Abnormal Liver Function Tests: Elevations in ALT and AST, Which Predominate Over Elevations of Alkaline Phosphatase (ALP), 5'-NT, and/or Gamma Glutamyltransferase (GGT)
If the diseases in the list below increase in severity, there may be findings suggestive of cirrhosis with or without hepatic failure:
Viral hepatitis, multiple forms (see chapters on Viral Hepatitis A, B, and C)
Suggested Additional Lab Testing
Total bilirubin and unconjugated bilirubin are markedly elevated in hepatic failure.
Prothrombin time is elevated as a result of decreased synthesis of coagulation factors.
Aminotransferase levels may increase and then decrease rapidly when there is significant and permanent loss of hepatocytes.
Serum creatinine may be elevated as evidence of hepatorenal syndrome.
Low blood glucose, elevated white blood cell (WBC) count, low platelet count, and low serum albumin are also common in hepatic failure.
Serum ceruloplasmin is low (90% of the serum copper is complexed to this protein).
Twenty-four-hour urinary copper excretion is elevated.
Liver function tests may be normal, but, as the disease progresses, abnormal values appear.
Serum copper is usually elevated but may be normal or low.
Hepatic copper concentration is markedly elevated because of the low amount of serum ceruloplasmin; an elevated hepatic copper concentration is highly indicative of Wilson disease.
Serum alpha-1-antitrypsin level is low.
Abnormal liver function tests are detectable in adults who suffer liver damage, but they may be normal in early stages of disease.
Liver biopsy can show characteristic red cytoplasmic granules demonstrable by a PAS stain of the liver. Hepatocellular carcinoma requires histopathologic examination of a liver biopsy for diagnosis.
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