Elevated Liver Function Tests

Posted by e-Medical PPT
Abnormal LFTs are frequently detected in asymptomatic patients (1-4%).
They do not always reflect liver diseases.
They may be a marker of worse health outcomes.

Isolated elevation of transaminases:
Medications  (NSAIDs, Anitbiotics, statins,
   antiepileptics  and herbal preparations)
Alcohol (AST/ALT >2:1,  twofold elevation
   of GGT)
Hereditary hemochromatosis (Caucasian, iron,
   TIBC, ferritin +/- liver biospy)
Viral hepatitis:  HBV ( HBsAg, anti HBsAg, anti HBc)  and HCV ( ELISA, RIBA, PCR )
Hepatic steatosis and NASH ( AST/ALT<1, ultrasound, CT or MRI) 
Muscular disorders (AST/ALT>3 if immediately after injury, CK, LDH, aldoalse)
Thyroid diseases (TSH)
Celiac disease (ALT>AST, reversible with gluten free diet)
Adrenal insufficency ( reversible within week of treatment)
Anorexia nervosa
Wilson ‘s disease (age 5-25, serum ceruloplasmin, 24hr urine  for copper, liver biopsy)
Autoimmune hepatitis ( SPEP, ANA , SMA, LKMA, liver biopsy)
Alpha 1 antitrypsin (associated emphysema, protein electrophoresis)
Isolated Hyperbilirubinemia
Hemolysis (smear, retic count, haptoglobin) can be inherited or acquired. Rarely exceeds 5mg/dl
Impaired uptake or conjugation, drugs, Crigller Najjar and Gilbert’s syndrome.

Dubin Johnson with altered excretion
Rotor syndrome with defective storage.

Isolated elevation of alkaline phosphatase
Alkaline phosphatase is derived from liver, bones, intestins and placenta.
Levels vary with age, more elevated in children.
To determine the source we check GGT or 5’ nucleotidase.
Initial evaluation includes U/S and AMA followed by ERCP v/s liver biopsy.

Isolated elevation of GGT
Very sensisitive for hepatobiliary disease but not specific.
Can reflect pancreatic disease, MI, renal failure, diabetes, COPD, alcoholism.

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