Liver enzymes

inflammation leaks in the circulation

Remember that AST is not specific, it is also found in the muscles

In cirrhosis: population of liver cells are also diminished

Still have normal or slight elevation of aminotransferase

Helpful in differentiating between hepatocellular process and cholestatic process

Critical step in determining what additional workup is indicated

Bilirubin can be prominently elevated in both; not necessarily helpful in differentiating

between the two.

Hepatocellular process

Generally disproportionate rise in aminotranferases compared with alkaline

phosphatase

Cholestatic process

Disproportionate rise in alkaline phosphatase compared with aminotransferases

Degree of aminotransferase elevation

Occasionally helpful in differentiating between hepatocellular and cholestatic process

ALT and AST values < 8 times normal may be seen in either hepatocellular or
cholestatic liver disease

Values ≥ 25 times normal seen primarily in acute hepatocellular diseases