International Scholarly Research Notices / 2013 / Article / Tab 1

Review Article

Mild Hypertransaminasemia in Primary Care

Table 1

Causes of mild hypertransaminasemia, clinical clues and initial diagnostic testing [1, 4, 5].

Etiology Clinical cluesInitial diagnostic testing

Common causes

Drugs
(including prescribed, over the counter, illicit drug use and herbals)
(i) Lack of illness prior to taking the drug
(ii) Clinical illness or biochemical abnormalities developing after beginning the drug
(iii) Improvement after the drug is withdrawn
History
Alcohol abuseExcessive alcohol consumption, AST/ALT ratio ≥ 2.0Accurate history, CAGE questionnaire, AST/ALT ratio, γ-glutamyl transpeptidase level (GGT)
Nonalcoholic fatty liver disease (NAFLD)Evidence of metabolic syndrome (dyslipidemia, hypertension, diabetes or central obesity)
AST/ALT ratio < 1.0
Fasting lipid profile, glucose level; consider ultrasonography to detect hepatic steatosis
Hepatitis BHigh risk factors including (Immigration from endemic countries, high risk sexual behavior, and intravenous drug use)Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (HBsAb), Hepatitis B core antibody (HBcAb)
Hepatitis CParenteral exposure (blood transfusions, intravenous drug use, occupational), tattoos, body piercing, and high risk sexual behaviorHepatitis C virus antibody testing
Hereditary HemochromatosisFamily historyTransferrin saturation and ferritin levels

Less common causes

Autoimmune hepatitisPersonal of family history of other autoimmune diseasesImmunoglobulin G levels, Serum protein electrophoresis (SPEP); antinuclear antibodies (ANA), smooth muscle antibodies (SMA) and liver-kidney microsomal antibodies testing (LKMA)
Wilson’s diseaseYounger than 40 years, neuropsychiatric symptoms, Kayser-Fleischer ringsSerum ceruloplasmin level and ophthalmologist consultation to rule out Kayser-Fleischer rings
α1-antitrypsin deficiencyEarly-onset emphysema, family historySerum α1-antitrypsin level and SPEP

Non-Hepatic causes

Muscle disordersMuscle weakness and pain, strenuous exerciseCreatine kinase (CK) and aldolase levels
Thyroid disordersSigns and symptoms of hypo- or hyperthyroidismThyroid-stimulating hormone (TSH) level
Celiac diseaseDiarrhea, abdominal pain, malabsorptionTissue transglutaminase antibody (TTG) testing

We are committed to sharing findings related to COVID-19 as quickly as possible. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Review articles are excluded from this waiver policy. Sign up here as a reviewer to help fast-track new submissions.