Developing approaches to a relatively common lab abnormality is essential in any ambulatory setting. Isolated liver transaminase elevation has a broad differential and is perhaps best considered in 3 categories before being appropriately narrowed with clinical and laboratory investigations.
1) Common Causes:
- Non-Alcoholic Liver Disease
Hx: Metabolic syndrome; Ix: Lipids, a1c elevated
- Alcoholic Liver Disease
Hx: EtOH consumption; Ix: AST:ALT > 2
2) Uncommon Causes
- Medications
Hx: consider overdose; Ix: plasma concentrations
- Hepatitis B
Hx: vaccination, travel, high-risk behaviour; Ix: HBV serology
- Hepatitis C
Hx: travel, high-risk behaviour; Ix: HCV serology
- Hereditary hemochromatosis
Hx: Family history; Ix: Serum iron, ferritin
3) Rare Causes
Alpha-1-antitrypsin deficiency
Hx: Early emphysema, family history; Ix: serum alpha-1-antitrypsin
Autoimmune hepatitis
Hx: young women, autoimmune disorders; Ix: SPEP, ANA, smAb, liver/kidney microsome type1 Ab
Wilson disease
Hx: neuropsychiatric, Kayser-Fleischer rings, Ix: Serum Ceruloplasmin
-TJ-
Reference:
Oh RC, Hustead TR, Ali SM, Pantsari MW. Mildly Elevated Liver Transaminase Levels: Causes and Evaluation. Am Fam Physician. 2017 Dec 1;96(11):709-715. PMID: 29431403.
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