Evaluating asymptomatic patients with mildly elevated liver enzymes

Because elevated liver enzymes are found in 1% to 4% of asymptomatic persons, extensive evaluation of all abnormal tests would expose many patients to undue risks and medical costs. On the other hand, not evaluating minor elevations of liver enzymes could result in missing the early diagnosis of potentially treatable disorders. This review discusses likely causes of elevated aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase levels and provides algorithms for evaluating abnormal liver enzyme values in apparently healthy patients in the primary care setting.