ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries

Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepa...

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Vydané v:The American journal of gastroenterology Ročník 112; číslo 1; s. 18 - 35
Hlavní autori: Kwo, Paul Y, Cohen, Stanley M, Lim, Joseph K
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.01.2017
Predmet:
Alanine Transaminase - blood
Alkaline Phosphatase - blood
alpha 1-Antitrypsin Deficiency - blood
alpha 1-Antitrypsin Deficiency - diagnosis
alpha 1-Antitrypsin Deficiency - pathology
Aspartate Aminotransferases - blood
Bilirubin - blood
Biopsy
Chemical and Drug Induced Liver Injury - blood
Chemical and Drug Induced Liver Injury - diagnosis
Chemical and Drug Induced Liver Injury - pathology
Cholestasis - blood
Cholestasis - diagnosis
Cholestasis - pathology
Gastroenterology
Hemochromatosis - blood
Hemochromatosis - diagnosis
Hemochromatosis - pathology
Hepatitis, Autoimmune - blood
Hepatitis, Autoimmune - diagnosis
Hepatitis, Autoimmune - pathology
Hepatitis, Viral, Human - blood
Hepatitis, Viral, Human - diagnosis
Hepatitis, Viral, Human - pathology
Hepatolenticular Degeneration - blood
Hepatolenticular Degeneration - diagnosis
Hepatolenticular Degeneration - pathology
Humans
Liver - metabolism
Liver - pathology
Liver Diseases - blood
Liver Diseases - diagnosis
Liver Diseases - pathology
Liver Diseases, Alcoholic - blood
Liver Diseases, Alcoholic - diagnosis
Liver Diseases, Alcoholic - pathology
Non-alcoholic Fatty Liver Disease - blood
Non-alcoholic Fatty Liver Disease - diagnosis
Non-alcoholic Fatty Liver Disease - pathology
ISSN:0002-9270, 1572-0241, 1572-0241
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Shrnutí:Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepatocellular injury is defined as disproportionate elevation of AST and ALT levels compared with alkaline phosphatase levels. Cholestatic injury is defined as disproportionate elevation of alkaline phosphatase level as compared with AST and ALT levels. The majority of bilirubin circulates as unconjugated bilirubin and an elevated conjugated bilirubin implies hepatocellular disease or cholestasis. Multiple studies have demonstrated that the presence of an elevated ALT has been associated with increased liver-related mortality. A true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females and levels above this should be assessed. The degree of elevation of ALT and or AST in the clinical setting helps guide the evaluation. The evaluation of hepatocellular injury includes testing for viral hepatitis A, B, and C, assessment for nonalcoholic fatty liver disease and alcoholic liver disease, screening for hereditary hemochromatosis, autoimmune hepatitis, Wilson's disease, and alpha-1 antitrypsin deficiency. In addition, a history of prescribed and over-the-counter medicines should be sought. For the evaluation of an alkaline phosphatase elevation determined to be of hepatic origin, testing for primary biliary cholangitis and primary sclerosing cholangitis should be undertaken. Total bilirubin elevation can occur in either cholestatic or hepatocellular diseases. Elevated total serum bilirubin levels should be fractionated to direct and indirect bilirubin fractions and an elevated serum conjugated bilirubin implies hepatocellular disease or biliary obstruction in most settings. A liver biopsy may be considered when serologic testing and imaging fails to elucidate a diagnosis, to stage a condition, or when multiple diagnoses are possible.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ObjectType-Instructional Material/Guideline-3
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.1038/ajg.2016.517