Evaluation of abnormal liver tests.

The evaluation of elevated serum aminotransferase levels requires attention to clinical clues obtained in the history and physical examination. The likelihood that an aminotransferase abnormality reflects significant liver disease is enhanced if the following occur: (1) more than one liver enzyme is abnormal; (2) the abnormalities are associated with clinical signs or symptoms of liver disease; (3) the enzyme level is high; or (4) the abnormalities are present for > 6 months. The subsequent laboratory investigation becomes relatively straightforward in confirming a cause for the abnormalities before initiating therapy.