B Chronic Viral Hepatitis

1.  Symptoms and signs—Chronic viral hepatitis may be and is often asymptomatic; many patients are unaware of their condition until the diagnosis is made incidentally or until progression to advanced liver disease results in systemic symptoms and clinical features of hepatic dysfunction.

2.  Laboratory findings—The most telling laboratory markers are the aminotransferase levels, which may be elevated continuously or may fluctuate; typically, ALT levels are higher than AST levels until cirrhosis develops, when AST levels tend to be higher. Otherwise, laboratory values that reflect hepatic function (bilirubin, albumin, prothrombin time) may be normal.

3.  Imaging findings—Ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) are useful to evaluate liver parenchyma and to assess for the existence of varices, reversal of portal hepatic flow, ascites, splenomegaly, and other signs of portal hypertension; hepatic vein occlusion and other vascular abnormalities; and focal mass lesions.

4. Histologic evaluation—Although its role is evolving, liver biopsy is useful for grading the activity and for staging the progression of disease, for identifying clinically relevant histologic features (eg, steatosis, iron deposition, pathognomonic features of autoimmune liver injury, granulomatous inflammation, etc), or for adding helpful information in diagnostically challenging cases.

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