Minireviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2021; 13(11): 1688-1698
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1688
Abnormal liver enzymes: A review for clinicians
M Ammar Kalas, Luis Chavez, Monica Leon, Pahnwat Tonya Taweesedt, Salim Surani
M Ammar Kalas, Luis Chavez, Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79905, United States
Monica Leon, Department of General Surgery, University of Mexico, Ciudad de Mexico 01120, Mexico
Pahnwat Tonya Taweesedt, Department of Medicine, Corpus Christi Medical Center, Corpus Christi, TX 78412, United States
Salim Surani, Department of Medicine, Texas A&M University, College Station, TX 77843, United States
Salim Surani, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: All authors have contributed to the preparation and review of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FACP, FCCP, MD, MSc, Doctor, Professor, Medicine, Texas A&M University, 400 Bizzell St, College Station, TX 77843, United States. srsurani@hotmail.com
Received: May 15, 2021
Peer-review started: May 15, 2021
First decision: July 8, 2021
Revised: July 24, 2021
Accepted: August 23, 2021
Article in press: August 23, 2021
Published online: November 27, 2021
Processing time: 193 Days and 6.5 Hours
Abstract

Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting, especially with the automatization of testing in this technological era. These tests include aminotransferases, alkaline phosphatase, gamma-glutamyl transferase, bilirubin, albumin, prothrombin time and international normalized ratio (INR). Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation. Generally, abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild [< 5 × upper limit of normal (ULN)], moderate (> 5-< 15 × ULN) and severe (> 15 × ULN). Hepatocellular pattern causes include but are not limited to; non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, alcohol use, chronic viral hepatitis, liver cirrhosis (variable), autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, celiac disease, medication-induced and ischemic hepatitis. Cholestatic pattern causes include but is not limited to; biliary pathology (obstruction, autoimmune), other conditions with hyperbilirubinemia (conjugated and unconjugated). It is crucial to interpret these commonly ordered tests accurately as appropriate further workup, treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.

Keywords: Liver function test; Liver enzymes; Hepatitis; Liver biochemical studies; Non-alcoholic steatohepatitis; Hyperbilirubenemia

Core Tip: Liver function test are one of the most commonly ordered tests. With the automation of test and its inclusion in the complete metabolic profile, the knowledge as it pertains to its interpretation is of paramount importance. It is also important for the clinician to understand the difference between cholestatic and hepatocellular abnormalities. This can be of help for the clinician to formulate appropriate further diagnostic workup and plan the treatment.