Differentials
Hepatitis B
SIGNS / SYMPTOMS
There may be no differentiating signs or symptoms.
INVESTIGATIONS
Hepatitis B surface antigen test is positive.
Hepatitis C antibody test is negative.
Hepatitis D
SIGNS / SYMPTOMS
There may be no differentiating signs or symptoms.
INVESTIGATIONS
Serum antibody to hepatitis D virus (HDV) may be positive.
Serum HDV RNA on polymerase chain reaction may be positive.
Hepatitis B surface antigen test is positive (HDV cannot propagate without the presence of hepatitis B virus surface antigen).
Hepatitis C antibody test is negative.
Hepatitis E
SIGNS / SYMPTOMS
There may be no differentiating signs or symptoms.
INVESTIGATIONS
Antibody to hepatitis E virus (anti-HEV) IgM may be positive.
Anti-HEV IgG may be positive (but may indicate past infection).
HEV RNA serum or stool may be positive.
Alcohol-related liver disease
SIGNS / SYMPTOMS
There may be symptoms of alcohol dependency, but these are not diagnostic.
INVESTIGATIONS
Hepatitis C antibody test is negative.
Steatotic liver disease
SIGNS / SYMPTOMS
There may be no differentiating signs or symptoms.
INVESTIGATIONS
Ultrasound may show fatty liver.
Hepatitis C antibody test is negative.
Liver biopsy shows steatohepatitis.
Haemochromatosis
SIGNS / SYMPTOMS
There may be no differentiating signs or symptoms, but some patients with advanced disease may also have features of cardiomyopathy, arthritis, or diabetes.
INVESTIGATIONS
Iron indices are abnormal (but a caution is that patients with advanced liver disease of any aetiology, particularly those with cirrhosis, may have very elevated ferritin and transferrin saturations). A genetic test for the haemochromatosis gene (C282Y mutation) may be helpful to differentiate.
Other chronic liver diseases
SIGNS / SYMPTOMS
Patients may have a history or physical findings suggestive of metabolic, auto-immune, or drug-induced liver disease.
INVESTIGATIONS
Hepatitis C antibody test is negative.
Blood chemistries or serologies, toxicology screen, or liver biopsy may confirm an alternate diagnosis.
Use of this content is subject to our disclaimer