Recommendations for the Evaluation of Chronic Abnormal Liver Function Tests (LFTs)

Definition

Persistently abnormal levels of liver transaminase (ALT, AST, GGTP or Alkaline Phosphatase) for 3 months or longer, or intermittently elevated LFT over a 6 month or longer period.

Evaluation

History

Behavioral risk factors for viral hepatitis; Injecting Drug Use (IDU), Transfusion, Snorting Cocaine, tattooing, body piercing, multiple sexual partners, STD, incarceration, health care employment. History of previous jaundice or liver disease, family history of liver disease or diabetes. Prescription and over the counter medication usage. Alcohol usage history. History of diabetes or elevated triglycerides.

Physical Exam

BMI, liver size to percussion, presence of splenomegaly, spider angioma, ascites, palmer erythema, asterixis, muscle wasting, gynecomastia in males.

Laboratory Testing

The following tests may be ordered all at once or in a sequential manner.

Tests for Chronic Viral Hepatitis:

HBsAg Hepatitis B surface antigen
anti-HCV Hepatitis C antibody

Tests for Autoimmune Liver Disease, especially in women with abnormal LFT:*

ANA: Anti-Nuclear Antibody
SMA: Smooth Muscle Antibody
AMA: Anti-Mitochondrial Antibody (diagnostic for PBC)
Serum IgG
Serum IgM

*Positive ANA and/or SMA and elevated IgG suggests autoimmune hepatitis; positive AMA and IgM suggests primary biliary cirrhosis (PBC)

Tests for Treatable Metabolic Liver Diseases:

Serum Iron, TIBC and % iron saturation or Hemochromatosis
Serum Ceruloplasmin for Wilson's Disease, only in persons <45 years old

Tests for Fatty Liver:

Serum Glucose
Serum Cholesterol
Serum Triglycerides

Radiology Testing

Ultrasound of Liver/Gallbladder

Referral to Liver Clinic (Internal Medicine)

Revision 1.2006