Evaluation of Abnormal Liver-Enzyme Results in Asymptomatic Patients

• Published in: The New England journal of medicine Vol. 342; no. 17; pp. 1266 - 1271
• Main Authors: Pratt, Daniel S, Kaplan, Marshall M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 27-04-2000
• Subjects: Alkaline Phosphatase - blood; Biological and medical sciences; Blood & organ donations; Errors of metabolism; gamma-Glutamyltransferase - blood; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis; Humans; Liver; Liver Diseases - blood; Liver Diseases - diagnosis; Liver Function Tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Metabolic diseases; Miscellaneous hereditary metabolic disorders; Other diseases. Semiology; Transaminases - blood; Human; Nervous system diseases; Hemochromatosis; Wilson disease; Deficiency; Glycoprotein; Hepatic disease; Metabolic diseases; Exploration; Patient; Autoimmune disease; Asymptomatic; Biology; Iron; Enzymopathy; α1-Antitrypsin; Genetic disease; Hepatitis; Chronic; Digestive diseases; Diagnosis
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM200004273421707

Now that routine laboratory testing is automated and is frequently part of an annual checkup, physicians are often faced with the problem of a patient with one abnormal result on measurement of serum aminotransferases or alkaline phosphatase but no symptoms. Many batteries of screening tests now include measurement of serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyltransferase. Although these enzymes are present in tissues throughout the body, they are most often elevated in patients with liver disease and may reflect liver injury.
The first step in the evaluation of a patient with elevated liver-enzyme levels but no symptoms is . . .