Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do? - PubMed (original) (raw)

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Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?

Mazyar Malakouti et al. J Clin Transl Hepatol. 2017.

Abstract

Elevated liver enzymes are a common scenario encountered by physicians in clinical practice. For many physicians, however, evaluation of such a problem in patients presenting with no symptoms can be challenging. Evidence supporting a standardized approach to evaluation is lacking. Although alterations of liver enzymes could be a normal physiological phenomenon in certain cases, it may also reflect potential liver injury in others, necessitating its further assessment and management. In this article, we provide a guide to primary care clinicians to interpret abnormal elevation of liver enzymes in asymptomatic patients using a step-wise algorithm. Adopting a schematic approach that classifies enzyme alterations on the basis of pattern (hepatocellular, cholestatic and isolated hyperbilirubinemia), we review an approach to abnormal alteration of liver enzymes within each section, the most common causes of enzyme alteration, and suggest initial investigations.

Keywords: Aminotransferase elevation; Approach to alteration of liver enzymes; Elevated liver enzymes; Evaluation of abnormal liver enzymes; Liver function tests.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1.

Fig. 1.. Schematic initial diagnostic algorithm for a patient presenting with mild aminotransferase abnormality.

Abbreviations: ANA, antinuclear antibody; ASMA, anti-smooth muscle antibody; LKM, anti-liver-kidney microsomal antibody; NAFLD, nonalcoholic fatty liver disease.

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References

    1. Hultcrantz R, Glaumann H, Lindberg G, Nilsson LH. Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases. Scand J Gastroenterol. 1986;21:109–113. <10.3109/00365528609034632>. - DOI - PubMed
    1. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol. 2006;101:76–82. <10.1111/j.1572-0241.2005.00341.x>. - DOI - PubMed
    1. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112:18–35. <10.1038/ajg.2016.517>. - DOI - PubMed
    1. Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem. 2000;46:2050–2068. - PMC - PubMed
    1. Dufour DR. Effects of habitual exercise on routine laboratory tests. Clin Chem. 1998;44:A136.

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