From the Guidelines
The appropriate workup for viral hepatitis begins with a thorough history and physical examination, followed by laboratory testing to identify the specific viral cause, including liver function tests, complete blood count, coagulation studies, and specific serologic testing for hepatitis A, B, C, D, and E, as recommended by the most recent guidelines 1. The initial evaluation should include:
- Liver function tests (ALT, AST, alkaline phosphatase, bilirubin, albumin)
- Complete blood count
- Coagulation studies
- Specific serologic testing:
- Hepatitis A IgM antibody
- Hepatitis B surface antigen
- Hepatitis B core IgM antibody
- Hepatitis B surface antibody
- Hepatitis C antibody
- Hepatitis D and E antibodies (in certain cases) For patients with positive hepatitis C antibody, confirmation with HCV RNA testing is necessary, as stated in the guidelines 1. Additional testing may include:
- Viral load quantification (particularly for hepatitis B and C)
- Genotyping for hepatitis C to guide treatment decisions
- Assessment of liver fibrosis through non-invasive methods like FibroScan or serum biomarkers Imaging studies such as ultrasound of the liver should be performed to evaluate for complications like cirrhosis or hepatocellular carcinoma, especially in chronic cases, as recommended by the guidelines 1. In some situations, liver biopsy may be indicated to assess the degree of inflammation and fibrosis, as stated in the guidelines 1. This comprehensive approach allows for accurate diagnosis, determination of disease phase (acute vs. chronic), assessment of severity, and guides appropriate treatment decisions for the specific viral hepatitis.
From the Research
Workup for Viral Hepatitis
The workup for viral hepatitis involves a combination of laboratory tests and physical examinations to determine the type and severity of the infection.
- Laboratory tests include:
- Serologic tests to detect the presence of viral antibodies and antigens 2
- Molecular assays to detect viral DNA or RNA and monitor responses to antiviral therapy 2
- Liver function tests, such as aspartate transaminase and alanine aminotransferase, to assess liver damage 3, 4
- Tests to assess liver function, such as bilirubin, albumin, and prothrombin time 3
- Physical examinations include:
Diagnosis of Viral Hepatitis
The diagnosis of viral hepatitis can be made using a variety of laboratory methods, including:
- Immunological methods, such as enzyme immunoassay and radio-immunoassay 5
- Molecular approaches, including non-amplification and amplification-based methods 5
- Advanced biosensors, such as mass-sensitive and electrical biosensors 5
- Classical methods, such as flocculation tests and electrophoretic determination of plasma protein picture 4
Treatment and Prevention
The treatment and prevention of viral hepatitis depend on the type and severity of the infection.
- Antiviral therapies, such as interferon alfa and lamivudine, are available for the treatment of chronic hepatitis B 3
- Vaccination is available for the prevention of hepatitis A and B 6
- Surgeons and healthcare workers should take precautions to prevent the transmission of viral hepatitis, including the use of personal protective equipment and careful surgical technique 6