hepatic and biliary disorders
The Asymptomatic Patient With Abnormal Liver Test Results
Aminotransferases
Mild isolated elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST;<2 times normal) may require only repeat testing; they resolve in about one third of cases. It is important to clarify if laboratory tests were done in the fasting state because oral intake can cause mild elevations in tests of liver function. If abnormalities are present in other laboratory tests, are severe, or persist on subsequent testing, further evaluation is indicated as follows: Metabolic Dysfunction–Associated Liver Disease (MASLD) should be considered in patients with Patients should be Serology . 40 should be screened for Hereditary Hemochromatosis . 30 should be screened for Wilson Disease . Most patients, especially young or middle-aged women, should be screened for autoimmune disorders. Patients at risk should be screened for Diagnosis and Most patients, especially those with early-onset obstructive lung disease, especially in the absence of smoking history, should be screened for Alpha-1 Antitrypsin Deficiency . Most patients should be screened for Celiac Disease . All patients should have a thorough review of all prescription drugs, herbals, supplements, energy drinks, and recent antibiotics to exclude Liver Injury Caused by Drugs . All patients should be asked about history of alcohol use. Abdominal ultrasound with Doppler can evaluate for Metabolic Dysfunction–Associated Liver Disease (MASLD) , If the entire evaluation reveals no cause, Liver Biopsy may be warranted. 