| Abstract: | Elevated liver function tests - as incidental finding in general practice Abstract. In general practice, elevated liver function tests are found in 25 % of patients presenting with unspecific symptoms or during a routine health checkup. Approximately 2.5 % of the general population are expected to show elevated values. Conversely, liver disease can present without abnormal liver function tests. Liver disease is not only frequent but may also imply a significant mortality. Worldwide its prevalence is steadily rising, and liver disease has become the fifth leading cause of death. Responsible for the rapidly increasing prevalence are primarily non-alcoholic fatty liver disease (NAFLD), alcohol-related liver disease (ARLD) and viral hepatitis. Due to the large range of possible differential diagnoses and the coexistence of aetiologies liver diseases represent a diagnostic challenge with important prognostic implication. In case of elevated liver function, a detailed medical history and a thorough clinical examination should be performed first. This allows narrowing down possible causes to the few most likely differential diagnoses. Subsequently, depending on the level of elevated liver function and the clinical presentation as hepatitis or cholestasis, screening tests for differential liver diseases are performed. Laboratory diagnostics and obligatory ultrasound scan can be supplemented by non-invasive methods (e. g. elastography, MRI / MRCP / CT) and in selected cases invasive methods (liver biopsy, ERCP). In the following article we delineate the diagnostic approach to elevated liver function tests using algorithms. |
