Approach to the patient with abnormal liver biochemistry

Abstract

Altered liver function tests are a common finding that requires careful interpretation and thorough correlation with the patient's clinical picture. This paper provides a systematic and practical approach to the management of patients with alterations in their liver biochemistry. The fundamental concepts of liver anatomy and physiology are reviewed, emphasizing the importance of understanding the microscopic organization of the organ and key metabolic processes. The most used liver tests, their interpretation and the patterns of alterations that may occur will be described, and the importance of a detailed anamnesis will be emphasized. Guidelines are provided for the diagnostic approach according to the pattern of alteration observed and the different patterns of transaminase elevation, from mild to moderate and severe, and their possible causes are discussed in detail. The importance of considering fatty liver disease as a frequent cause of mild and persistent transaminase elevations is highlighted, and noninvasive tools for the evaluation of liver fibrosis, such as specialized scores and markers, are mentioned. In summary, this document presents an updated and practical text for the proper interpretation of alterations in liver biochemistry, emphasizing the importance of a close correlation with the clinical context of the patient, which will allow an accurate diagnosis and appropriate management.