Evaluation and management of abnormal liver chemistry tests in the asymptomatic outpatient

• Objective: To review the evaluation and management of liver enzyme abnormalities in asymptomatic patients. • Methods: Review of the literature. • Results: Liver chemistry tests include alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, bilirubin, and gammaglutamyltransferase (GGT). In general, AST and ALT abnormalities suggest a pattern of hepatocellular injury or necrosis, whereas alkaline phosphatase, bilirubin, and GGT elevations reflect cholestatic injury. A detailed history with attention paid to alcohol consumption, medication and herb or supplement use, travel history, and risk factors for viral hepatitis and metabolic syndrome can often quickly narrow the differential diagnosis. Nonalcoholic fatty liver disease is an increasing cause of chronic liver disease and should be approached in the context of the metabolic syndrome. • Conclusion: A thorough understanding of the pathogenesis of abnormal liver chemistry tests, prevalence and risk factors of common liver diseases, and a clinically directed, stepwise approach to evaluation can help to avoid common pitfalls.