Abnormal Lfts Table 1
Abnormal Lfts Table 1
Abnormal Lfts Table 1
Arterial bruit heard over the liver Hepatocellular carcinoma, alcoholic hepatitis,
arteriovenous malformation (rare)
5 nucleotidase Cholestasis
Aminotransferases
Aminotransferases are used to detect and monitor the progression and resolution
of hepatocellular injury.[16] Aspartate aminotransferase (AST) and alanine
aminotransferase (ALT) levels may be elevated in 8%-21% of
patients.[1,3] Elevations are more common in non-Hispanic blacks and Mexican
Americans than in non-Hispanic whites, are more common in persons 30-40
years of age, decrease in likelihood after age 60 years, and are associated with
hepatocellular injury from ethanol, medications, hepatitis B or C viruses, and,
occasionally, chronic underlying liver diseases such as hemochromatosis.[17]
The ratio of AST to ALT may indicate alcoholic liver disease when greater than
2:1.[19] Other considerations for aminotransferase elevation include Wilson's
disease, celiac disease, and hyperthyroidism. Injury to other tissues containing
aminotransferases, such as skeletal muscle, can cause an elevation of AST.
Cholestasis
Laboratory tests for cholestasis include GGT, alkaline phosphatase, and 5
nucleotidase, of which GGT and alkaline phosphatase are most widely
used.[16] These enzymes are elevated in hepatobiliary diseases, including
abnormalities of either the canaliculus or the intrahepatic and extrahepatic bile
ducts and in replacement disease from hepatic tumors or
granulomas.[20] Hepatobiliary diseases include partial biliary tract obstruction from
stones, pancreatitis, parasitic disease, acute cholecystitis, and papillary
dysfunction. With biliary disorders, the tests may fluctuate in value, suggesting
intermittent or partial blockage.
Isolated GGT elevations occur, and if other liver test results are normal and no
ethanol or medication use is evident, additional workup can generally be delayed.
Isolated alkaline phosphatase elevation occurs from bone disease, bone growth
in children, and the placenta during pregnancy. GGT levels should be normal in
these conditions. Additional evaluation of patients suspected of having
cholestasis should include a careful history and physical examination and
ultrasonography of the biliary tree or magnetic resonance cholangiography, and
endoscopic retrograde cholangiography or liver biopsy when needed.
Hyperbilirubinemia
Bilirubin elevation can develop in any acute or chronic liver disease. Congenital
disorders of hyperbilirubinemia are generally classified as unconjugated or
conjugated depending on whether the indirect fraction or direct fraction of bilirubin
is dominant.[18] Unconjugated syndromes include Gilbert's (a hepatocyte bilirubin
uptake alteration) and Crigler-Najjar's (glucuronyl transferase deficiency).
Conjugated syndromes include Dubin-Johnson's and Rotor's, both related to
impairment of hepatocyte bilirubin secretion. Unconjugated hyperbilirubinemia
also occurs with hemolysis and ineffective erythropoiesis. A direct bilirubin
fraction >0.4 mg/dL should prompt an evaluation for hepatobiliary disease,
hemolysis, or a congenital disorder of bilirubin metabolism.