Abnormal liver enzymes: A review for clinicians

Abstract

Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting, especially with the automatization of testing in this technological era. These tests include aminotransferases, alkaline phosphatase, gamma-glutamyl transferase, bilirubin, albumin, prothrombin time and international normalized ratio (INR). Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation. Generally, abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild [< 5 × upper limit of normal (ULN)], moderate (> 5-< 15 × ULN) and severe (> 15 × ULN). Hepatocellular pattern causes include but are not limited to; non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, alcohol use, chronic viral hepatitis, liver cirrhosis (variable), autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, celiac disease, medication-induced and ischemic hepatitis. Cholestatic pattern causes include but is not limited to; biliary pathology (obstruction, autoimmune), other conditions with hyperbilirubinemia (conjugated and unconjugated). It is crucial to interpret these commonly ordered tests accurately as appropriate further workup, treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.

Study of serum cholinesterase as a biomarker in a sample of patients with viral hepatitis B or hepatitis C in Baghdad

“…Because albumin is synthesized in the liver, it is considered a biomarker for the synthetic function of the liver. However, other factors can affect albumin levels, including systemic inflammation, protein malnutrition, nephropathy, fluid overload, and protein-losing enteropathy (14). Our study showed that the TP and ALB concentrations in viral hepatitis patients were lower than in controls, and it agrees with another study that found a significant decrease (p < 0.05) in the TP and ALB concentrations in viral hepatitis patients (15).…”

Comparative Proteomic Analysis of Liver Tissues and Serum in db/db Mice

“…As for the upregulated DEPs, alkaline phosphatase (ALPL), also named ALP, together with alanine aminotransferase (AST), aspartate aminotransferase (ALT), bilirubin, and albumin is already known as a biochemical indicator for liver function tests. If the serum level of ALP exceeds the normal range of 30–120 IU, it means that liver function is impaired [ 44 ]. Apart from the aforementioned information, ALDOB is enriched in the liver and kidney, as well as the small intestine [ 45 ].…”

Acute Hepatitis A-Induced Autoimmune Hepatitis: A Case Report and Literature Review

“…Liver enzyme alteration can be found in various liver diseases, but if you look closely, the common causes of liver disease have typical patterns [ 6 , 7 ]. For example, ischemic liver injury shows marked aminotransferase level (>1000 IU/L), and viral hepatitis or toxic hepatitis show slightly lower aminotransferase levels than the above disease.…”