From the Guidelines
A good workup for hepatitis should begin with a thorough history and physical examination, followed by laboratory testing including liver function tests (ALT, AST, alkaline phosphatase, bilirubin, albumin, and prothrombin time) as recommended by the most recent guidelines 1.
Initial Evaluation
The initial evaluation of patients with hepatitis should include:
- History-taking (including alcohol consumption and drug use) and physical examination
- Family history of liver disease and HCC
- Laboratory tests to assess liver disease: complete blood count, AST/ALT, alkaline phosphatase, gamma-glutamyl transpeptidase, bilirubin, albumin, creatinine, and prothrombin time 1
- Serologic tests for HBV replication: HBeAg/anti-HBe and HBV DNA
- Tests to rule out other viral coinfections: anti-HCV, anti-HDV, and anti-HIV 1
Viral Hepatitis Serologies
Viral hepatitis serologies are essential, including:
- Hepatitis B surface antigen
- Hepatitis B core antibody
- Hepatitis B surface antibody
- Hepatitis C antibody with reflex RNA testing if positive 1
Additional Tests
Additional tests should include:
- Complete blood count
- Basic metabolic panel
- Coagulation studies
- Autoimmune markers (ANA, anti-smooth muscle antibody, anti-LKM)
- Iron studies
- Ceruloplasmin (for Wilson's disease)
- Alpha-1 antitrypsin levels
- Alcohol use assessment 1
Imaging
Imaging with ultrasound of the liver is recommended to evaluate for structural abnormalities, fatty infiltration, or cirrhosis 1.
Liver Biopsy
In cases where the diagnosis remains unclear, a liver biopsy may be necessary for definitive diagnosis 1. This comprehensive approach helps identify the specific cause of hepatitis, which is crucial for determining appropriate treatment and management strategies. Early diagnosis is important as some forms of hepatitis can progress to chronic liver disease if not properly addressed 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Evaluation
A good workup for hepatitis typically involves a combination of medical history, physical examination, serological, biochemical, and virological tests to confirm the diagnosis and assess the disease activity and stage 2. The initial evaluation may also include an imaging study to establish a baseline for future monitoring.
Laboratory Tests
Laboratory tests for hepatitis diagnosis include:
- Determination of specific viral markers, such as HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, IgM anti-HBc, and HBV DNA for HBV infection 3
- Anti-HCV and HCV RNA for HCV infection 3
- Serologic testing, including liver function tests, to assess liver injury and guide diagnostic evaluation 4, 5
Imaging Studies
Imaging studies, such as ultrasonography, may be used to:
- Establish a baseline for future monitoring 2
- Screen for hepatocellular carcinoma (HCC) every 6-12 months in high-risk patients 2
Liver Biopsy
A liver biopsy may be performed to:
- Provide useful information on prognosis, need for surveillance for HCC, and whether to recommend therapy 2
- Assess liver fibrosis and disease stage 5
Follow-up Monitoring
Follow-up monitoring is aimed at determining disease progression, development of complications, and reassessing the need for treatment 2. The frequency of monitoring should be determined based on the activity and stage of disease.
Patient Care
Patient care includes:
- Sign and symptom management
- Medication administration
- Prevention of transmission to friends and family members
- Follow-up serologic testing
- Evaluation for chronic infection 6