[Evaluation of deviating liver tests in ambulatory practice].

The finding of disturbed hepatic function, associated with an unclear clinical picture or during of a health checkup, is frequent. A physician's approach to a patient presenting disturbed hepatic function tests does not depend on well-defined algorithms but requires a sound knowledge of hepatic function tests and indicators of hepatobiliary disease. There are two major categories of hepatic function tests: non-specific tests which may indicate the existence of hepatic disease, and specific tests which permit assessment of the nature of hepatic damage. To facilitate the search for an etiology, it is helpful to classify hepatobiliary diseases according to the type of disturbance of hepatic function. One may speak of hepatocellular necrosis if elevation of the transaminases is the sole or predominant feature, and of cholestasis if the elevation solely or essentially involves the alkaline phosphatases and gamma-GT. Chronic hepatitis C, alcoholism and obesity frequently underline an isolated elevation of the transaminases.