Testing for viral hepatitis. A practice parameter.

Abstract

Hepatitis is defined broadly as liver parenchymal inflammation. The differential diagnosis of this inflammation is extensive and includes a wide variety of infections, drug and toxin exposures, vascular disease, and metabolic and immune derangements. This practice parameter focuses on viral hepatitis ❚Table 1❚; however, other causes of hepatitis must be excluded in the workup of a patient with evidence of inflammatory liver disease. Indeed, in view of the prevalence of viral hepatic infection, the presence of serologic markers of hepatitis may not represent the only cause of the patient’s illness. Laboratory evaluation is a necessary adjunct in the assessment of the patient with liver disease and complements the history and physical examination. In the evaluation of hepatic disease, laboratory test results can indicate parenchymal injury; biliary injury; abnormalities of bilirubin metabolism, excretory function, or synthetic function; evidence of immunologic damage; hepatic neoplasia; and viral hepatic diseases. These categories can be expanded to include several specific blood tests, such as measurement of alpha1-antitrypsin, antinuclear antibodies, anti–smooth muscle antibodies in autoimmune hepatitis, antimitochondrial antibodies in primary biliary cirrhosis, iron studies in hemochromatosis, and ceruloplasmin in Wilson disease.