assessing liver injury tests

ASSESSING LIVER INJURY TESTSRay Thomason MD

Who Do We Evaluate

¨ Persistently Abnormal: AST, ALT, or Alkaline Phosphatase

¨ Persistent unexplained hepatomegaly

¨ Abnormal hepatic imaging suggestive of NAFLD

Types of Liver Injury Tests

¨Aminotransferases Enzymes (Transaminases) Alanine Aminotransferases - ALT-Aspartate Aminotransferases - AST Located in the hepatocyte thus markers for liver injury

¨Canalicular Enzymes Alkaline Phosphatase - APGamma-Glutamyl Transpeptidase - GGTLocated in the cells lining the biliary tree

Liver Tests Assessment in the General Population

Typical ALT Elevations

¨ Acute hepatitis due to a virus or drug injury other than acetaminophen: 500-2000

¨ Chronic viral hepatitis: 40-200¨ Nonalcoholic fatty liver disease: 40-150¨ Alcoholic liver disease:40-150(AST:ALT>2:10¨ Autoimmune Hepatitis: 200-1000¨ If ALT > 1000-5000: acetaminophen, ischemia,

unusual virus like herpes

Acute Hepatitis When the Usual Tests Are Negative

Acute Hepatitis When the Usual Tests Are Negative

¨ Autoimmune hepatitis ¨ Hepatitis E¨ CMV, EBV, adenovirus ¨ Diffuse Hepatic Malignancy ¨ If patient is not improving, consider:

Hepatology Consult Liver Biopsy

¨ For indeterminate cases, consider empiric trial of corticosteroids

HEPATITIS EASSESSING SERO-PREVALENCE-NHANES

HEPATITIS E CLINICAL CHARACTERISTICS

Hepatitis due to Non-Hepatotropic Viruses

Elevated Alkaline PhosphataseCommon Causes

MODALITIES TO ASSESSABNORMAL LIT

¨ Serologies¨ Imaging U/S with

doppler¨ Liver biopsy¨ FibroScan

¨ Serologies¨ Imaging-U/S, CT

SCAN, MRI-CP¨ Liver biopsy

Transaminases Cannalicular