- If AlkPhos ↑ disproportionately to ALT/AST, suspect Biliary Disease (get image)
- Acute Pancreatitis can mimic hepatitis: order serum Lipase
- If painless jaundice, consider pancreatic cancer (CT), hemolytic anemia (CBC)
-
HepA IgM Antibody = Acute Hep A
- Total Hep A Ab pos, IgM neg = already immune
- HepB surface Antigen (HBsAg)
-
HepB core IgM Antibody
- Only HBsAg Pos = Chronic Hep B Only HepB core IgM AB Pos = tail end Acute Hep B
- Hep C Viral Load (HCV RNA) [esp. if risk factors]
-
HepC Antibody: 50% Pos; others convert by 12 wks
- Only HCV RNA Pos = Acute Hep C for sure Both pos. could be acute or chronic
- Only in pt. w/ Chronic HepB. Hep D rare in US.
- HepD Antibody (rarely ordered)
- 3rd World Travel; no commercial test available
- 25% mortality in pregnancy (call CDC for test kit)
- Epstein-Barr IgM Antibody
- Heterophile (Monospot) may take weeks to convert
- Self- limiting (e.g. CMV, Toxo, Herpesvirus-6, -7, etc.)
- Don’t Test
- History of recent binge
- AST > ALT, usually in 200-300 IU range
- History: Meds, Environmental, Lead, Mushrooms, etc.
- Low serum ceruloplasmin