% &'(%)'%4*% ; '- 2%+*-'+ ,- %4'>' '+(4'-'%4*%. E- +, *-*2* 4+ *+)*-)+ >*/,+ 8,' 2%,+%- &'(%)*)*+ )*'-'- ,-% 24<-*2% ,; (%/'2*% (/ 4 8,' - +' (,'' 2-2'/ '4 )*( ' &'(%)*)*+ +*- /'%4*=%/ ,-% +'/4<%. L+ %-)*2,'/(+ %-)*VA +- 4% *-,-4,4*-% M 8,' *-*2% '-'/'% %,% ; 4% *-,-4,4*-% G 8,' *-*2% *-'22*- (%+%% ' *-,-*% ('/%-'-)' %(%/'2' '- '4 (/*'/ '+ ; +' %-)*'-' ,/%-)' %+. S, (/'>'-2*- +' %+% '- ,-% &**'-' 2//'2)% 2- '4 %+ ')*2,4+ ' %-+ ; 4% 2//'2)% *-,-*=%2*-.
#6
Marcadores Hepáticos
CONCLUSIONES: Se describieron los diversos tipos de Hepatitis, con sus características estructurales, su patogenia, las manifestaciones clínicas. No se puede distinguir las diferentes tipos de hepatitis víricas solo por los datos clínicos o parámetros químicos habituales, para ello son necesarios las pruebas serológicas. Las pruebas de laboratorio que se utilizan habitualmente para la detección o confirmación de una posible hepatopatía comprenden la medición de los niveles sricos de las aminotransferasas, fosfatasas alcalina ! "ammaglutamil transferas principalmente ! se tratan de pruebas complementarias que proporcionan una estimulación de la función de síntesis ! puede indicar la naturaleza del trastorno. #l diagnóstico de enfermedades hepáticas depende del historial clínico completo, del e$amen físico completo ! de la evaluación de las pruebas serológicas.
#7
Marcadores Hepáticos
BIBLIOGRAFÍA: •
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V*/,+ ' 4%+ &'(%)*)*+. N. C/'*/ R. T%/2 . C&*(%/'44*. P%. $77 MURRA PATRIC ROSENTAL EN OBASASI GEORGE PFALLER MICAEL. M*2/*4<% 9*2%. C,%/)% '*2*-. E*)/*%4 M+;. E+(%% #00# R'>*+)% ' 4% S2*'% V'-'=4%-% ' M*2/*4<% #01# 3#:61#. A/)<2,4 ' /'>*+*- V*/,+ ' 4% &'(%)*)*+ E. C%/%2)'/<+)*2%+ *4*2%+ ; '(*'*4*2%+. D-';4% A4'%-/% S-2&'= P%/)*%+ C/*+)*-% '4 R+%/* G,)*9//'= G%/2<%\. V'-'=,'4%.
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&))(:^^^.&**'-'.',.,;2'%#00&'(%)*)*+.(
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&))(:^^^.',/-%4.,-%./-$33RFM$3306.(
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