Liver Test Patterns in Hepatobiliary Disorders | |||||
| TYPE OF DISORDER | BILIRUBIN | AMINOTRANSFERASES | ALKALINE PHOSPHATASE | ALBUMIN | PROTHROMBIN TIME |
|---|---|---|---|---|---|
| Hemolysis/Gilbert's syndrome | Normal to 86 µmol/L (5 mg/dL) 85% due to indirect fractions No bilirubinuria | Normal | Normal | Normal | Normal |
| 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 | Normal to <3× normal elevation | Normal | Usually normal. If >5× above control and not corrected by parenteral vitamin K, suggests poor prognosis |
| Chronic hepatocellular disorders | Both fractions may be elevated Bilirubinuria | Elevated, but usually <300 IU | Normal to <3× normal elevation | Often decreased | Often prolonged Fails to correct with parenteral vitamin K |
| Alcoholic hepatitis, cirrhosis | Both fractions may be elevated Bilirubinuria | AST:ALT >2 suggests alcoholic hepatitis or cirrhosis | Normal to <3× normal elevation | Often decreased | Often prolonged Fails to correct with parenteral vitamin K |
| Intra- and extrahepatic cholestasis | Both fractions may be elevated | Normal to moderate elevation | Elevated, often >4× normal elevation | Normal, unless chronic | Normal If prolonged, will correct with parenteral vitamin K |
(Obstructive jaundice) Infiltrative diseases (tumor, granulomata); partial bile duct obstruction | Bilirubinuria Usually normal | Rarely >500 IU Normal to slight elevation | Elevated, often >4× normal elevation Fractionate, or confirm liver origin with 5'-nucleotidase or γ; glutamyl transpeptidase | Normal | Normal |