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Abnormal liver enzyme levels

Abnormal liver enzyme levels. challenge even for the experienced clinician and set off a battery of further tests a nd consultations. Liver disease. Liver disease is reflected by biochemical abnormalities of 1 of 2 different hepatic systems or of liver function.

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Abnormal liver enzyme levels

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  1. Abnormal liver enzyme levels challenge even for the experienced clinician and set off a battery of furthertests andconsultations

  2. Liver disease Liver disease is reflected by biochemical abnormalitiesof 1 of 2 different hepatic systems or of liver function

  3. Where, when and how: a schematic approachto liver enzyme alteration < 5 times, 5–10 times or > 10 times the upper reference limit, or mild, moderate or marked

  4. Hepatocellular predominance • the most sensitive and specific aminotransferasethreshold level to identify acute injury (viralhepatitis) lies within the moderaterange of increase (5–10 times the URL), • at 200 IU/L for AST [sensitivity 91%,specificity95%] • 300 IU/L for ALT [sensitivity 96%, specificity 94%])

  5. Hepatocellular predominance

  6. Hepatocellular predominance • Very high aminotransferase levels (> 75 times the upper reference limit) indicateischemic or toxic liver injury in more than 90% of cases ofacute hepatic injury,whereas they are less commonly observed with acute viral hepatitis

  7. Hepatocellular predominance

  8. Mild ↓ ↓ ↑

  9. 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

  10. Reference for liver tests

  11. Case #1 ALT/AP = 0.2

  12. Case #1

  13. Case #2 ALT/AP = 0.06

  14. Case #2

  15. Case #3 HEPATOCELLULAR MILD (<5xURL) NORMAL AST/ALT = 1.6

  16. Mild ↓ ↓ ↑

  17. Case #3

  18. Case #4 HEPATOCELLULAR MODERATE/MARKED (5-10 - >10 xURL) ALT/AP = 5.3 AST/ALT = 0.5

  19. Case #4

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