Elevated cholestatic liver enzymes

From IDWiki

Background

  • Refers to a rise in ALP and GGT +/- bilirubin that is much more pronounced than any rise in ALT
  • ALP can also come from bone and placenta

Differential Diagnosis

Marked Elevation

Investigations

  • Liver/biliary ultrasound to help differentiate between extrahepatic cholestasis (if biliary dilatation is seen) versus intrahepatic
  • For intrahepatic cholestasis
    • First order AMA (for PBC), ANA, anti-smooth muscle antibodies
    • Then consider MRCP, hepatitis A, B, C, and E testing, and EBV and CMV testing
    • Finally, consider liver biopsy