Pediatric Hepatitis A Workup

Updated: Apr 14, 2016
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Workup

Liver Function Tests

Liver inflammation during hepatitis A virus (HAV) infection can be identified by elevations in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltranspeptidase (GGTP; also known as gamma glutamyltransferase [GGT]) levels. Increases in ALT and AST levels are seen most consistently, and the values are usually 4-100 times the normal levels. Elevations in ALT and AST levels may precede the onset of symptoms by a week or more and usually peak within 3-10 days after onset of clinical illness.

Serum bilirubin levels, although elevated, usually remain below 10 mg/dL and peak after 1-2 weeks of illness. Prolongation of the prothrombin time (PT) and a significant decrease in the albumin level suggest a more severe course.

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Serologic Tests

Specific antibody tests for HAV confirm infection. Anti-HAV immunoglobulin M (IgM) is present at the onset of symptoms, and its level remains high for 4-8 weeks. It usually disappears by 4-6 months, but occasionally it persists for a longer period.

Anti-HAV immunoglobulin G (IgG) becomes detectable shortly after the IgM titer appears and usually increases as the IgM level decreases. IgG persists for life and provides ongoing immunity against reinfection.

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Ultrasonography

Ultrasonography of the liver may be helpful when cholelithiasis is a consideration. However, imaging studies are generally not necessary. The history and physical examination and laboratory findings are used to establish the diagnosis in most cases of HAV infection.

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Histologic Findings

Histologic findings are similar to those in other forms of acute viral hepatitis and include inflammatory cell infiltration, hepatocellular necrosis, and liver cell regeneration.

Liver biopsy is not indicated, because of the self-limited nature of HAV infection and the absence of a chronic infectious state.

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