[The patient with slightly increased liver function tests].
The availability of serum blood chemistries for screening both symptomatic and asymptomatic patients has resulted in a marked increase in the number of abnormal liver chemistry tests that must be interpreted by physicians. Usually the first step in the evaluation of a patient with elevated liver enzymes is to repeat the test to confirm the result. If the result is still abnormal, it seems wise to differentiate between a predominant "necrotic pattern" of liver chemistry, as indicated by an elevation of ALT- or AST-activity or a predominant "cholestatic pattern", as indicated by elevated activities of g-GT and alkaline phosphatase. In patients with elevated serum amino transferases hepatic diseases should be excluded primarily with non-invasive serologic tests. The most common causes of elevated amino transferase levels are chronic hepatitis B and C, autoimmunhepatitis, non-alcoholic steatohepatitis, hemochromatosis, Wilson-disease and (only recently recognized) celiac sprue. In the case of a dominant "cholestatic pattern", primary biliary cirrhosis, primary sclerosing cholangitis, but also drugs and granulomatose hepatitis must be excluded. If non-invasive serologic studies remain inconclusive, ultrasound, mini-laparoscopy and liver biopsy will help to establish the final diagnoses.
Maier
K P
KP
Fachbereich Gastroenterologie, Akademisches Lehrkrankenhaus der Universität Tübingen, Städtische Kliniken Esslingen. kp.maier@kliniken-es.de
D000469:Alkaline Phosphatase / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis; D015209:Cholangitis, Sclerosing / Q000175:diagnosis; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis; D006432:Hemochromatosis / Q000175:diagnosis; D019694:Hepatitis B, Chronic / Q000175:diagnosis; D019698:Hepatitis C, Chronic / Q000175:diagnosis; D019693:Hepatitis, Autoimmune / Q000175:diagnosis; D006527:Hepatolenticular Degeneration / Q000175:diagnosis; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology; D008111:Liver Function Tests; D000637:Transaminases / Q000097:blood; D014463:Ultrasonography
D000637:Transaminases; D000469:Alkaline Phosphatase