Sulava Eric, Bergin Samuel, Long Brit, Koyfman Alex
Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia.
Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, Nevada.
J Emerg Med. 2017 May;52(5):654-667. doi: 10.1016/j.jemermed.2016.10.016. Epub 2016 Nov 23.
Liver function test (LFT) abnormalities are a common problem faced by emergency physicians. This has become more common with the introduction of laboratory panels and automated routine laboratory testing. Fortunately, not all patients with irregularities in liver enzymes possess underlying pathology. This emergency medicine focused review provides a discussion of the various biochemical tests, their underlying biological basis, and an algorithmic approach to the interpretation of abnormalities.
Our aim was to provide emergency physicians with an overview of the evaluation and management of patients with elevated LFTs.
The liver is a complex organ with multiple roles. The key biochemical markers of hepatic function can be organized into the groupings of hepatocellular, cholestatic, or functioning liver, based on underlying enzymatic roles. Pathologic alterations to these markers can be algorithmically assessed by separating disease processes of these groupings, followed by assessment of the magnitude of enzymatic elevation. This review conducts an in-depth evaluation of the differential diagnosis and emergency department-centered clinical response of elevated LFTs based on subcategories of mild, moderate, and severe transaminase elevation.
By understanding the biochemical basis of each LFT, it is possible to correlate laboratory findings to a patient's clinical presentation. An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis. This may assist providers in ensuring appropriate management and evaluation of the patient with elevated LFTs.
肝功能检查（LFT）异常是急诊医生面临的常见问题。随着实验室检查项目组合和自动化常规实验室检测的引入，这一情况变得更加普遍。幸运的是，并非所有肝酶异常的患者都存在潜在病理状况。这篇以急诊医学为重点的综述讨论了各种生化检查、其潜在的生物学基础以及解读异常结果的算法方法。
我们的目的是为急诊医生提供肝功能检查结果升高患者评估和管理的概述。
肝脏是一个具有多种功能的复杂器官。基于潜在的酶学作用，肝功能的关键生化标志物可分为肝细胞型、胆汁淤积型或功能性肝型。通过区分这些类型的疾病过程，然后评估酶升高的幅度，可以对这些标志物的病理改变进行算法评估。本综述基于轻度、中度和重度转氨酶升高的亚类别，对肝功能检查结果升高的鉴别诊断和以急诊科为中心的临床反应进行了深入评估。
通过了解每项肝功能检查的生化基础，有可能将实验室检查结果与患者的临床表现相关联。可以采用算法方法来帮助缩小鉴别诊断的范围。这可能有助于医疗人员确保对肝功能检查结果升高的患者进行适当的管理和评估。
