Suspected Liver Disease

Diagnostic evaluation

IgM Anti-HAV
HBsAg
IgM Anti-HBc
Anti-HCV
ANA, SMA
Monospot, heterophile
Ceruloplasmin
Alcohol history
Drug history

Diagnostic evaluation

AMA
Drug history
Ultrasound/MRI
MRCP/ERCP

Liver biopsy in acute liver disease: Reserved for patients in whom the diagnosis remains unclear despite medical evaluation

Diagnostic evaluation

HBsAg
Anti-HCV
Fe saturation, ferritin
Ceruloplasmin
α₁AT
ANA, SMA
Ultrasound
Alcohol history

Diagnostic evaluation

Drug history
AMA
P-ANCA
Ultrasound
MRCP/ERCP

Liver biopsy in chronic liver disease: Often valuable for diagnosis as well as staging and grading liver disease

End

Abnormal liver tests

Acute <6 months

Chronic >6 months

Hepatic: ↑ ↑ ALT
Mixed: ↑ ALT, ↑ AlkP

Cholestatic: ↑ ↑ AlkP,

↑↑ GGT,

↑ ALT

Hepatic: ↑ ↑ ALT
Mixed: ↑ ALT, ↑ AlkP

Cholestatic: ↑ ↑ AlkP,

↑↑ GGT, ↑ ALT