Algorithm for evaluation of abnormal liver tests

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Algorithm for evaluation of abnormal liver tests Algorithm for evaluation of abnormal liver tests. For patients with suspected liver disease, an appropriate approach to evaluation is initial routine liver testing—e.g., measurement of serum bilirubin, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (AlkP). These results (sometimes complemented by testing of γ-glutamyl transpeptidase; gGT) will establish whether the pattern of abnormalities is hepatic, cholestatic, or mixed. In addition, the duration of symptoms or abnormalities will indicate whether the disease is acute or chronic. If the disease is acute and if history, laboratory tests, and imaging studies do not reveal a diagnosis, liver biopsy is appropriate to help establish the diagnosis. If the disease is chronic, liver biopsy can be helpful not only for diagnosis but also for grading of the activity and staging the progression of disease. This approach is generally applicable to patients without immune deficiency. In patients with HIV infection or recipients of bone marrow or solid organ transplants, the diagnostic evaluation should also include evaluation for opportunistic infections (e.g., with adenovirus, cytomegalovirus, Coccidioides, hepatitis E virus) as well as for vascular and immunologic conditions (veno-occlusive disease, graft-versus-host disease). HAV, hepatitis A virus; HCV, hepatitis C virus; HBsAg, hepatitis B surface antigen; anti-HBc, antibody to hepatitis B core (antigen); ANA, antinuclear antibody; SMA, smooth-muscle antibody; MRCP, magnetic resonance cholangiopancreatography; ERCP, endoscopic retrograde cholangiopancreatography; α1 AT, α1 antitrypsin; AMA; antimitochondrial antibody; P-ANCA, peripheral antineutrophil cytoplasmic antibody. Source: Approach to the Patient with Liver Disease, Harrison's Principles of Internal Medicine, 19e Citation: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine, 19e; 2015 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/Books/1130/kas_ch357_f001.png&sec=98727889&BookID=1130&ChapterSecID=79748328&imagename= Accessed: December 16, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved

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