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Hepatitis (Diagnosis)

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How hepatitis is diagnosed?

Acute hepatitis can be diagnosed with the help of clinical presentation and blood tests including liver function tests and viral markers. Less often imaging tests or biopsy is required which is generally used for assessing chronic hepatitis and its complications. These can be categorised into blood tests, imaging studies and liver biopsy.

1. Blood tests:

• Liver function tests:



Alanine aminotransferase (ALT)

Aspartate aminotransferase(AST)

Alkaline phosphatase

Prothrombin time

Total protein, albumin and globulin

• Complete blood count and coagulation studies.


• Viral markers:

The cause of viral hepatitis can’t be differentiated clinically. For this purpose blood tests for viral markers of hepatitis A,B,C,D and E are done. These are as follows:

– Serum IgM anti-HAV for hepatitis A virus (HAV).

– Serum HBsAg and Anti-HBc IgG for Hepatitis B Virus. Serum HBsAg indicate acute infection and if it persists for more than 6 months on serial tests, it indicates chronic hepatitis. Anti-HBc IgG suggest past infection.

– Serum anti-HCV antibody testing for screening of hepatitis C virus (HCV). If this comes positive then it is followed by serum HCV-RNA test to check if there is an active infection.

– Serum HDAg for HDV done along with anti-HBc IgM and IgG for Hepatitis B virus infection.

– IgM anti-HEV for hepatitis E virus

• Autoimmune markers:

To test for autoimmune hepatitis using following tests, ANA (antinuclear antibody), ASMA (antismooth muscle antibody), Anti-LKM-1 (anti-liver/kidney microsomal-1) antibodies and total IgG or γ-globulin level.

2. Imaging studies:

• Ultrasound (USG): is done to look for any abnormality in the appearance of the liver and see for any signs of complications such:


– Changes of cirrhosis: shrunken and nodular liver, fluid in abdomen, dilated portal vein with abnormal blood pressure, enlarged spleen etc.

– Liver mass to suggest liver cancer.

• Elastography: to check detect the presence of fibrosis (scarring) in the liver and to grade the severity of fibrosis. This test is typically done in cases of chronic hepatitis. This test is available in 3 types:

– Transient elastography: popularly know by fibroscan. Usually done by hepatologist.

– Acoustic radiation force impulse elastography (ARFI): done with help of high end ultrasound machine in radiology departments. Better for obese and people with fluid in abdomen.

– Magnetic resonance elastography: special type of MRI that detects fibrosis. Considered as most accurate modality.

3. Liver biopsy:


It is an invasive test where a needle is passed into liver to obtain a small sample of tissue which is the checked under microscope for abnormalities. It is provides more detailed information about the changes and abnormality in the liver cells than other tests. However, it is usually not performed until other tests are not able to give a clear picture.


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