Approach to abnormal liver function tests

Note: Figures and table numbers appear above the figures and tables and taken from the following source.

Woreta TA1, Alqahtani SA. Evaluation of abnormal liver tests. Med Clin North Am. 2014 Jan;98(1):1-16.

Table 1. Categorization of liver diseases by pattern of elevation of liver enzymes

Liver Disease Category Aminotransferases Alkaline Phosphatase
Hepatocellular ↑↑
Cholestatic ↑↑

Table 5. Patterns of liver enzymes and liver function tests in various hepatobiliary diseases – Part 1

Hepatobiliary Disorder Aminotransferases Alkaline Phosphatase
Hepatocellular
Acute
Toxin/drug
Viral
Ischemic
↑↑↑ (>500 IU/mL) Normal or ↑ to < 3 times normal
Chronic ↑↑ (<300 IU/mL) Normal or ↑ to < 3 times normal
Cholestatic
Acute Normal to ↑↑↑ Normal to ↑
Chronic Normal to ↑↑ ↑↑↑ to >4 times normal
Infiltrative Normal to ↑ ↑↑↑ to >4 times normal

Table 5. Patterns of liver enzymes and liver function tests in various hepatobiliary diseases – Part 2

Hepatobiliary Disorder Bilirubin Albumin Prothrombin Time
Hepatocellular
Acute
Toxin/drug
Viral
Ischemic
Normal Usually normal ↑ to >5 seconds above control value portends poor prognosis
Chronic Normal to ↑ Normal or ↓ Often ↑, will not correct with parenteral vitamin K administration
Cholestatic
Acute Normal to ↑ Normal Normal
Chronic Normal or ↓ Normal or ↑, will correct with vitamin K administration
Infiltrative Normal Normal Normal

View in article – Fig. 3. Algorithm for evaluation of patients with hepatocellular pattern of liver injury. ANA, antinuclear antibodies; HAV, hepatitis A virus; HBsAG, hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus

View in article – Fig. 4. Algorithm for evaluation of patients with elevated alkaline phosphatase. ERCP, endoscopic retrograde cholangiopancreatography

View in article – Figure 5. Algorithm for evaluation of patients with hyperbilirubinemia

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About Lisa

I have been a Clinical Informationist (aka Medical Librarian) for Emory University since September 2013. Prior to that, I was a Medical Librarian for Lincoln Memorial University (LMU) from March 2007 to August 2013 and served its DeBusk College of Osteopathic Medicine, Caylor School of Nursing, and allied health programs. From January 2002 - March 2007, I served the Medical Assisting (MA), Occupational Therapy Assistant, Physical Therapy Assistant, Radiologic Technologist, and Nursing programs at South College in Knoxville, Tennessee. I graduated from The University of Tennessee School of Information Sciences with a Master of Science degree in December 2000.
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