Abnormal liver tests occur frequently. Liver enzymes are frequently confused with liver function tests. This module will help distinguish the two. It is important to be able to assess the test results in light of the patient’s presenting complaint, risk factors and condition. This module will also cover an approach to patients with abnormal liver test results. medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. Gastroenterology – Abnormal Liver Tests Whiteboard Animation Transcript with Kelly Burak, MD https://medskl.com/module/index/abnormal-liver-tests INTRODUCTION Liver tests or liver enzymes, sometimes incorrectly call liver “function” tests, refer to AST, ALT, ALP, and may include GGT. Abnormal values are often found on routine blood tests and indicate liver injury. Bilirubin, albumin and prothrombin time (or INR) are better tests of the function of the liver and are the LFTs. How to Interpret Abnormal Liver Tests A patient with abnormal liver tests can present in a number of different ways or can be completely asymptomatic.1,2,3 While a clinical assessment focused on risk factors and stigmata of liver disease remains key, the pattern of liver enzyme elevation will guide the differential and workup. 1. Take a look at which enzymes are elevated. A rise in ALT and/or AST that is proportionally higher than ALP indicates a hepatocellular pattern of injury,1 while A rise in ALP, confirmed to be from liver by an abnormal GGT, indicates a cholestatic pattern.1 2. What is the pattern? If the pattern of injury is cholestatic – that is the ALP (and GGT) rise > ALT or AST – you will need to obtain a dedicated ultrasound of the liver and biliary tree to look at the bile ducts Dilated bile duct indicate extrahepatic cholestasis and an ERCP may be needed for diagnosis and therapy Normal bile ducts indicate intrahepatic cholestasis, and a liver biopsy may be required if the cause is not identified by history or other investigations, such as an anti-mitochondrial antibody or MRCP If the pattern of injury is hepatocellular – that is the ALT or AST rise is greater than ALP (and GGT) – determine severity using the ALT level An ALT of <300 is mild and 300-1000 correspond to moderate liver disease.1 These can be acute or chronic and unfortunately the differential diagnosis is broad Non Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of mild elevation4,5 Alcoholic liver disease is associated with an AST that is often 2-3 times higher than the ALT, but alcohol or NAFLD rarely cause the ALT to be <3001,4,5 Further evaluation and testing will be guided by your history and clinical suspicion If ALT >1000 there is SEVERE liver injury which is always acute and symptomatic. These patients are at high risk of acute liver failure.1,3 If you see these values, think and test for the following: Drugs – especially acetaminophen overdose; Viruses – Hepatitis A through E, HSV, CMV, VZV; Ischemia from Budd-Chiari Syndrome or shock; Autoimmune Hepatitis; Wilson’s Disease; and if the patient is pregnant or recently postpartum, HELLP syndrome or acute fatty liver of pregnancy (AFLP)1,3 Quick recognition and diagnosis can guide appropriate management in these patients

Gastroenterology – Abnormal Liver Tests: By Kelly Burak M.D.
- Post author:
- Post published:June 6, 2021
- Post category:Uncategorized
- Post comments:0 Comments
You Might Also Like

Ultimate Fat-Burning Workout | Brian Casad

Free Paleo Meal Plan + Shopping List for weight loss

I Lost My Hair

Best Means for Measuring Fitness Level & Body Composition. BMI, Skinfold Calipers, Hydro?

Do Not Ignore These 10 Early Symptoms of Diabetes

Soccer/ Football Video – 3

How To: Romanian Deadlift (Barbell)

Renin Angiotensin Aldosterone System

Real Cause Of High Blood Pressure (Hypertension) | Dr.Berg

Aroma Therapy Video – 1
Lat Pull Down-6

Review: Skinny Sprinkles Day 5 l Clare Elise

What is Arthritis? – Arthritis Types and Basic Information – Dr. Rakesh Aggarwal – Tell Me Doctor
Flexibility

What is EXERCISE? What does EXERCISE mean? EXERCISE meaning – How to pronounce EXERCISE?

3 Mass Building Chest Exercises with Tyrone Bell – Best Training Tips – BPI Sports

Dutasteride vs Finasteride – Hair, Side effects and More

Sugar Free, Low Sugar Video – 28

skeletal system song // thrift shop parody

Breads For Your Weight Loss Diets

“Complete Blood Count (CBC) Test” by getLABtested.com

ORLISTAT: Medicamento para el Sobrepeso y la Obesidad (Orlistat)

How to Do Biceps Curls with a Balance Ball

Neurological Physiotherapy Video – 7

Athletics Video – 4

Ondansetron (Zofran) Nursing Pharmacology Considerations

Creatine Before & After

How To Take Finasteride (Propecia) Without Side Effects

Reverse back extension

Top Vegan Protein Sources (Plant-Based) | Dr. Berg

7 Proven Fat Burning Foods

Nerveous System And Stress Management Asanas Video – 2

✔Series: SEROTONIN, A CAUSE OF WEIGHT GAIN AND OBESITY. Weight loss tips and tricks: Hormonal balanc

CoAx 10mm Stone Control Catheter from Accordion Medical

Anabolic Steroids – History, Definition, Use & Abuse Video – 45

How to Treat a Low Sperm Count | Infertility

Meditation Video – 3

Vascular Surgery Video – 3
![Read more about the article Top 5 Vitamins to Build Muscle & Gain Weight [HD]](https://videos.drmaheshkumar.com/wp-content/uploads/2021/05/Top-5-Vitamins-to-Build-Muscle-Gain-Weight-HD-300x225.jpg)
Top 5 Vitamins to Build Muscle & Gain Weight [HD]
Human Body – Anat & Physio
![Read more about the article Osteoporosis [Bone Disease] | Simple & Effective Natural Home Remedies for Osteoporosis & Arthritis](https://videos.drmaheshkumar.com/wp-content/uploads/2021/05/Osteoporosis-Bone-Disease-Simple-Effective-Natural-Home-Remedies-for-Osteoporosis-Arthritis-300x169.jpg)
Osteoporosis [Bone Disease] | Simple & Effective Natural Home Remedies for Osteoporosis & Arthritis
