title: Elevated Liver Enzymes: Emergency Department-Focused Management.
abstract: BACKGROUND
  Liver function test (LFT) abnormalities are a common problem faced by emergency physicians. This has become more common with the introduction of laboratory panels and automated routine laboratory testing. Fortunately, not all patients with irregularities in liver enzymes possess underlying pathology. This emergency medicine focused review provides a discussion of the various biochemical tests, their underlying biological basis, and an algorithmic approach to the interpretation of abnormalities.
  
  
  OBJECTIVE
  Our aim was to provide emergency physicians with an overview of the evaluation and management of patients with elevated LFTs.
  
  
  CONCLUSIONS
  The liver is a complex organ with multiple roles. The key biochemical markers of hepatic function can be organized into the groupings of hepatocellular, cholestatic, or functioning liver, based on underlying enzymatic roles. Pathologic alterations to these markers can be algorithmically assessed by separating disease processes of these groupings, followed by assessment of the magnitude of enzymatic elevation. This review conducts an in-depth evaluation of the differential diagnosis and emergency department-centered clinical response of elevated LFTs based on subcategories of mild, moderate, and severe transaminase elevation.
  
  
  CONCLUSIONS
  By understanding the biochemical basis of each LFT, it is possible to correlate laboratory findings to a patient's clinical presentation. An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis. This may assist providers in ensuring appropriate management and evaluation of the patient with elevated LFTs.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: Eric
authors.initials: E
authors.lastname: Sulava
authors.affiliation: Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, Nevada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bergin
authors.affiliation: Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
authors.forename: Brit
authors.initials: B
authors.lastname: Long
authors.affiliation: Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Alex
authors.initials: A
authors.lastname: Koyfman
mesh_terms: D000469:Alkaline Phosphatase / Q000032:analysis / Q000097:blood; D001219:Aspartate Aminotransferases / Q000032:analysis / Q000097:blood; D001663:Bilirubin / Q000032:analysis / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000145:classification / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis; D008111:Liver Function Tests; D008297:Male; D005723:gamma-Glutamyltransferase / Q000032:analysis / Q000097:blood
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: alanine aminotransferase; albumin; alkaline phosphatase; aspartate aminotransferase; hepatitis; liver function test; prothrombin time; γ-glutamyl transpeptidase