What is the best approach to managing a patient with a mildly elevated AST and/or ALT?
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A detailed history and physical examination should direct initial laboratory evaluation within the clinical context of the individual patient. If the history and physical provide no clinical clues, a stepwise approach is recommended to evaluate for common liver diseases, such as viral hepatitis and hemochromatosis. Further studies for less common causes, such as autoimmune hepatitis, Wilson's disease, alpha1-antitrypsin deficiency, and celiac disease, are recommended if enzyme levels remain elevated after 6 months of lifestyle modifications (SOR: C, based on consensus guidelines).
Evidence-based practice 13, no. 08 (2010): 09