- Evaluating a patient with abnormal liver function tests should take into account simple clinical characteristics such as dietary habits, use of drugs or herbal remedies, exposure to environmental toxins, history of blood transfusion or other risk factors for parenteral exposure, and recent travel to areas endemic for enterically transmitted hepatitis viruses
- Because the liver tends to respond uniformly to injury, the type of alteration in liver function tests seldom helps you to make a diagnosis. Therefore, you often need to carry out specific diagnostic testing
- A simple, first line screening for the most frequent conditions associated with abnormal liver function tests (viruses, autoimmune and metabolic diseases) will help you to identify the cause in most patients
CLINICAL TIPS
- You may find abnormal liver function tests in up to 17.5% of the asymptomatic general population†, although in 58% of these patients they are not adequately followed up
- Evaluate both the clinical context in which abnormal liver function tests are found and the degree of alteration (mild versus severe)
- Suggest liver ultrasonography to evaluate signs of advanced liver disease, fatty infiltration of the liver, and obstacles to bile flow
- Liver biopsy is the only way of accurately staging liver fibrosis, although it is sometimes unnecessary when obvious clinical or instrumental signs of cirrhosis are evident
- Transient elastography - an instrumental technique able to assess hepatic stiffness - may be proposed in patients with a definite cause of liver disease so as to non-invasively evaluate the stage of the disease
- Although some biochemical scores can help to stage liver disease non-invasively and more sophisticated biochemical markers of liver fibrosis are available, they have not been validated in clinical practice and their practical role has not yet been defined
