Elevated Liver Enzymes in Asymptomatic Patients – What Should I Do?

Abstract

Elevated liver enzymes are a common scenario encountered by physicians in clinical practice. For many physicians, however, evaluation of such a problem in patients presenting with no symptoms can be challenging. Evidence supporting a standardized approach to evaluation is lacking. Although alterations of liver enzymes could be a normal physiological phenomenon in certain cases, it may also reflect potential liver injury in others, necessitating its further assessment and management. In this article, we provide a guide to primary care clinicians to interpret abnormal elevation of liver enzymes in asymptomatic patients using a step-wise algorithm. Adopting a schematic approach that classifies enzyme alterations on the basis of pattern (hepatocellular, cholestatic and isolated hyperbilirubinemia), we review an approach to abnormal alteration of liver enzymes within each section, the most common causes of enzyme alteration, and suggest initial investigations.

Updated Population Pharmacokinetic Model of Cabozantinib Integrating Various Cancer Types Including Hepatocellular Carcinoma

“…There is no single marker that measures liver function to reliably classify liver disease with good predictive value for dose adjustment due to several etiologies involved in liver dysfunction . The Food and Drug Administration and European Medicines Agency have issued similar guidance for studies on the effect of liver impairment, and both recommend the CP classification as the preferred criterion for addressing liver dysfunction.…”

“…There is no single marker that measures liver function to reliably classify liver disease with good predictive value for dose adjustment due to several etiologies involved in liver dysfunction. 23 The Food and Drug Administration 24 and European Medicines Agency 25 have issued similar guidance for studies on the effect of liver impairment, and both recommend the CP classification as the preferred criterion for addressing liver dysfunction. The CP score is a composite of 2 clinical assessments (ascites and encephalopathy) and 3 biochemical markers (total bilirubin, albumin, and international normalized ratio) for placement in 3 ordinal levels of liver impairment (mild, moderate, and severe).…”

Elevated serum aspartate aminotransferase levels concomitant with normal alanine aminotransferase levels in older low body weight people: Preliminary findings from a community-based epidemiological study

“…1984, Nathwani at al. 2005, Malakouti et al 2017). However, ALT and GGT are predominantly found in the liver.…”

“…Therefore, elevated serum AST levels concomitant with normal serum ALT levels could reflect injury of skeletal muscle and myocardium in clinical practice (Nathwani at al. 2005, Malakouti et al 2017). Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) are also found in multiple organs, whereas ALP is preferentially included in bone tissue (Malakouti et al 2017, Lowe and John.…”

Conjugated Linoleic Acid Supplemented Diet Influences Serum Markers in Orchidectomized Sprague‐Dawley Rats

“…ALT is a marker of liver injury when there is an increase of more than twofold its normal concentrations or when there is a combined increase in AST, alkaline phosphatase, and total bilirubin concentrations . It is considered as a minor hepatocellular damage when the increase in transaminase concentrations is greater than five times its normal value . Because the rise in transaminases did not exceed more than twice the healthy control concentrations, and that the concentrations of alkaline phosphatase and bilirubin did not increase under the conditions of our experimental design, we propose that the CLA diet did not cause a hepatotoxic effect.…”