What are the diagnostic criteria for acute and chronic hepatitis?
Dec 03, 2025
Source: Cainiu Health
Dr. Gao Jun
Introduction
In general, the diagnosis of acute and chronic hepatitis requires a comprehensive assessment based on multiple factors. The core criteria include medical history and clinical symptoms, liver function tests, etiological testing, imaging examinations, and liver biopsy. Diagnosis of acute and chronic hepatitis should rely on the integration of multiple indicators to avoid misdiagnosis due to reliance on a single criterion. After confirmation, the underlying cause should be promptly identified and targeted treatment initiated accordingly.
In general, the diagnosis of acute and chronic hepatitis requires a comprehensive evaluation based on multiple factors. The core criteria include medical history and clinical symptoms, liver function tests, etiological testing, imaging examinations, and liver biopsy. A detailed analysis is as follows:
1. Medical history and symptoms: Acute hepatitis often has clear triggers such as viral infection or drug-induced injury, with sudden onset commonly presenting symptoms including fatigue, loss of appetite, and jaundice. Chronic hepatitis lasts longer than six months; some patients may have subtle or no symptoms, while others may only experience prolonged mild fatigue or abdominal distension.
2. Liver function tests: Transaminases are key indicators. In acute hepatitis, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels rise. In chronic hepatitis, transaminase levels may fluctuate repeatedly, and long-term abnormalities may be accompanied by decreased albumin and elevated bilirubin, reflecting the degree of liver damage.
3. Etiological testing: This helps identify the underlying cause, including tests for hepatitis A virus antibodies, hepatitis B virus antigens/antibodies and nucleic acids, hepatitis C virus antibodies and nucleic acids, etc. A positive viral test confirms viral hepatitis, while non-viral causes—such as drugs, alcohol, or autoimmune conditions—must be investigated in absence of viral markers.
4. Imaging examinations: Ultrasound is commonly used. In acute hepatitis, findings may include enlarged liver and increased echogenicity. In chronic hepatitis, ultrasound may show uneven liver parenchymal echotexture or splenomegaly, helping assess structural changes in the liver and rule out cirrhosis or tumors.
5. Liver biopsy: This is the gold standard for diagnosis. By examining liver tissue samples, it allows precise assessment of inflammatory activity and fibrosis stage. It is particularly useful for patients with atypical symptoms or when determining optimal treatment strategies, providing critical evidence for accurate diagnosis.
The diagnosis of acute and chronic hepatitis requires integration of multiple indicators to avoid misdiagnosis based on a single criterion. Once diagnosed, the underlying cause should be promptly identified and treated accordingly. Additionally, maintaining regular作息 (daily routines), eating a light diet, reducing liver burden, and supporting liver function recovery are essential.
