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Common causes of abnormal liver blood tests

Common causes of abnormal liver blood tests
Disease Tests and findings
Alcoholic liver disease History of alcohol abuse
AST/ALT >2 with both being less than 500 international unit/mL if alcoholic hepatitis is present
Chronic hepatitis C ELISA assay for anti-HCV
PCR for HCV RNA if confirmatory test is necessary
Primary biliary cholangitis Antimitochondrial antibodies as an isolated finding
IgM elevation
Primary sclerosing cholangitis Strong association with inflammatory bowel disease
Cholangiography to establish the diagnosis
Antinuclear and antismooth muscle antibodies and ANCA; these are not diagnostic
Autoimmune hepatitis Hypergammaglobulinemia
Antinuclear and smooth muscle antibodies and ANCA in type 1; anti-LKM-1 in type 2
Chronic hepatitis B HBsAg and HBeAg and, in some cases, HBV DNA by hybridization or bDNA assay
Hereditary hemochromatosis Family history of cirrhosis
Transferrin saturation and plasma ferritin should be performed but may be elevated by liver disease itself
Diagnosis established by genetic testing or liver biopsy and calculation of hepatic iron index
Wilson disease Family or personal history of cirrhosis at a young age
Serum ceruloplasmin reduced in 95 percent of patients
Liver biopsy shows increased copper content, which may also be seen in cholestatic liver diseases
Alpha-1 antitrypsin deficiency Family or personal history of cirrhosis at a young age
Serum AAT; phenotyping if low or borderline values
Nonalcoholic fatty liver disease History of diabetes mellitus or metabolic syndrome
Diagnosis may be suspected by abnormal liver biochemical tests and hepatic imaging showing fatty infiltration and is confirmed by liver biopsy
Congestive hepatopathy   History of right-sided heart failure, constrictive pericarditis, mitral stenosis, tricuspid regurgitation, cor pulmonale, cardiomyopathy
Right upper quadrant ultrasonography with Doppler studies of the portal and hepatic veins and hepatic artery, electrocardiogram, and cardiac ultrasound
AAT: alpha-1 antitrypsin; ANCA: antineutrophil cytoplasmic antibody; anti-LKM-1: anti-liver-kidney microsomal 1 antibodies; ALT: alanine aminotransferase; AST: aspartate aminotransferase; DNA: deoxyribonucleic acid; ELISA: enzyme-linked immunosorbent assay; HBeAg: hepatitis B e antigen; HBsAg: hepatitis B surface antigen; HBV: hepatitis B virus; HCV: hepatitis C virus; Ig: immunoglobulin; PCR: polymerase chain reaction; RNA: ribonucleic acid.
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