| TABLE 7. Role of
history in diagnosis of chronic hepatitis |
||
| Etiology | Key points in the history | Useful lab tests |
| Hepatitis B | Sexual history (homosexuality, use of prostitute services, promiscuity), family history, country of origin, IV drug use | HBsAg - if positive, measure HBeAg, HBeAb and HBV-DNA (if available) |
| Hepatitis C | Blood transfusions (pre-1990), IV drug use (even once), tattoos, ear or body piercing, sexual promiscuity, HCV-positive partner, incarceration | anti-HCV |
| Autoimmune hepatitis | Usually young or middle-aged females, often chronic symptoms - especially fatigue (but may present acutely), other autoimmune disease (e.g., thyroid) | Quantitative immuno-globulins Antinuclear antibodies Smooth-muscle antibody |
| Drug-induced hepatitis | Careful history of all drugs and herbs: common offenders include isoniazid, nitrofurantoin, NSAIDs, sulfa drugs | None |
| Wilson's disease | Family history, neurologic or
psychiatric symptoms in children or young adults |
Serum ceruloplasmin 24-hr urinary copper |
| a1-antitrypsin deficiency | Family history of liver or lung disease (emphysema) | a1-antitrypsin levels and Pi typing |
| Nonalcoholic steatohepatitis (NASH) | Obesity - especially recent weight gain, diabetes mellitus, corticosteroids, intestinal by-pass surgery | Glucose Hgb Alc Abdominal ultrasound |