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My Patient Has Elevated Liver Function Tests
Amar Shah, MD
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Imaging Options
• Radiographs
• Ultrasound
• CT Scan
• MRI
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Liver Dysfunction
• Elevated ALT, AST, Non drinker
• Elevated ALT, AST, drinker
• Elevated Direct Bilirubin
• The Incidental Hepatic lesion
• Elevated
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Elevated ALT and AST, Non drinkerUltrasound
Normal Fatty Infiltrated
CT MR
Persistent Pain
Confirm/Discordant with clinical
findings/Evaluate for cirrhosis/Pseduolesio
n due to focal fat
Biopsy
NAFLD NASHDo not suspect Medication, Alcohol or virus
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Fatty Liver
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Fatty Liver-Pseudolesion
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Elevated Liver Function Tests, Alcohol Related
Ultrasound
Normal Acute Hepatitis Cirrhosis
Serial Ultrasound
CT MR
Elevated AFP, Clinical Concern for
Hepatocellular Cancer
Triphasic
Mass
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Cirrhosis
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Hepatocellular Carcinoma
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Elevated Bilirubin
Elevated Direct
Evaluate for Obstruction
Ultrasound
Choledocholithiasis Normal
CT MR/MRCP
Intrinsic/Extrinsic Obstruction
Elevated Total Bilirubin
PrehepaticHepatic
Posthepatic
Triphasic
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Choledocholithiasis
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Sclerosing Cholangitis
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My patient has an incidental lesion
Ultrasound
Cyst Hyperechoic Lesion
CT MR
Triphasic
BenignFocal Nodular Hyperplasia
HemangiomaAdenoma
MalignantHCC
Cholangiocarcinoma
Metastasis
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Characterizing Incidental Lesion
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Thank you