[The patient with slightly increased liver function tests]

Area of Science:

• Hepatology
• Clinical Chemistry

Background:

• Increased use of serum blood chemistries leads to more abnormal liver enzyme tests.
• Physicians must interpret these abnormal results to diagnose underlying conditions.

Purpose of the Study:

• To outline an approach for interpreting abnormal liver chemistry tests.
• To differentiate between necrotic and cholestatic patterns of liver injury.
• To guide the diagnostic workup for elevated liver enzymes.

Main Methods:

• Initial confirmation of abnormal results by repeating tests.
• Classification of liver enzyme patterns into "necrotic" (ALT/AST elevation) or "cholestatic" (g-GT/alkaline phosphatase elevation).
• Utilizing non-invasive serologic tests to exclude hepatic diseases.

Main Results:

• Common causes of elevated aminotransferases include hepatitis B/C, autoimmune hepatitis, NASH, hemochromatosis, Wilson disease, and celiac sprue.
• Cholestatic patterns suggest primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced liver injury, or granulomatous hepatitis.
• Non-invasive tests are the primary diagnostic tool, with imaging and biopsy reserved for inconclusive cases.

Conclusions:

• A systematic approach to interpreting abnormal liver tests is crucial for accurate diagnosis.
• Differentiating between necrotic and cholestatic patterns aids in narrowing down potential causes of liver disease.
• A combination of serologic testing, imaging, and biopsy is essential for definitive diagnosis when initial tests are inconclusive.