Managing the patient with an abnormal liver test: Part 1, persistent aminotransferase elevations

Eugene R. Schiff, Julie Foont

Research output: Contribution to journalReview articlepeer-review


Identifying the cause of a persistent, asymptomatic aminotransferase elevation can be challenging. The possible diagnoses are many and varied. To narrow the differential, begin with a detailed history. Consider first the more common causes of chronic liver disease: hepatitis B or C; nonalcoholic steatohepatitis (NASH); heavy alcohol consumption; autoimmune hepatitis; and medications (usually an agent that the patient recently started). NASH is becoming one of the most common causes of liver disease in the United States; it usually occurs in overweight or obese patients and is typically accompanied by hypertriglyceridemia. If you suspect NASH, order ultrasonography or CT of the liver. If the workup does not support any of the more common causes of a persistent aminotransferase elevation, consider other, more rare possibilities: exercise-induced rhabdomyolysis, celiac disease, macroenzymes, and hereditary disorders that produce liver injury (eg, Wilson disease, hemochromatosis, α1-antitrypsin deficiency).

Original languageEnglish (US)
Pages (from-to)1217-1222
Number of pages6
Issue number14
StatePublished - Dec 2007


  • Alcoholic liver disease
  • Aminotransferase elevations
  • Autoimmune hepatitis
  • Drug-induced liver injury
  • Hemochromatosis
  • Hepatitis B
  • Hepatitis C
  • Nonalcoholic steatohepatitis

ASJC Scopus subject areas

  • Medicine(all)


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