#293 The Best of Liver Tests with Dr. Elliot Tapper

Liver enzyme abnormalities require a systematic approach that distinguishes between hepatocellular and cholestatic injury patterns. The R-score, calculated by dividing the ALT elevation by the alkaline phosphatase elevation, serves as a primary tool for categorization. Hepatocellular injury, often caused by drug-induced liver injury, viral hepatitis, or autoimmune conditions, necessitates a focused history of recent exposures and targeted serologic testing. Conversely, isolated alkaline phosphatase elevations often warrant imaging, such as an ultrasound, to rule out biliary obstruction or infiltrative conditions. While clinicians frequently encounter mild enzyme elevations, advanced non-invasive tools like the Fibrosis-4 Index help assess the risk of underlying fibrosis. In acute scenarios, such as acetaminophen toxicity, clinicians must prioritize identifying coagulopathy and hepatic encephalopathy to determine the presence of acute liver failure, a rare but critical condition requiring immediate intervention.