70 TRANSAMINASE ELEVATION General Discussion The following discussion applies to mild elevations of liver transaminase levels (up to five times normal) in asymptomatic patients. The first step in the evaluation of the patient is to repeat the test to confirm the result. Both alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are released into the blood in increasing amounts when the liver cell membrane is damaged. However, necrosis of liver cells is not required for the release of the aminotransferases, and there is a poor correlation between the level of the aminotransferases and the degree of liver cell damage. The initial evaluation includes a detailed history, review of medications, and a physical examination. The history should include an assessment of the patient’s risk factors for liver disease with attention directed toward family history, medications, vitamins, herbal supplements, alcohol consumption, drug use, history of blood-product transfusions, and symptoms of liver disease. Signs of liver disease are outlined below. The most common causes of elevated aminotransferase levels are alcohol-related liver injury, hepatitis B and C, autoimmune hepatitis, fatty infiltration of the liver, nonalcoholic steatohepatitis (NASH), hemochromatosis, Wilson’s disease, alpha1-antitrypsin deficiency, and celiac sprue. According to the American Gastroenterological Association (AGA), 1–4% of the asymptomatic population may have elevated serum liver chemistries. A minor elevation (less than twice the normal value) may be of no clinical importance if the disorders listed below have been ruled out. If the aminotransferase levels are less than twice normal and no chronic liver condition has been identified, observation alone may be indicated. If the aminotransferases are persistently more than twice normal, a liver biopsy may be indicated. Medications That May Cause Transaminase Elevation Acetaminophen Amiodarone Amoxicillin–clavulanic acid Aspirin Azathioprine/6-mp Carbamazepine Ciprofloxacin Cyclosporine Erythromycin Estrogens Fluconazole Glipizide Glucocorticoids Glyburide Halothane Heparin Isoniazid Ketoconazole L-asparaginase Labetalol Methotrexate Minocycline Nitrofurantoin NSAIDs Pemoline Phenobarbital Phenytoin Propylthiouracil Protease inhibitors Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: HAIR LOSS HYPOTHYROIDISM SYNCOPE THROMBOCYTOPENIA Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on TRANSAMINASE ELEVATION Full access? Get Clinical Tree
70 TRANSAMINASE ELEVATION General Discussion The following discussion applies to mild elevations of liver transaminase levels (up to five times normal) in asymptomatic patients. The first step in the evaluation of the patient is to repeat the test to confirm the result. Both alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are released into the blood in increasing amounts when the liver cell membrane is damaged. However, necrosis of liver cells is not required for the release of the aminotransferases, and there is a poor correlation between the level of the aminotransferases and the degree of liver cell damage. The initial evaluation includes a detailed history, review of medications, and a physical examination. The history should include an assessment of the patient’s risk factors for liver disease with attention directed toward family history, medications, vitamins, herbal supplements, alcohol consumption, drug use, history of blood-product transfusions, and symptoms of liver disease. Signs of liver disease are outlined below. The most common causes of elevated aminotransferase levels are alcohol-related liver injury, hepatitis B and C, autoimmune hepatitis, fatty infiltration of the liver, nonalcoholic steatohepatitis (NASH), hemochromatosis, Wilson’s disease, alpha1-antitrypsin deficiency, and celiac sprue. According to the American Gastroenterological Association (AGA), 1–4% of the asymptomatic population may have elevated serum liver chemistries. A minor elevation (less than twice the normal value) may be of no clinical importance if the disorders listed below have been ruled out. If the aminotransferase levels are less than twice normal and no chronic liver condition has been identified, observation alone may be indicated. If the aminotransferases are persistently more than twice normal, a liver biopsy may be indicated. Medications That May Cause Transaminase Elevation Acetaminophen Amiodarone Amoxicillin–clavulanic acid Aspirin Azathioprine/6-mp Carbamazepine Ciprofloxacin Cyclosporine Erythromycin Estrogens Fluconazole Glipizide Glucocorticoids Glyburide Halothane Heparin Isoniazid Ketoconazole L-asparaginase Labetalol Methotrexate Minocycline Nitrofurantoin NSAIDs Pemoline Phenobarbital Phenytoin Propylthiouracil Protease inhibitors Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: HAIR LOSS HYPOTHYROIDISM SYNCOPE THROMBOCYTOPENIA Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on TRANSAMINASE ELEVATION Full access? Get Clinical Tree
