What is the standard of care for a patient with elevated liver function tests? There is no evidence of hepatitis A, B, or C, and an abdominal ultrasound shows only fatty liver. Is a gastroenterology consult required?

Or is it sufficient to watch and wait? Many of these patients also have hyperlipidemia and/or type 2 diabetes. — Mary Josephs, PA-C, Gilbert, Ariz.

Fatty liver is the most common cause of elevated liver enzymes in the United States. Fatty liver is most often the result of alcohol use but is also caused by diabetes, obesity, chronic hepatitis (namely hepatitis C) and medications. Less common causes of fatty liver are hemochromatosis, Wilson disease, a1-antitrypsin deficiency, autoimmune disorders and liver cancer.

Most cases of elevated liver enzymes are discovered on screening of asymptomatic patients. It is important to compare recent determinations with old records to see if this is a new finding. Carefully evaluate all risk factors, including alcohol, medications, lifestyle factors, and family history. Patients should be screened for hepatitis, autoimmune disorders and iron-study abnormalities.

The liver can be assessed via ultrasound or CT to look for tumors; biopsy is reserved for definitive diagnosis of such potentially treatable conditions as Wilson disease and hemochromatosis. Patients should be instructed to lose weight, avoid alcohol and other toxins, and have their liver enzymes monitored for any change. — Claire Babcock O’Connell, MPH, PA-C (177-2)


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