Chronic Hepatitis / Elevated LFTs

Work-Up of Chronic Elevation of Liver Transaminases (ALT / AST)

First Step Diagnoses
  • Alcohol
  • Meds (OTCs, herbs, etc.)
  • Hepatitis B
  • Hepatitis C
  • Hemochromatosis
  • Fatty Liver; Metastases
Second Step
  • Thyroid Disorders
  • Wilson’s Disease
  • Celiac Disease
  • Muscle Disorders
  • Autoimmune Hepatitis
  • α-1 Antitrypsin Deficiency
  • Anorexia Nervosa
Tests to Order
  • History
  • History
  • HBsAg  [more work-up if +]
  • Hep C AB  [more W/U if +]
  • Iron + TIBC (= trans. sat. %)
  • Ultrasound; Biopsy lesions
Tests to Order
  • TSH
  • Ceruloplasmin (low = pos)
  • Tissue Transglutaminase IgA AB; Endomysial IgA AB
  • History; Creatinine Kinase (CK)
  • Serum Protein Electrophoresis (SPEP), ANA
  • Serum α-1 Antitrypsin
  • History (esp. from family)
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