Acute and Chronic Hepatitis

Classically acute hepatitis is defined clinically as a significant (at least 2X elevation above the upper reference level) elevation of the serum ALT and/or AST levels in a patient without a previous history of liver disease. Serum markers of cholestatic liver injury should not be present. Most patients with acute hepatitis are asymptomatic. The causes of mild elevations in serum ALT or AST are listed in Table 1. In more severe cases fatigue, abdominal pain, nausea and vomiting, muscle aches or jaundice might be present (fulminant acute hepatitis is considered separately below). Serologic tests for hepatitis A, B or C infection and autoimmune hepatitis should be obtained routinely. A careful drug/toxin history must also be sought.