Evaluation of Hepatitis

Biochemical Tests

The American Association for the Study of Liver Diseases recommends that the liver profile in suspected hepatitis should include transaminases (ALT/AST), bilirubin, alkaline phosphatase, GGT, prothrombin time, albumin, and platelet count, in addition to specific serological markers according to the suspected type of hepatitis 1, 2
Elevated alkaline phosphatase and GGT suggest a cholestatic pattern, important for differentiating between types of hepatitis 2
Prothrombin time/INR reflects the liver's synthetic capacity and is an important prognostic indicator 1
Serum albumin is a marker of long-term liver function 1, 3
Platelet count may decrease in advanced liver disease with portal hypertension 1, 3

For hepatitis B, a complete panel including HBsAg, anti-HBs, anti-HBc IgM, anti-HBc IgG, HBeAg, and anti-HBe is recommended to evaluate viral replication and infectivity 1, 4, 5, 6
Hepatitis C diagnosis involves anti-HCV antibodies and confirmation with HCV RNA qualitative/quantitative testing 7
Hepatitis D diagnosis involves anti-HDV and HDV RNA (only in HBsAg-positive patients) 8

A hepatocellular pattern is characterized by predominant elevation of transaminases (ALT/AST) over alkaline phosphatase 2
A cholestatic pattern is characterized by predominant elevation of alkaline phosphatase and GGT over transaminases 2
The magnitude of transaminase elevation does not always correlate with the histological severity of the disease 7
Normal transaminase levels do not rule out significant liver disease, especially in chronic hepatitis C and B 7
The presence of thrombocytopenia, hypoalbuminemia, and prolonged prothrombin time suggests advanced liver disease 1, 3

Abdominal ultrasound is recommended in all patients with abnormal liver tests to evaluate liver structure, rule out focal lesions, and signs of portal hypertension 1, 2
Liver elastography is a non-invasive assessment of fibrosis 1, 8
Liver biopsy is considered when biochemical and viral marker results are inconclusive or to assess the degree of activity and fibrosis 1, 7