Liver Test Patterns in Hepatobiliary Disorders
| Type of Disorder | Bilirubin | Aminotransferases |
|---|---|---|
| Hemolysis/Gilbert's syndrome | Normal to 86 µmol/L (5 mg/dL) | Normal |
| 85% due to indirect fractions | ||
| No bilirubinuria | ||
| Acute hepatocellular necrosis (viral and drug hepatitis, hepatotoxins, acute heart failure) | Both fractions may be elevated Peak usually follows aminotransferases Bilirubinuria | Elevated, often >500 IU ALT >AST |
| Chronic hepatocellular disorders | Both fractions may be elevated | Elevated, but usually <300 IU |
| Bilirubinuria | ||
| Alcoholic hepatitis, cirrhosis | Both fractions may be elevated Bilirubinuria | AST:ALT > 2 suggests alcoholic hepatitis or cirrhosis |
| Intra- and extra-hepatic cholestasis | Both fractions may be elevated | Normal to moderate elevation |
| (Obstructive jaundice) | Bilirubinuria | Rarely >500 IU |
| Infiltrative diseases (tumor, granulomata); partial bile duct obstruction | Usually normal | Normal to slight elevation |
| Alkaline Phosphatase | Albumin | Prothrombin Time |
| Normal | Normal | Normal |
| Normal to <3 times normal elevation | Normal | Usually normal. If >5 × above control and not corrected by parenteral vitamin K, suggests poor prognosis |
| Normal to <3 times normal elevation | Often decreased | Often prolonged Fails to correct with parenteral vitamin K |
| Normal to <3 times normal elevation | Often decreased | Often prolonged Fails to correct with parenteral vitamin K |
| Elevated, often >4 times normal elevation | Normal, unless chronic | Normal If prolonged, will correct with parenteral vitamin K |
Elevated, often >4 times normal elevation Fractionate, or confirm liver origin with 5' nucleotidase or 𝛄-glutamyl transpeptidase | Normal | Normal |