Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis

Hepatocellular Pattern (ALT or AST > ALP):

 • Severe - ALT >15X ULN 

     - Drugs, Viral, Ischemia, AIH, Wilsons, Pregnancy - AFLP, HELLP

 • Moderate - ALT 5-15X ULN - 

     - Viral, AIH, Wilson's, HH, NAFLD, Others

 • Mild - ALT < 5x ULN

     - NAFLD, Alcohol, Viral, HH, AIH, A1AT def, Wilson's, Cholestatic dz

Cholestatic Pattern (ALP > ALT or AST):

 • US - Normal Bile Ducts

     - PBC, PSC, Alcoholic Hep, Drugs, Infection, Sepsis, Infiltrative, Congenital, Others, Cirrhosis (any)

 • US - Dilated Bile Ducts

     - CBD stone, Biliary stricture, PSC, Worms/Flukes, Cholangio CA, Pancreatic CA, Others



Dr. Kelly Warren Burak @kwburak



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