Liver enzyme alteration: a guide for clinicians

Liver enzyme alteration: a guide for clinicians
Edoardo G. Giannini, Roberto Testa and Vincenzo Savarino

CMAJ • February 1, 2005; 172 (3):367-379

ISOLATED ALTERATIONS OF BIOCHEMICAL MARKERS OF LIVER DAMAGE in a seemingly healthy patient can present a challenge for the clinician. In this review we provide a guide to interpreting alterations to liver enzyme levels. The functional anatomy of the liver and pathophysiology of liver enzyme alteration are briefly reviewed. Using a schematic approach that classifies enzyme alterations as predominantly hepatocellular or predominantly cholestatic, we review abnormal enzymatic activity within the 2 subgroups, the most common causes of enzyme alteration and suggested initial investigations.