The clinical symptoms of autoimmune hepatitis are often insidious, especially in the early stages, and may include malaise, loss of appetite, or even nausea or jaundice in severe cases, but the appearance of jaundice is often less frequent. During physical examination, patients may be found to have enlarged liver, enlarged spleen, possibly spider nevus or liver palm, and some further blood tests will reveal abnormal liver function, and transaminases, especially transpeptidase and alkaline phosphatase, may all be elevated. If the autoantibody profile is also abnormal, such cases may be considered to have autoimmune hepatitis. Symptoms are not the main concern in this group of patients, as they are mild and difficult to distinguish from other diseases.