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Published byAudra Miller Modified over 8 years ago
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Abnormal liver enzyme levels liver enzyme levels symptoms or signs suggestive of liver disease isolated, unexpected finding challenge even for the experienced clinician and set off a battery of further tests and consultations
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Liver disease Liver disease is reflected by biochemical abnormalities of 1 of 2 different hepatic systems or of liver function
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Where, when and how: a schematic approach to liver enzyme alteration 10 times the upper reference limit, or mild, moderate or marked
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Hepatocellular predominance the most sensitive and specific aminotransferase threshold level to identify acute injury (viral hepatitis) lies within the moderate range of increase (5–10 times the URL), –at 200 IU/L for AST [sensitivity 91%, specificity 95%] –300 IU/L for ALT [sensitivity 96%, specificity 94%])
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Hepatocellular predominance
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Very high aminotransferase levels (> 75 times the upper reference limit) indicate ischemic or toxic liver injury in more than 90% of cases of acute hepatic injury, whereas they are less commonly observed with acute viral hepatitis
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Hepatocellular predominance
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Mild ↓ ↓ ↑
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ALT/ALP ratio < 2 Abnormal ALP levels may also be a sign of metastatic cancer of the liver, lymphoma or infiltrative diseases such as sarcoidosis
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Reference for liver tests
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Case #1 ALT/AP = 0.2
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Case #1
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Case #2 ALT/AP = 0.06
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Case #2
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Case #3 NORMAL AST/ALT = 1.6 HEPATOCELLULAR MILD (<5xURL)
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Mild ↓ ↓ ↑
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Case #3
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Case #4 ALT/AP = 5.3 HEPATOCELLULAR MODERATE/MARKED (5-10 - >10 xURL) AST/ALT = 0.5
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Case #4
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