This document provides guidance on interpreting liver enzyme test results. It explains that increases in aspartate transaminase (AST) and alanine transaminase (ALT) should be referred to as "transaminase elevation" rather than "transaminitis" as laboratory tests cannot be inflamed. Specific liver enzymes like alkaline phosphatase, gamma-glutamyl transpeptidase, and bilirubin are discussed in terms of their clinical significance and causes of elevation. Approaches to mild or moderate/marked increases in liver enzymes are outlined, emphasizing the importance of considering a patient's clinical context over isolated lab results.

1. Crack the Basic Code
Sila pilih terma yang betul.
A. Goreng Pisang
B. Pisang Goreng
Jawapan: Pisang Goreng
Ini kerana mengikut hukum tatabahasa, kata
nama harus diikuti oleh kata kerja. Terma
‘goreng pisang’ merujuk kepada aktiviti
mengoreng pisang dan bukan merujuk kepada
makanan tersebut

2. Crack the Basic Code
Name the
laboratory
investigation.

3. Crack the Basic Code
Interpret the
given results.

4. Crack the Basic Code
Transaminitis
Liver Function Test
Transamin = Transaminase
-itis = Inflammation
Inflammation of the transaminase?
A lab test is inflamed?
Fact: AST and ALT are non specific markers
of the liver
Is the representation of LFT correct?

6. Code Cracked!
Transaminase
Elevation
Liver Function Test
Increase in AST and ALT DOES NOT refer
to liver causes alone
The term should refer to the increase in
transaminases level

7. Liver Enzymes
Alkaline Phosphatase
• Common pathological
elevation caused by liver and
bone disease
• Cholestasis and consequent
accumulating bile salts
enhances synthesis and
release of ALP
• Hal-life: 1 week
• Explains the late rise in
obstructive liver disease
ᵧ- Glutamyl Transpeptidase
• Low specificity, high
sensitivity for liver disease
• Elevation observed in other
non-hepatic diseases
(pulmonary, renal & cardiac)
• Elevation in alcoholic liver
disease due to enzyme
induction and decreased
clearance
Bilirubin
• Common cause of
unconjugated
hyperbilirubinemia are
hemolysis and Gillbert’s
Syndrome
• Increased conjugated
bilirubin is sign of liver
disease
• Biliary obstruction causes
various degrees of
conjugated
hyperbilirubinemia
depending on degree and
duration of obstruction

8. Schematic Approach to Transaminase Elevation
Where When
How

9. Approach to Liver Enzyme Alteration

10. Key Biochemical Markers

11. Transaminases Alteration
Hepatocellular
Predominance
Cholestatic
Predominance

12. Magnitude of Liver Enzyme
Alteration Mild
Moderate
Marked

13. Causes of Moderate to Marked Increase

14. Approach to Mild
Increase in Liver
Enzyme

15. Approach to
Elevated ALP

16. Albumin & Prothrombin Time
• Often considered as ‘tests of liver function’
• Neither test is specific for liver disease
• In confirmed cases of liver disease, useful tests to monitor liver synthetic activity
• Albumin half-life: 20 days
• Clotting factors half-life: 1 day
• Albumin level prognosticate cirrhosis patients
• Interpretation to be done within clinical and biochemical context of patient

17. Take Home Message
• Diagnose and treat patient and not the laboratory investigation results
• Interpret abnormalities based on patient’s characteristics to guide on subsequent work-up
• Knowledge on pathophysiology of liver enzymes is essential to guide in understanding
their alterations
• In approaching liver enzyme alteration, perform clinically guided screening with
repetition of test
• Awareness on prevalence of hepatic involvement in specific population aids in
identifying cause of alteration