Diagnosing hepatitis

A consultation with a primary health care provider (general practitioner / GP) will begin with a short discussion to determine a few things about your overall symptoms and medical history.

Your doctor may likely ask you questions such as:

• When did you first notice your symptoms?
• Would you describe your symptoms as occasional or continuous?
• Would you describe your symptoms as mild or severe?
• Have you tried anything that has either alleviated any symptoms?
• Is there anything you’ve noticed has appeared to worsen your symptoms?
• Are you currently taking any medications or supplements? (*This is important as it can affect any tests performed as well as their results)

The general diagnosis procedure will then follow the below steps:

• A physical examination: Your doctor will ask you to lay down on an examination bed and gently press down on your abdomen (tummy area). He or she will be looking for any signs (mild or severe) of discomfort, tenderness and pain. Your doctor will also look for signs of an enlarged liver (indicating damage and inflammation) and assess the colour of your skin and the whites of your eyes (possible jaundice).
• Blood and liver function tests: Your doctor may recommend blood tests to assess the presence of a hepatitis virus (A, B, C, D and E). He or she will be testing for antibodies and antigens (toxins or foreign substances) in the blood that will typically indicate the presence of a virus (these will be higher if you currently have an infection or have had a hepatitis infection before – antibodies can stay in your blood permanently to fight off potential infections down the line), and underlying cause of a hepatitis infection. Blood samples will also be used to test the function of your liver and measure how effectively it is currently working. The test analyses whether the liver is clearing (metabolising) any blood waste, enzymes and proteins not needed for the body to function. If enzyme levels are high, it is an indication that the liver is inflamed and being damaged as a result. A blood sample will be taken from a vein in your arm. The test typically takes a few minutes to perform.
• Viral antibody tests: These tests (a blood sample) can be used to determine the type of hepatitis virus present in the system or rule out a non-viral cause. These tests are also used to screen individuals with a higher risk of infection or transmitting an infection, such as nurses, doctors and dentists, as well as organ and blood donors.
• Imaging tests: An abdominal ultrasound can give your doctor detailed images of the organs inside your abdomen. Your doctor can use an ultrasound to determine whether you have a build-up of fluid in your abdomen, which is often an indication of an enlarged / failing liver (due to inflammation and damage).
• Invasive testing: Your doctor will consider an invasive method of testing if it is determined that you have an infection and presence of inflammation that is causing damage to your liver. A liver biopsy is a closed procedure that involves a doctor removing a sample of liver tissue through the skin with a needle. Testing will assess the nature of the damage, which in turn will help to determine a final diagnosis and appropriate treatment plan.

If hepatitis B is suspected, your doctor may recommend the following blood test screenings:

• Hepatitis B surface antigen test: This blood sample will help your doctor determine whether or not you are contagious. Positive results indicate not only a HBV infection, but also your capability of transmitting the disease. Negative results will indicate the lack of an infection present in the body. Your doctor won’t be able to use this test to determine acute or chronic variations of HBV.
• Hepatitis B core antigen test: Positive results from this sample will indicate an HBV infection, as well as whether you have an acute or chronic variation of the disease.
• Hepatitis B surface antibody test: This test will assess whether you have immunity to HBV. A positive result will indicate that you are immune to hepatitis B (you have either been vaccinated against the virus causing the disease or you have already recovered from an acute infection and are no longer contagious).

Other tests that may be recommended to assess liver damage and diagnose hepatitis (particularly chronic hepatitis) are:

• MRE (Magnetic Resonance Elastography): If available, a doctor may opt for a non-invasive alternative to a liver biopsy. MRE technology looks at patterns formed when sound waves bounce off the liver and create a visual map of the organ. Your doctor will be able to see gradients of rigidity throughout the organ. A liver which is quite stiff (or rigid) may indicate scarring damage (fibrosis) as a result of chronic hepatitis.
• Transient elastography: Also a non-invasive procedure, this type of ultrasound can also be used, when available to your doctor as an alternative to a biopsy. He or she will perform the imaging test to transmit vibrations to the liver and measure the dispersal speed through the organ in order to estimate its level of rigidity.

Both tests are completely painless to experience and results can be analysed fairly quickly.

Diagnosis for non-viral hepatitis:

• Alcoholic hepatitis: Along with a physical exam, your doctor may wish to discuss your alcohol consumption history in detail. It is important to honestly disclose information about your drinking habits so that your doctor can make the best assessment for diagnosis, and ultimately the best course of action for treatment. Tests may include blood and liver function tests, imaging tests (ultrasound, MRI and CT scan) of your liver and if necessary, a liver biopsy.
• Autoimmune hepatitis: A diagnosis will involve blood tests to rule out any potential viral causes (testing for antibodies) or other conditions that may have similar symptoms. The blood tests will also help your doctor to determine which autoimmune hepatitis type you have. A liver biopsy may also be recommended to confirm a diagnosis, as well as an ultrasound.