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Chapter 9 : Diagnosis

Diagnosis arrow_upward

  • Doctors diagnose hepatitis based on a physical examination and the results of blood tests.
  • In addition to specific tests for hepatitis antibodies, doctors will order other types of blood tests to evaluate liver function.

  • Tests for Liver Function arrow_upward

  • In people suspected of having or carrying viral hepatitis, doctors will measure certain substances in the blood.
  • Bilirubin:
    • Bilirubin is one of the most important factors indicative of hepatitis
    • It is a red-yellow pigment that is normally metabolized in the liver and then excreted in the urine
    • In patients with hepatitis, the liver cannot process bilirubin, and blood levels of this substance rise
  • Liver Enzymes (Aminotransferases):
    • Enzymes known as aminotransferases, including aspartate (AST) and alanine (ALT), are released when the liver is damaged
    • Measurements of these enzymes, particularly ALT, are the least expensive and most noninvasive tests for determining severity of the underlying liver disease and monitoring treatment effectiveness
    • Enzyme levels vary, however, and are not always an accurate indicator of disease activity
  • Alkaline Phosphatase (ALP):
    • High ALP levels can indicate bile duct blockage
  • Serum Albumin Concentration:
    • Serum albumin measures protein in the blood (low levels indicate poor liver function)
  • Prothrombin Time (PT):
    • The PT test measures in seconds the time it takes for blood clots to form

    Liver Biopsy arrow_upward

  • The liver tissue sample is taken in a process called a liver biopsy.
  • Patient will either be sedated or given a local anesthetic, and a tiny sample of liver tissue will be removed with a long needle through a small incision on your right side.
  • If patient have chronic hepatitis B and C, a biopsy can determine the stage and severity of disease.
  • A liver biopsy can also be used to diagnose some of the complications of advanced hepatitis including fibrosis, cirrhosis, and liver cancer.
  • A liver biopsy is not without risk. Dangerous bleeding can sometimes occur, as well as infection.
  • There is now a trend to use less invasive methods of diagnosing liver tissue damage from chronic hepatitis.

  • Other Diagnostic Tools arrow_upward

  • Other tests for advanced disease include checking your liver for signs of fibrosis (stiffening from scarring), which can tell your doctor how far along your hepatitis has progressed.
  • These include:
    • Paracentesis
    • Elastography
    • Surrogate markers


  • Fluid from your abdomen can be tested to help differentiate among the many possible causes of liver disease.
  • During this test, a doctor will remove the fluid through a needle.

  • Elastography

  • This non-invasive test is a means of checking for fibrosis and uses sound waves to measure the liver’s stiffness.
  • Elastography tests are most accurate in identifying advanced disease.

  • Surrogate markers

  • These are panels of blood tests that look for abnormal levels of certain substances in the blood (surrogate markers) that seem to parallel the development of fibrosis and cirrhosis.
  • These markers are different than the usual blood tests done to diagnose hepatitis.

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