EVALUATION OF ABNORMAL LIVER TESTS

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 pts in whom the diagnosis remains unclear despite medical evaluation

Diagnostic evaluation

HBsAg
Anti-HCV
Fe saturation, ferritin
Ceruloplasmin
₁AT
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

₁AT, ₁ antitrypsin; AlkP, alkaline phosphatase; ALT, alanine aminotransferase; AMA, antimitochondrial antibody; ERCP, endoscopic retrograde cholangiopancreatogram; GGT, -glutamyl transpeptidase; HAV, hepatitis A virus; HBc, hepatitis B core; HBsAG, hepatitis B surface antigen; HCV, hepatitis C virus; MRCP, magnetic resonance cholangiopancreatography; p-ANCA, perinuclear antineutrophil cytoplasmic antibody; SMA, smooth-muscle antibody.

Hepatitic: ALT
Mixed: ALT, AlkP

Cholestatic: AlkP, gGT, ALT

Hepatitic: ALT
Mixed: ALT, AlkP

Cholestatic: AlkP, gGT, ALT