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Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?

Authors
  • Malakouti, Mazyar1
  • Kataria, Archish2
  • Ali, Sayed K3
  • Schenker, Steven1
  • 1 Division of Gastroenterology and Nutrition, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
  • 2 Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
  • 3 Department of Internal Medicine, University of Central Florida, College of Medicine, Orlando, FL, USA.
Type
Published Article
Journal
Journal of clinical and translational hepatology
Publication Date
Dec 28, 2017
Volume
5
Issue
4
Pages
394–403
Identifiers
DOI: 10.14218/JCTH.2017.00027
PMID: 29226106
Source
Medline
Keywords
License
Unknown

Abstract

Elevated liver enzymes are a common scenario encountered by physicians in clinical practice. For many physicians, however, evaluation of such a problem in patients presenting with no symptoms can be challenging. Evidence supporting a standardized approach to evaluation is lacking. Although alterations of liver enzymes could be a normal physiological phenomenon in certain cases, it may also reflect potential liver injury in others, necessitating its further assessment and management. In this article, we provide a guide to primary care clinicians to interpret abnormal elevation of liver enzymes in asymptomatic patients using a step-wise algorithm. Adopting a schematic approach that classifies enzyme alterations on the basis of pattern (hepatocellular, cholestatic and isolated hyperbilirubinemia), we review an approach to abnormal alteration of liver enzymes within each section, the most common causes of enzyme alteration, and suggest initial investigations.

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