Elevated liver enzymes in asymptomatic patients – what should i do?

Mazyar Malakouti, Archish Kataria, Sayed K. Ali, Steven Schenker

Research output: Contribution to journalReview articlepeer-review

48 Scopus citations


Elevated liver enzymes are a common scenario encountered by physicians in clinical practice. For many physicians, how-ever, evaluation of such a problem in patients presenting with no symptoms can be challenging. Evidence supporting a standardized approach to evaluation is lacking. Although alterations of liver enzymes could be a normal physiological phenomenon in certain cases, it may also reflect potential liver injury in others, necessitating its further assessment and management. In this article, we provide a guide to primary care clinicians to interpret abnormal elevation of liver enzymes in asymptomatic patients using a step-wise algorithm. Adopting a schematic approach that classifies enzyme alterations on the basis of pattern (hepatocellular, cholestatic and isolated hyperbilirubinemia), we review an approach to abnormal alteration of liver enzymes within each section, the most common causes of enzyme alteration, and suggest initial investigations.

Original languageEnglish (US)
Pages (from-to)394-403
Number of pages10
JournalJournal of Clinical and Translational Hepatology
Issue number4
StatePublished - 2017


  • Aminotransferase elevation
  • Approach to alteration of liver enzymes
  • Elevated liver enzymes
  • Evaluation of abnormal liver enzymes
  • Liver function tests

ASJC Scopus subject areas

  • Hepatology


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