CBC
Leukocytosis with elevated ANC
Chemistry including magnesium and phosphate
LFTs
Very high elevations possibly more suggestive of viral or drug-induced hepatitis
Elevated AST/ALT (characteristically >2:1 and < 500 IU/L)
GGT alone is less reliable (low sensitivity and specificity)
Coagulation factors
Elevated PT/INR
Lipase if suspect pancreatitis
Consider viral hepatitis panel
Leukocytosis with elevated ANC
Very high elevations possibly more suggestive of viral or drug-induced hepatitis
Elevated AST/ALT (characteristically >2:1 and < 500 IU/L)
GGT alone is less reliable (low sensitivity and specificity)
Elevated PT/INR
Consider transabdominal ultrasound if concern for:
Biliary obstruction
Budd-Chiari syndrome
Hepatic or biliary neoplasms
Biliary obstruction
Budd-Chiari syndrome
Hepatic or biliary neoplasms
Diagnosis is difficult and relies on a good history
History of significant alcohol intake
Clinical evidence of liver disease
Supporting laboratory abnormalities
May be nondiagnostic in patients with mild disease or early cirrhosis
May also have electrolyte abnormalities from malnutrition or alcoholic ketoacidosis
History of significant alcohol intake
Clinical evidence of liver disease
Supporting laboratory abnormalities
May be nondiagnostic in patients with mild disease or early cirrhosis
May be nondiagnostic in patients with mild disease or early cirrhosis
Acute alcoholic hepatitis
Alcoholic pancreatitis
Ischemic hepatitis
Gallstones
Acute hepatitis
Budd-Chiari syndrome
Viral hepatitis
Autoimmune hepatitis