Published in:
01-09-2019 | Letter to the Editor
Abnormal Liver Enzymes
Author:
Shih-Wei Lai, MD
Published in:
Journal of General Internal Medicine
|
Issue 9/2019
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Excerpt
One study by Bian et al. examined the follow-up patterns of abnormal liver enzymes in primary care.
1 The authors reported that no association between race and follow-up patterns after an initial abnormal liver test, but approximately 50.7 to 56.5% of people with abnormal liver enzymes did not perform a repeating test.
1 In addition, Schreiner et al. reported that 11.7% of people with abnormal liver enzymes did not perform a repeating test during the study period.
2 Malakouti et al. reviewed that abnormal liver enzymes might only be a normal physiological variation in some people, but it might reflect potential pathological changes in other cases and need further evaluation and management.
3 The most common causes of pathologic changes are disorders of hepatocellular injury and disorders of cholestasis.
3,4 A review of Agganis et al. disclosed that the three most common etiologies of abnormal liver enzymes are alcoholic toxicity, medication overdose, and fatty liver disease.
4 Agganis et al. emphasized that even asymptomatic, any people having abnormal liver enzymes should receive further investigations including a detailed history taking and physical examination, followed by appropriate laboratory testing and other diagnostic workup.
4 Therefore, the potential underlying causes can be found. The American College of Gastroenterology recommends a practice guideline regarding the evaluation of abnormal liver enzymes.
5 This guideline is easily understood and performed in clinical practice. Primary care clinicians serve as the first-line healthcare providers and they should keep this guideline in mind. …