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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Liver and gallbladder diseases are a significant health concern, with prominent conditions including cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), and gallstones. Jaundice is a common manifestation of liver and biliary disease.
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Related Experiment Video

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Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis
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Mild Hypertransaminasemia in Primary Care.

Said A Al-Busafi1, Nir Hilzenrat2

  • 1Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, P.O. Box 35, 123 Muscat, Oman; Department of Gastroenterology, Jewish General Hospital, McGill University, Montreal, QC, Canada H3T 1E2.

ISRN Hepatology
|June 24, 2016
PubMed
Summary

Mild elevations in liver enzymes like ALT and AST are common. Evaluating these asymptomatic findings requires a stepwise approach based on suspected liver disease causes, such as nonalcoholic fatty liver disease.

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Area of Science:

  • Hepatology
  • Clinical Biochemistry
  • Internal Medicine

Background:

  • Liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) are vital clinical markers for liver disease screening and diagnosis.
  • ALT is a more specific indicator of liver injury than AST and predicts liver-related and all-cause mortality.
  • Asymptomatic mild hypertransaminasemia (less than five times normal) is frequently encountered in primary care, with varied potential causes from benign to serious.

Purpose of the Study:

  • To review the diagnostic considerations and approaches for asymptomatic mild hypertransaminasemia.
  • To highlight common and less common etiologies of elevated liver enzymes.
  • To guide clinicians on when to consider specialist referral or liver biopsy.

Main Methods:

  • Literature review of studies on liver enzyme evaluation and causes of hypertransaminasemia.
  • Analysis of diagnostic pathways for asymptomatic mild elevations.
  • Discussion of differential diagnoses including hepatic and nonhepatic conditions.

Main Results:

  • Nonalcoholic fatty liver disease is the leading cause of mild hypertransaminasemia globally.
  • Other significant causes include alcohol abuse, medications, and viral hepatitis (B and C).
  • Less frequent causes encompass hemochromatosis, alpha-1-antitrypsin deficiency, autoimmune hepatitis, and Wilson's disease.

Conclusions:

  • A stepwise diagnostic approach, guided by pretest probability, is recommended for asymptomatic mild hypertransaminasemia when clinical suspicion is unclear.
  • Non-hepatic conditions like celiac disease and thyroid disorders should be considered in the differential diagnosis.
  • Persistent hypertransaminasemia for over six months warrants specialist consultation and potential liver biopsy.