Abnormal liver function tests

Rationale

Abnormal liver function tests are common in clinical practice. Appropriate investigation can distinguish benign reversible liver disease from potentially life-threatening conditions.

Causal Conditions

(list not exhaustive)

1. Hepatocellular
   1. Acute (e.g., infection, medication)
   2. Chronic (e.g., infection, medication)
2. Cholestatic
   1. Intrahepatic (e.g., pregnancy)
   2. Extrahepatic (e.g., gallstones)
3. Congenital abnormalities (e.g., Gilbert disease)
4. Other (e.g., celiac disease)

Key Objectives

Given a patient with abnormal liver function tests, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan, in particular, assessing for any potential underlying liver disorder or systemic disease.

Enabling Objectives

Given a patient with abnormal liver function tests, the candidate will

1. list and interpret critical clinical findings, including
   1. differentiate between abnormal liver function tests due to disease that require treatment from those that do not;
   2. differentiate primary hepatic disease from systemic disease;
   3. identify complications related to the presence of liver disease (e.g., bleeding, ascites);
2. list and interpret critical investigations, including
   1. laboratory tests appropriate for the identification of specific acute and chronic liver diseases (e.g., viral serology);
   2. diagnostic imaging (e.g., ultrasound);
3. construct an effective initial management plan, including
   1. determining if the patient requires urgent referral or hospitalization;
   2. refering the patient for specialized care (e.g., non-urgent), if necessary;
   3. counseling and educating the patient to prevent further hepatic insult (e.g., primary and secondary prevention strategies for viral hepatitis);
   4. communicating with the public health authorities, if applicable.