TY - JOUR
T1 - Elevated Liver Enzymes
T2 - Emergency Department-Focused Management
AU - Sulava, Eric
AU - Bergin, Samuel
AU - Long, Brit
AU - Koyfman, Alex
PY - 2016/7/11
Y1 - 2016/7/11
N2 - Background: Liver function test (LFT) abnormalities are a common problem faced by emergency physicians. This has become more common with the introduction of laboratory panels and automated routine laboratory testing. Fortunately, not all patients with irregularities in liver enzymes possess underlying pathology. This emergency medicine focused review provides a discussion of the various biochemical tests, their underlying biological basis, and an algorithmic approach to the interpretation of abnormalities. Objective: Our aim was to provide emergency physicians with an overview of the evaluation and management of patients with elevated LFTs. Discussion: The liver is a complex organ with multiple roles. The key biochemical markers of hepatic function can be organized into the groupings of hepatocellular, cholestatic, or functioning liver, based on underlying enzymatic roles. Pathologic alterations to these markers can be algorithmically assessed by separating disease processes of these groupings, followed by assessment of the magnitude of enzymatic elevation. This review conducts an in-depth evaluation of the differential diagnosis and emergency department-centered clinical response of elevated LFTs based on subcategories of mild, moderate, and severe transaminase elevation. Conclusions: By understanding the biochemical basis of each LFT, it is possible to correlate laboratory findings to a patient's clinical presentation. An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis. This may assist providers in ensuring appropriate management and evaluation of the patient with elevated LFTs.
AB - Background: Liver function test (LFT) abnormalities are a common problem faced by emergency physicians. This has become more common with the introduction of laboratory panels and automated routine laboratory testing. Fortunately, not all patients with irregularities in liver enzymes possess underlying pathology. This emergency medicine focused review provides a discussion of the various biochemical tests, their underlying biological basis, and an algorithmic approach to the interpretation of abnormalities. Objective: Our aim was to provide emergency physicians with an overview of the evaluation and management of patients with elevated LFTs. Discussion: The liver is a complex organ with multiple roles. The key biochemical markers of hepatic function can be organized into the groupings of hepatocellular, cholestatic, or functioning liver, based on underlying enzymatic roles. Pathologic alterations to these markers can be algorithmically assessed by separating disease processes of these groupings, followed by assessment of the magnitude of enzymatic elevation. This review conducts an in-depth evaluation of the differential diagnosis and emergency department-centered clinical response of elevated LFTs based on subcategories of mild, moderate, and severe transaminase elevation. Conclusions: By understanding the biochemical basis of each LFT, it is possible to correlate laboratory findings to a patient's clinical presentation. An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis. This may assist providers in ensuring appropriate management and evaluation of the patient with elevated LFTs.
KW - Alanine aminotransferase
KW - Albumin
KW - Alkaline phosphatase
KW - Aspartate aminotransferase
KW - Hepatitis
KW - Liver function test
KW - Prothrombin time
KW - γ-glutamyl transpeptidase
UR - http://www.scopus.com/inward/record.url?scp=85007277386&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85007277386&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2016.10.016
DO - 10.1016/j.jemermed.2016.10.016
M3 - Article
C2 - 27889359
AN - SCOPUS:85007277386
SN - 0736-4679
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
ER -