COMMENTARY

Evaluating the Patient With Abnormal Liver Tests

Rowen K. Zetterman, MD

Disclosures

October 08, 2009

In This Article

Abnormal Liver Test Results: Points for Clinical Practice

1. Abnormal liver test results will be identified in 8%-20% of patients during clinical care.

2. Most patients with abnormal liver test results should have additional evaluation. A referral to the gastroenterologist may be needed.

3. A careful history and physical examination frequently provide the diagnosis, obviating the need for invasive testing.

4. If there are signs or symptoms of chronic liver disease, considering the patient's age may assist in the diagnosis.

5. Isolated elevation of GGT occurs and a cause may not be identified.

6. The presence of multiple abnormal test results makes significant liver disease more likely.

7. Aminotransferase, alkaline phosphatase, and GGT levels can be elevated from causes other than liver disease.

8. Persisting abnormalities of aminotransferases or enzymes of cholestasis should be further evaluated because up to two thirds will have a diagnosis requiring follow-up or intervention.

9. Supplemental testing with additional laboratory tests, ultrasonography, or magnetic resonance cholangiography should be considered when the diagnosis is unclear or confirmation of liver disease diagnosis is required.

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