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CLINICAL APPROACH TO THE PATIENT WITH ABNORMAL LIVER TEST
RESULTS
Abnormal results of standard biochemical liver tests occur
frequently; however, the prevalence of clinically significant liver
disease is only about 1% in all patients screened. Thus,
development of a rational and cost-effective approach to these
patients is important. Liver diseases are generally classified as
hepatocellular, cholestatic, and infiltrative, Cholestatic liver
disease is further categorized as intrahepatic and extrahepatic.
Hepatocellular disease is characterized by transaminase increases
greater than 5 times the upper limit of normal, with alkaline
phosphatase levels usually increased less than 2 to 3 times the
upper limit of normal. Cholestatic disease is characterized by an
increase in the alkaline phosphatase level that is 3 to 5 times
greater than the upper limit of normal, with only a mild increase
of transaminases. The exception to this is cholestasis with
cholangitis when the transaminases can be more substantially
increased, In infiltrative diseases of the liver such as lymphoma
or granulomatous hepatitis, the alkaline phosphatase level is
increased disproportionately to that of the bilirubin. Specific
etiologic diagnoses cannot usually be based on routine biochemical
liver test results, and thus more specialized serum tests are
necessary. A liver biopsy is often needed for a precise diagnosis
in patients with long-term increases in liver test results.
Ultrasonography is the best initial imaging technique for the
liver, and if biliary dilatation is noted, endoscopic retrograde
cholangiopancreatography is recommended.
Author: KAMATH PS, MAYO CLIN & MAYO FDN, DIV
GASTROENTEROL, 200 1ST ST SW, ROCHESTER, MN 55905
Source: MAYO CLINIC PROCEEDINGS 1996 NOV;71(11):1089-1095
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