A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis?
A. Elevated hemoglobin level
B. Elevated serum bilirubin level
C. Elevated blood urea nitrogen level
D. Decreased erythrocyte sedimentation rate
Correct Answer: B. Elevated serum bilirubin level.
Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. Baseline evaluation in a patient suspected to have viral hepatitis can be started by checking a hepatic function panel. Patients who have a severe disease can have elevated total bilirubin levels. Typically, levels of alkaline phosphatase (ALP) remain in the reference range, but if it is elevated significantly, the clinician should consider biliary obstruction or liver abscess.
Option A: A hemoglobin level is unrelated to this diagnosis. In advanced liver disease, prothrombin time (PT) and international normalized ratio (INR) may appear prolonged. Patients may also have leukopenia and thrombocytopenia. Patients who suffer from easy bruising, variceal bleed, or hemorrhoidal bleed due to advanced liver disease may have anemia with low hemoglobin and hematocrit levels.
Option C: An elevated blood urea nitrogen level may indicate renal dysfunction. Blood urea nitrogen (BUN) and serum creatinine levels are also necessary for patients suspected to have advanced liver disease to look for renal impairment. Patients who present with altered mental status should have serum ammonia levels checked and are usually elevated in the presence of hepatic encephalopathy.
Option D: Elevated erythrocyte sedimentation rate is a laboratory indicator of hepatitis. The increase in the ESR in type A hepatitis could be explained by changes in the serum protein levels in the course of acute viral hepatitis and/or by the different inflammatory activity of the underlying disease.
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