ASGE Annual GI Advanced Practice Provider Course - Day Two (On-Demand) | April 2022-24_Evaluation of Abnormal Liver Tests

24_Evaluation of Abnormal Liver Tests - Martin

Pdf Summary

In this document, Dr. John A. Martin provides an evaluation of abnormal liver tests, discussing the definition and categorization of different types of liver tests, as well as their implications and associated disorders. The document begins with a series of polling questions to test the reader's knowledge on liver tests.<br /><br />The liver tests discussed in the document include ALT, which is a liver injury test; ALP, which is specific to the liver and can rise in any cholestatic process; and bilirubin, which is a breakdown product of hemoglobin. The document also mentions γGT and 5’-nucleotidase, which are used to detect liver injury and help determine the source of an elevated ALP level.<br /><br />The document emphasizes that liver tests are more than just numbers and can provide information about liver injury, liver function, and the liver's ability to synthesize proteins and transport bilirubin. The categories of liver tests discussed include liver injury tests, liver synthetic function tests, liver enzymes, and liver function tests.<br /><br />The document highlights that liver tests can be misused and explains that terms like "transaminase" and "transaminitis" are non-existent. It also clarifies that AST and ALT reflect liver injury rather than liver function, and bilirubin is not an enzyme but can reflect liver function.<br /><br />Patterns of abnormality in liver tests, such as hepatocellular injury and cholestasis, are discussed, along with the importance of considering the patient's history and physical examination findings. The document provides clinical approaches to abnormal liver tests based on different patterns of abnormality.<br /><br />Finally, the document includes three cases that illustrate the management of abnormal liver tests in different clinical scenarios. The cases involve acute viral hepatitis, acute alcohol hepatitis, and drug-induced liver injury.<br /><br />In summary, this document provides an overview of abnormal liver tests, their categories, and their implications. It emphasizes the importance of considering the patient's history and physical examination findings in order to determine the appropriate workup and management.

Keywords

abnormal liver tests

evaluation

liver injury

liver function

ALT

ALP

bilirubin

hepatocellular injury

cholestasis

management