[Hepatitis diagnostics : Differential diagnosis of viral hepatitis from other causes of elevated transaminases]

Liver biopsies in unclear hepatitis are required to assess etiology together with the clinico-serological findings to differentiate comorbidities. In addition, inflammatory activity should be graded, extent of necrosis estimated, and the stage of fibrosis determined in order to estimate pre-existing parenchymal damage. In liver biopsies from patients with acute liver failure, drug-induced liver injury, most often in idiosyncrasy is most common. While a liver biopsy is required for the diagnosis of autoimmune hepatitis, the diagnosis of viral hepatitis A-D is usually made clinically and serologically. Yet, hepatitis E is often underestimated: in addition to acute hepatitis in immunocompetent patients, hepatitis E-virus (HEV) infection may also manifest with a fulminant course in patients with pre-existing liver cirrhosis and follow a chronic course in immunocompromised patients.