section name header

Table 42-4

Liver Test Patterns in Hepatobiliary Disorders

Type of DisorderBilirubinAminotransferases
Hemolysis/Gilbert's syndromeNormal 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 disordersBoth fractions may be elevatedElevated, 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 cholestasisBoth fractions may be elevatedNormal to moderate elevation
(Obstructive jaundice)BilirubinuriaRarely >500 IU
Infiltrative diseases (tumor, granulomata); partial bile duct obstructionUsually normalNormal to slight elevation
Alkaline PhosphataseAlbuminProthrombin Time
NormalNormalNormal
Normal to <3 times normal elevationNormalUsually normal. If >5 × above control and not corrected by parenteral vitamin K, suggests poor prognosis
Normal to <3 times normal elevationOften decreased

Often prolonged

Fails to correct with parenteral vitamin K

Normal to <3 times normal elevationOften decreased

Often prolonged

Fails to correct with parenteral vitamin K

Elevated, often >4 times normal elevationNormal, 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

NormalNormal