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Approach to the patient with abnormal LFTs

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The document provides an overview of approach to evaluating abnormal liver function tests (LFTs). It defines relevant liver enzymes and tests. Epidemiology studies show most abnormal LFT cases can be diagnosed noninvasively, and the most common findings are non-alcoholic fatty liver disease and steatohepatitis. A thorough history and physical exam is important to identify potential causes like medications, viruses, autoimmune conditions, or metabolic disorders. Common patterns on lab testing can help indicate hepatocellular injury, cholestasis or other chronic processes. A methodical evaluation and testing approach is outlined.

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Approach to The Patient with Abnormal Liver Function Tests Bushra MI Sulieman, MD MS Consultant, Gastroenterology & Hepatology Department of Medicine King Faisal Specialist Hospital & Research Center - Jeddah
Definition  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kundrotas Dig Dis Sci. 1993;38(12):2145-50. Daniel Am J Gastroenterol. 1999;94(10):3010-4. Skelley J Hepatol. 2001;35(2):195-9. Ruhl Gastroenterology. 2009;136(2):477-85.e11.
Epidemiology Conclusions ,[object Object],[object Object],[object Object],[object Object]
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patterns ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Testing Patterns Pattern Cause  AST/ALT >  ALP  Bilirubin Hepatocellular Injury  ALP > AST/ALT  Bilirubin Cholestasis  Albumin Chronic process (cirrhosis / cancer)  Albumin Acute process (viral hepatitis / choledocholithiasis.  PT/INR Prolonged jaundice / Vit K malabsorption Hepatocellular dysfunction.
Mild Chronic AST/ALT Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation Medications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Watkins JAMA. 2006;296(1):87-93.
Mild Chronic AST/ALT Elevation Alcohol Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cohen Dig Dis Sci. 1979;24(11):835-8.
Mild Chronic AST/ALT Elevation Viral Hepatitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation Hereditary Hemochromatosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation Fatty Liver/NASH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation Autoimmune Hepatitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation Metabolic/other conditions ,[object Object],[object Object]
Mild Chronic AST/ALT Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Chronic AST/ALT Elevation ,[object Object],[object Object],[object Object],[object Object],Das, A, Post, AB. Should liver biopsy be done in asymptomatic patients with chronically elevated transaminases: A cost-utility analysis (abstract). Gastroenterology 1998; 114:A9. ,[object Object],[object Object],[object Object]
Isolated Hyperbilirubinemia Unconjugated ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Isolated Hyperbilirubinemia Conjugated ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Isolated Elevation in GGT ± ALP
Laboratory Testing Patterns Pattern Cause  AST/ALT >  ALP  Bilirubin Hepatocellular Injury  ALP > AST/ALT  Bilirubin Cholestasis  Albumin Chronic process (cirrhosis / cancer)  Albumin Acute process (viral hepatitis / choledocholithiasis.  PT/INR Prolonged jaundice / Vit K malabsorption Hepatocellular dysfunction.
Imaging ,[object Object],[object Object],[object Object],[object Object]
 
 
 
Case One ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case One ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Two ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Two ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Three ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Three ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Four ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Four ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SAMA www.sama-sd.org

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Approach to the patient with abnormal LFTs

  • 1. Approach to The Patient with Abnormal Liver Function Tests Bushra MI Sulieman, MD MS Consultant, Gastroenterology & Hepatology Department of Medicine King Faisal Specialist Hospital & Research Center - Jeddah
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  • 8. Laboratory Testing Patterns Pattern Cause  AST/ALT >  ALP  Bilirubin Hepatocellular Injury  ALP > AST/ALT  Bilirubin Cholestasis  Albumin Chronic process (cirrhosis / cancer)  Albumin Acute process (viral hepatitis / choledocholithiasis.  PT/INR Prolonged jaundice / Vit K malabsorption Hepatocellular dysfunction.
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  • 24. Isolated Elevation in GGT ± ALP
  • 25. Laboratory Testing Patterns Pattern Cause  AST/ALT >  ALP  Bilirubin Hepatocellular Injury  ALP > AST/ALT  Bilirubin Cholestasis  Albumin Chronic process (cirrhosis / cancer)  Albumin Acute process (viral hepatitis / choledocholithiasis.  PT/INR Prolonged jaundice / Vit K malabsorption Hepatocellular dysfunction.
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