Hepatitis E; Symptoms, Diagnosis, Prevention, & Treatment Options

Diagnosis and workup

After suspecting viral hepatitis, doctors usually run a series of tests that include blood chemistry (liver enzymes and bilirubin levels) and imaging tests (usually limited to an abdominal ultrasound). The workup depends on each patient and includes:

• Serum liver enzymes: These enzymes belong only to the liver. So, when found in large numbers in the blood, serum liver enzymes are a reliable sign of liver damage. The most important include alanine aminotransferase (ALT) and aspartate aminotransferase (AST). ALT is usually higher than ALT, and hepatitis E usually raises its values 10 or 20 times their normal range. Their peak values are found after 4 weeks of the infection and return to normal 1 or 2 months after the disease has cleared.
• Serum bilirubin: This is also a critical exam to rule out hepatitis. The usual numbers range between 5 and 20 mg/dL to diagnose viral hepatitis.
• Other blood tests: Your doctor may also need to evaluate your alkaline phosphatase, which is usually slightly increased. It is also essential to measure prothrombin time, which is prolonged. And the complete blood count usually shows a low level of white blood cells with a high proportion of lymphocytes.
• Serologic tests: Once viral hepatitis is suspected, doctors may need to investigate the type of hepatitis, which is done through serologic tests. They would order anti-HEV immunoglobulin M. This antibody is positive after 4 weeks have passed from the infection and remain positive for up to 2 months. In some cases, IgG levels should also be evaluated, especially to confirm acute cases of hepatitis E.
• Liver biopsy: This is not necessary in most cases. It is only required in severe hepatitis E and when concomitant liver problems are suspected.