Diagnosis

Chronic hepatitis should be considered in cases with persistent elevated liver enzymes with a definitive diagnosis made on histopa­thology. The history and physical examina­tion will vary from no visible clinical signs to marked clinical signs dependent on the amount of liver damage present.

Laboratory results include persistent ele­vated high liver enzymes and total bilirubin; the latter indicative of a poorer prognosis (Gomez et al. 2014). Important differential diagnoses such as neoplasia must be excluded, as both prognosis and manage­ment of the patient will change. Patients with persistent elevated liver enzymes with or without ultrasonographic changes should undergo a liver biopsy. Biopsies can be obtained via exploratory laparotomy, ultra­sound-guided, and laparoscopy. Ensure to check clotting factors prior to any liver biopsy. Fine-needle aspirate cytology of the liver is often unrewarding (Bahr et al. 2013; Cole et al. 2002; Wang et al. 2004).

Common comorbidities seen with chronic hepatitis includes cirrhosis and end-stage liver failure with acquired portosystemic shunts forming. Clinical signs can include hypoglycemia, coagulopathies, ascites, and hepatic encephalopathy.