Canadian Association of Gastroenterology Practice Guidelines: Evaluation of Abnormal Liver Enzyme Tests

Minuk, Gerald Y.

doi:10.1155/1998/943498

Cited by 24 publications

(22 citation statements)

References 12 publications

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“…Patients with the following should be considered for a specialist opinion:54 unexplained liver abnormalities >1.5 times normal on two occasions, a minimum of 6 months apart;unexplained liver disease with evidence of hepatic dysfunction (hypoalbuminemia, hyperbilirubinemia, prolonged prothrombin time or INR);known liver disease where treatment beyond the withdrawal of the implicating agent is required.…”

Section: When To Refer For a Specialist Opinion?mentioning

confidence: 99%

“…The following tests are recommended:54 screen for viral hepatitis: IgM antihepatitis A virus, HBsAg, antihepatitis C virus;antinuclear antibodies;ceruloplasmin in patients younger than 40 years;iron studies (iron, total iron binding capacity and ferritin);ultrasound of the liver especially where fatty infiltration is suspected (obese individuals, diabetics and/or hyperlipidemic patients).…”

Section: When To Refer For a Specialist Opinion?mentioning

confidence: 99%

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Evaluation of abnormal liver function tests

Limdi

Hyde

2016

Postgraduate Medical Journal

239

112

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Incidentally detected abnormality in liver function tests is a common situation encountered by physicians across all disciplines. Many of these patients do not have primary liver disease as most of the commonly performed markers are not specific for the liver and are affected by myriad factors unrelated to liver disease. Also, many of these tests like liver enzyme levels do not measure the function of the liver, but are markers of liver injury, which is broadly of two types: hepatocellular and cholestatic. A combination of a careful history and clinical examination along with interpretation of pattern of liver test abnormalities can often identify type and aetiology of liver disease, allowing for a targeted investigation approach. Severity of liver injury is best assessed by composite scores like the Model for End Stage Liver Disease rather than any single parameter. In this review, we discuss the interpretation of the routinely performed liver tests along with the indications and utility of quantitative tests.

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Section: When To Refer For a Specialist Opinion?mentioning

confidence: 99%

Section: When To Refer For a Specialist Opinion?mentioning

confidence: 99%

Evaluation of abnormal liver function tests

Limdi

Hyde

2016

Postgraduate Medical Journal

239

112

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show abstract

“…If IgM anti-HBc is negative suggesting a chronic hepatitis B virus infection, the HbeAg and anti-HBe will help determine whether the infection in the carrier is actively replicating or is quiescent. 6 Patients with a positive HBe Ag and hepatitis B virus DNA may be considered for a liver biopsy. 4 Family members and intimate contacts of HbsAg positive individuals should be screened for exposure to hepatitis B by checking HbsAg and anti-HBc.…”

Section: Viral Hepatitismentioning

confidence: 99%

Evaluation of abnormal liver function tests

Limdi¹

2003

Postgraduate Medical Journal

473

249

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Interpretation of abnormalities in liver function tests is a common problem faced by clinicians. This has become more common with the introduction of automated routine laboratory testing. Not all persons with one or more abnormalities in these tests actually have liver disease. The various biochemical tests, their pathophysiology, and an approach to the interpretation of abnormal liver function tests are discussed in this review.

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“…GGT can be elevated in many diseases (see Table 1) and so is not recommended as a screening test for liver disease [9]. However, GGT can be useful to confirm the hepatic origin of elevations in AP or alcohol abuse if AST is elevated coupled with an AST:ALT ratio of > 2:1 [12].…”

Section: Overview Of Routinely Used Liver Testsmentioning

confidence: 99%

Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis

Tremlett

Oger

2004

J Neurol

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This review explores the salient issues surrounding liver injury and liver monitoring associated with beta-interferon (IFNB) treatment for multiple sclerosis (MS). Post-marketing studies have found a higher proportion of IFNB-treated MS patients with elevated aminotransferases than reported in the pivotal clinical trials. Although the risk of severe liver injury appears small, the true incidence is unknown. Post-marketing studies have shown that the greatest period of risk for the development of liver test abnormalities appears to be in the first year of IFNB treatment. The risk also increases with the more frequently administered, higher-dosage IFNBs. Males are more likely than females to develop elevated aminotransferases (> upper normal limit), although females appear at a greater risk of severe liver injury. Of the commonly used biochemical liver tests, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and bilirubin appear the most useful for routine monitoring of IFNB treatment. Whilst many other factors can affect liver test results, including obesity, alcohol, concomitant medications, co-morbidities and theoretically even MS itself, regular liver testing both prior and during IFNB therapy might help minimise Type A or dose/frequency dependent aminotransferase elevations. However, testing will probably not prevent the Type B idiosyncratic reactions which can result in severe hepatic injury; hence patients need to be aware, and to report hepatic side effects promptly.

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Canadian Association of Gastroenterology Practice Guidelines: Evaluation of Abnormal Liver Enzyme Tests

Cited by 24 publications

References 12 publications

Evaluation of abnormal liver function tests

Evaluation of abnormal liver function tests

Evaluation of abnormal liver function tests

Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis

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