LFTs
AST and ALT
Enzymes found mainly in<unk>  cells, though ALT is more specific to the liver than AST
Extreme elevation in AST (>3000U/L, or >40x upper limit of normal) is consistent with acetaminophen toxicity or ischemic injury
Moderate elevations (10-40x upper limit of normal) is consistent with viral<unk> is
Mild elevations (<10x upper limit of normal) is consistent with alcoholic<unk> is
Alkaline Phosphatase
Found in bile canaliculi (but also in placenta, ileal mucosa, bone, and kidney)
Elevated in diseases of cholestasis
Rare for levels to be >3x normal limit in<unk>  liver<unk> 
Bilirubin
Elevated in diseases of cholestasis
In obstructive diseases, the direct bilirubin will usually be about 50% of the total bilirubin; if indirect bilirubin is higher, more suggestive of hemolysis or problem with conjugation
Coagulation Studies
Reflects the liver’s ability to synthesize clotting factors
INR >6.5 or PT >20 seconds indicates patients at high risk for death
Albumin
Reflects synthetic function of the liver
Has a long half-life (20 days) and may not be decreased early in disease
Ammonia
Elevated as a result of impaired clearance
Poor correlation between degree of elevation and severity of encephalopathy symptoms
Chemistry Panel
Electrolyte abnormalities may indicate malnutrition or dehydration
Creatinine is used as a prognostic indicator
Need to check a glucose because patients with liver<unk>  are prone to hypoglycemia
CBC
Not useful in diagnosing the cause of liver<unk> , but helpful in determining coexisting infection, anemia, thrombocytopenia
Viral<unk> is Serologies
Consider for all patients with undifferentiated liver<unk> 
IgM anti-HBc may be the only positive marker in<unk> <unk> is B infection
Anti-HCV and HCV RNA are present in both chronic and<unk> <unk> is C infections, so it is difficult to differentiate based on serologies, but presence of HCV RNA in the absence of anti-HCV is more suggestive of<unk>  infection
Only need to test for IgM anti-HEV in patients who are symptomatic and have just travelled from areas where<unk> is E is endemic
AST and ALT
Enzymes found mainly in<unk>  cells, though ALT is more specific to the liver than AST
Extreme elevation in AST (>3000U/L, or >40x upper limit of normal) is consistent with acetaminophen toxicity or ischemic injury
Moderate elevations (10-40x upper limit of normal) is consistent with viral<unk> is
Mild elevations (<10x upper limit of normal) is consistent with alcoholic<unk> is
Alkaline Phosphatase
Found in bile canaliculi (but also in placenta, ileal mucosa, bone, and kidney)
Elevated in diseases of cholestasis
Rare for levels to be >3x normal limit in<unk>  liver<unk> 
Bilirubin
Elevated in diseases of cholestasis
In obstructive diseases, the direct bilirubin will usually be about 50% of the total bilirubin; if indirect bilirubin is higher, more suggestive of hemolysis or problem with conjugation
Enzymes found mainly in<unk>  cells, though ALT is more specific to the liver than AST
Extreme elevation in AST (>3000U/L, or >40x upper limit of normal) is consistent with acetaminophen toxicity or ischemic injury
Moderate elevations (10-40x upper limit of normal) is consistent with viral<unk> is
Mild elevations (<10x upper limit of normal) is consistent with alcoholic<unk> is
Found in bile canaliculi (but also in placenta, ileal mucosa, bone, and kidney)
Elevated in diseases of cholestasis
Rare for levels to be >3x normal limit in<unk>  liver<unk> 
Elevated in diseases of cholestasis
In obstructive diseases, the direct bilirubin will usually be about 50% of the total bilirubin; if indirect bilirubin is higher, more suggestive of hemolysis or problem with conjugation
Reflects the liver’s ability to synthesize clotting factors
INR >6.5 or PT >20 seconds indicates patients at high risk for death
Reflects synthetic function of the liver
Has a long half-life (20 days) and may not be decreased early in disease
Elevated as a result of impaired clearance
Poor correlation between degree of elevation and severity of encephalopathy symptoms
Electrolyte abnormalities may indicate malnutrition or dehydration
Creatinine is used as a prognostic indicator
Need to check a glucose because patients with liver<unk>  are prone to hypoglycemia
Not useful in diagnosing the cause of liver<unk> , but helpful in determining coexisting infection, anemia, thrombocytopenia
Consider for all patients with undifferentiated liver<unk> 
IgM anti-HBc may be the only positive marker in<unk> <unk> is B infection
Anti-HCV and HCV RNA are present in both chronic and<unk> <unk> is C infections, so it is difficult to differentiate based on serologies, but presence of HCV RNA in the absence of anti-HCV is more suggestive of<unk>  infection
Only need to test for IgM anti-HEV in patients who are symptomatic and have just travelled from areas where<unk> is E is endemic
Consider RUQ US or CT in patients with jaundice to evaluate for a mechanical obstruction
Otherwise, tailor imaging towards specific complaints
High SAAG > 1.1 g/dL – Indicative of portal hypertension
Cirrhosis
Heart<unk> 
Ascites total protein > 2.5 g/dL suggests cardiac ascites
Alcoholic<unk> is
Budd-Chiari syndrome
Portal vein thrombosis
Cirrhosis
Heart<unk> 
Ascites total protein > 2.5 g/dL suggests cardiac ascites
Alcoholic<unk> is
Budd-Chiari syndrome
Portal vein thrombosis
Ascites total protein > 2.5 g/dL suggests cardiac ascites
Low SAAG < 1.1 g/dL
Malignancy / peritoneal carcinomatosis
Nephrotic syndrome
Pancreatitis
Peritoneal tuberculosis
Serositis
Bowel infarction
Chylous
Malignancy / peritoneal carcinomatosis
Nephrotic syndrome
Pancreatitis
Peritoneal tuberculosis
Serositis
Bowel infarction
Chylous
Acute hepatic failure
Hypoglycemia
Acute hepatitis
Hypoxia
Adrenal crisis
Intracerebral hemorrhage or mass
Acute kidney injury
Meningitis/encephalitis