Evaluation of Abnormal Liver Biochemical Test Results
I TEST EPATICI: SAPPIAMO TUTTO? MAH. AVVISO AI NAVIGANTI DA “GASTROENTEROLOGY”
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Un aggiornamento autorevole sull’interpretazione degli esami epatici alterati nell’era della MASLD. La novità risiede nell’integrazione di elastografia e score non invasivi come strumenti di prima linea per la valutazione della fibrosi, riducendo il ricorso alla biopsia. Un approccio pratico e moderno per l’epatologia clinica del 2026.
(KEY POINTS FROM IA)
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Figure 1 Evaluation of hepatocellular injury with elevations in ALT and AST. ∗Based on an ALT ULN of 33 U/L for males and 25 U/L for females. †ANA, anti-smooth muscle antibodies, ceruloplasmin, α1-antitrypsin level/phenotype may be deferred after a period of observation when elevations of aminotransferase levels are minimal (<2 × ULN). α1-antitrypsin deficiency should be confirmed with genotyping of the SERPINA1 gene. anti-HBc, hepatitis B core antibody; anti-HBs, hepatitis B surface antibody; ALF, acute liver failure; ASMA, anti-smooth muscle antibody; CBC, complete blood count; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HAV, hepatitis A virus; HbsAg, hepatitis B antigen; HSV, herpes simplex virus; IG, immunoglobulin; PCR, polymerase chain reaction; PEth, phosphatidylethanol; PMH, past medical history; US, ultrasonography.
Figure 2 Evaluation of cholestatic presentation with elevation in alkaline phosphatase level. ∗Rare inherited causes of cholestasis present primarily in childhood and are caused by mutations in canalicular membrane proteins or other proteins involved in bile acid metabolism with next-generation sequencing allowing identification of many of these genetic causes of cholestatic disorders. Most common is progressive familial intrahepatic cholestasis, a group of disorders with 6 variants, of which progressive familial intrahepatic cholestasis 3 is most likely to present in adulthood with cirrhosis due to cholestasis and a high GGT level. Alagille syndrome is a disorder resulting from mutation in the notch signaling pathway that presents with an elevated alkaline phosphatase and a paucity of bile ducts on liver biopsy specimens. †Anti-SP100 and anti-GP210 are highly specific for primary biliary cholangitis. AMA, antimitochondrial antibody; ANA, antinuclear antibody; ASMA, anti–smooth muscle antibody; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis; US, ultrasound.
