Diagnosis of Hepatitis
The diagnosis of hepatitis requires a careful and systematic approach that combines medical history, physical examination, and a variety of diagnostic tests to confirm liver inflammation, identify its cause, and assess the extent of liver damage. Because hepatitis may present with vague or no symptoms—especially in its early stages—many cases go undetected unless specifically investigated. Early and accurate diagnosis of hepatitis is essential to prevent long-term complications such as cirrhosis, liver failure, or liver cancer.
The diagnostic process begins with a comprehensive clinical history. The healthcare provider will ask about recent symptoms such as fatigue, nausea, jaundice (yellowing of the skin and eyes), dark urine, pale stools, abdominal discomfort, or unexplained weight loss. Questions also focus on potential risk factors, including:
Recent travel to areas with poor sanitation (suggestive of hepatitis A or E)
History of unprotected sex, intravenous drug use, or tattoos (hepatitis B and C)
Blood transfusions before the 1990s or shared needle use
Alcohol consumption patterns
Use of prescription or over-the-counter medications, herbal remedies, or supplements
Autoimmune conditions or family history of liver disease
Next, a physical examination is conducted to detect signs of liver inflammation or dysfunction. Findings may include an enlarged liver (hepatomegaly), yellowing of the skin and eyes, abdominal tenderness, and, in more advanced cases, signs of chronic liver disease such as spider angiomas, ascites (fluid in the abdomen), or confusion due to hepatic encephalopathy.
Diagnosis of Hepatitis
The cornerstone of the diagnosis is a series of blood tests, starting with liver function tests (LFTs). These measure enzymes and substances produced or processed by the liver, including:
When liver cells are damaged, they release enzymes called alanine aminotransferase (ALT) and aspartate aminotransferase (AST) into the bloodstream, causing their levels to rise.
Alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) – elevated in bile duct problems or alcohol-related liver disease
Bilirubin – a substance that builds up in the blood when the liver fails to excrete it properly
Albumin and prothrombin time (INR) – markers of the liver’s synthetic function
Elevated levels of ALT and AST are the most direct indicators of liver inflammation, while abnormalities in bilirubin, albumin, or clotting time may suggest more advanced or chronic disease.
Once liver inflammation is confirmed, doctors work to identify the cause. Blood tests called viral serologies help detect hepatitis viruses and reveal whether the infection is acute or chronic:
- Hepatitis A: IgM anti-HAV indicates acute infection; IgG anti-HAV indicates past infection or immunity
- Hepatitis B: A combination of tests, including HBsAg (surface antigen), anti-HBs (surface antibody), anti-HBc (core antibody), and IgM anti-HBc, is used to determine infection status, chronicity, and immunity
- Hepatitis C: Anti-HCV antibody indicates exposure; HCV RNA confirms active infection
- Hepatitis D: Anti-HDV and HDV RNA testing (only done if HBV infection is confirmed)
- Hepatitis E: IgM anti-HEV confirms recent infection
In addition to viral testing, the provider may request autoimmune markers such as ANA (antinuclear antibodies), ASMA (anti-smooth muscle antibodies), and LKM-1 (liver kidney microsomal antibodies) if autoimmune hepatitis is suspected.
If drug-induced hepatitis is a concern, the medication history becomes crucial. Although there is no single test for all hepatotoxic drugs, elevated liver enzymes in a patient taking known hepatotoxic medications—such as paracetamol, methotrexate, or certain antibiotics—can suggest drug-induced injury. In some cases, a toxicology screen or paracetamol level test may be ordered, especially in acute overdose scenarios.
Diagnosis of Hepatitis
When metabolic or genetic conditions are suspected, additional blood tests may include:
Iron studies (for haemochromatosis)
Ceruloplasmin and serum copper (for Wilson’s disease)
Alpha-1 antitrypsin levels
Fasting blood sugar and lipid profiles (for metabolic syndrome or NAFLD)
To evaluate the extent of liver damage, imaging studies are commonly used. These may include:
Abdominal ultrasound: A non-invasive test that assesses liver size, texture, and fat content. It can detect cirrhosis, fatty liver, tumours, or bile duct obstruction.
CT scan or MRI: More detailed imaging for suspected liver masses or structural abnormalities.
Elastography (FibroScan): A specialised ultrasound that estimates liver stiffness and helps assess fibrosis or cirrhosis without a biopsy.
Diagnosis of Hepatitis
Doctors may perform a liver biopsy when the diagnosis is unclear or when they suspect autoimmune or chronic hepatitis. This involves taking a small sample of liver tissue using a needle for examination under a microscope. A biopsy can provide valuable information on the degree of inflammation, fibrosis, and the exact cause of hepatitis.
Screening for co-infections or complications may also be part of the workup. Doctors test people with hepatitis B for hepatitis D and screen those with hepatitis C for HIV. When they suspect cirrhosis, they order imaging and blood tests to check for oesophageal varices, ascites, or liver cancer.
The diagnosis is not complete without assessing the duration and progression of the disease. Doctors classify hepatitis as acute if symptoms and lab results improve within six months. If inflammation or viral markers last longer, they diagnose chronic hepatitis, which needs long-term treatment to avoid complications.
Diagnosis of Hepatitis
In summary, the diagnosis of hepatitis involves a combination of history-taking, physical examination, blood tests, imaging, and sometimes biopsy. Determining the cause and severity of liver inflammation is critical for guiding treatment and preventing long-term liver damage. Timely and accurate diagnosis helps doctors manage most hepatitis cases effectively. This approach improves patient outcomes and lowers the risk of serious complications.
