Answer

a. Liver biopsy

A liver biopsy is almost never useful in acute hepatocellular injury as it will only show hepatocyte necrosis, which will not be specific for the cause of injury and does not have prognostic value. The most common causes of acute hepatitis are viral and therefore hepatitis A and hepatitis B should be excluded with the determination of IgM-anti-HAV (for hepatitis A) and HBsAg and IgM-anti-HBc (for hepatitis B). Since autoimmune hepatitis can present as acute hepatitis and antinuclear antibodies are considered standard in the workup of acute hepatitis.