Evaluating the Patient With Abnormal Liver Tests

Introduction

The signs and symptoms of potential liver disease are often encountered in clinical practice. The 42-year-old asymptomatic man with an aspartate aminotransferase level of 96 U/L, the 35-year-old woman with itching and an alkaline phosphatase level of 182 U/L, and the obese woman with right-upper-quadrant pain and minimal aminotransferase elevation may all show up in the busy office of the primary care physician. These patients require further evaluation, and some may need a gastroenterology consultation.

Abnormal liver test results are also common, with or without further evidence of liver disease. Aminotransferase elevation occurs in approximately 8% of Americans, with men (9.3%) more likely to have abnormalities than women (6.6%).^[1,2,3] Men (especially Native American men^[4]) are also more likely to have underlying chronic liver disease,^[5] including hepatitis C with or without alcoholic liver disease, alcoholic liver disease, nonalcoholic fatty liver disease (NAFLD), and hepatitis B.^[5,6] NAFLD is often the most likely diagnosis when abnormal liver tests are encountered in adults in the absence of overt signs of advanced liver disease.^[7]

Patients with abnormal liver tests pose clinical challenges in diagnosis.^[8] The presence of elevated aminotransferase and gamma glutamyltranspeptidase (GGT) serum levels can indicate a greater likelihood of finding a cause for the liver injury.^[3] In the absence of signs of chronic liver disease, factors such as ethanol, medications, nutritional issues, female sex, or NAFLD will account for most causes of abnormal liver test results.^[9,10]

If there are no physical signs of chronic liver disease in patients with mild increases of aminotransferase or alkaline phosphatase, it may be best to simply retest the patient in 3-5 months. If more than 1 liver test result is abnormal or test values are moderately or markedly elevated, the patient should be evaluated immediately.^[11] A careful history and physical examination coupled with a thoughtful laboratory and radiologic evaluation will often provide a likely diagnosis.

Cite this: Rowen K. Zetterman. Evaluating the Patient With Abnormal Liver Tests - Medscape - Oct 08, 2009.

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