Viral Hepatitis: Risk Factors and Diagnosis

Risk Factors

Exposure to blood or body fluids (eg, intravenous drug use, high–risk sexual intercourse, tattoos, body piercing, blood transfusion, occupational needlestick exposure). Transmission via blood transfusion is now rare due to universal screening.

Contact with an infected person (hepatitis A).

Poor hygiene and inadequate sanitation (hepatitis A and hepatitis E).

Underlying liver disease. Patients with underlying liver disease (eg, autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha–1 antitrypsin deficiency) are at increased risk of developing symptomatic hepatitis.

Alcohol use, smoking, HIV infection, and fatty liver are risk factors for progression of hepatitis.

Diagnosis

Abnormal liver function tests are common in viral hepatitis patients. Transaminases such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), bilirubin, and alkaline phosphatase are generally elevated. Coagulation studies, such as prothrombin time (PT) and partial thromboplastin time (PTT), and albumin are often normal, except in severe disease.

Hepatitis Virus Serology

• Hepatitis A: Antihepatitis A virus IgM reflects acute infection. IgG reflects past exposure or vaccination and confers lifelong immunity.
• Hepatitis B: Surface antigen and core antibody reflect acute infection. Hepatitis B envelope antigen indicates high infectivity. Be sure to test for superinfection with hepatitis D virus.
• Hepatitis C: Testing includes serology, PCR, and genotyping.
• Hepatitis D: Antihepatitis D virus IgM or IgG is consistent with infection.
• Hepatitis E: Antihepatitis E virus IgM or IgG is consistent with infection.

Biopsy may be indicated to evaluate for etiology and staging of disease.

Right–upper–quadrant ultrasound is usually indicated to evaluate the biliary system and rule out cholelithiasis and biliary obstruction.

Xray, CT scan, MRI, and/or endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to rule out other abdominal pathology (eg, pancreatitis, cholecystitis, malignancy).