Liver enzyme alteration: a guide for clinicians

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.Abnormal liver enzyme levels may signal liver damage or alteration in bile flow. Liver enzyme alteration may be either the accompanying biochemical picture in a patient with symptoms or signs suggestive of liver disease or an isolated, unexpected finding in a patient who has undergone a wide range of laboratory tests for a nonhepatic disease or for minor, vague complaints. The latter situation is a common clinical scenario today because of the routine incorporation of hepatic tests in automated blood chemistry panels. Isolated alterations of biochemical markers of liver damage in a seemingly healthy patient often represent a challenge even for the experienced clinician and usually set off a battery of further, costly tests¹ and consultations that may ultimately prove unnecessary. The aim of this review is to provide physicians in general practice with a guide to interpreting liver enzyme alterations.