Evaluation of elevated serum transaminase levels
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The evaluation of patients with elevated transaminase levels should be individualized based on the presence of symptoms or physical examination findings that suggest serious disease or hepatic decompensation. (Strength of Recommendation [SOR]: C, expert opinion.) The initial evaluation should determine specific etiologies, such as exposure to alcohol or hepatotoxic medications, viral hepatitis, or hemochromatosis. In patients with reassuring initial test results, lifestyle modification can reverse presumed nonalcoholic fatty liver disease (NAFLD), the most common cause of persistently elevated liver transaminase levels. (SOR: B, based on cohort trials.) Transaminase levels that are elevated for longer than six months warrant additional investigation, which may include ultrasonography, additional serology, and possible liver biopsy. (SOR: C, expert opinion.)
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