Assessment of abnormal liver injury tests

Evidence of hepatic injury on routine biochemical evaluation should prompt a rapid decision-making process in the clinician. Elevations of hepatocellular injury tests (aspartate transaminase or AST, alanine transaminase or ALT) should be evaluated with an eye to the relative magnitude, pace of elevation, and relative increase over other markers. In this way, appropriate resources can be devoted to rapid evaluation. Increases in cholestatic injury tests (alkaline phosphatase liver fraction, γ-glutamyl transpeptidase, and bilirubin) should prompt assessment of biliary tree anatomy and consideration of autoimmune, metabolic, or toxic injury of the liver. Finally, the liver 's ability to synthesize factors such as albumin and factor V is a very quick gauge of the extent of the liver injury.