My Patient Has Elevated Liver Function Tests

Amar Shah, MD

Imaging Options

• Radiographs

• Ultrasound

• CT Scan

• MRI

Liver Dysfunction

• Elevated ALT, AST, Non drinker

• Elevated ALT, AST, drinker

• Elevated Direct Bilirubin

• The Incidental Hepatic lesion

• Elevated

Elevated ALT and AST, Non drinkerUltrasound

Normal Fatty Infiltrated

CT MR

Persistent Pain

Confirm/Discordant with clinical

findings/Evaluate for cirrhosis/Pseduolesio

n due to focal fat

Biopsy

NAFLD NASHDo not suspect Medication, Alcohol or virus

Fatty Liver

Fatty Liver-Pseudolesion

Elevated Liver Function Tests, Alcohol Related

Ultrasound

Normal Acute Hepatitis Cirrhosis

Serial Ultrasound

CT MR

Elevated AFP, Clinical Concern for

Hepatocellular Cancer

Triphasic

Mass

Cirrhosis

Hepatocellular Carcinoma

Elevated Bilirubin

Elevated Direct

Evaluate for Obstruction

Ultrasound

Choledocholithiasis Normal

CT MR/MRCP

Intrinsic/Extrinsic Obstruction

Elevated Total Bilirubin

PrehepaticHepatic

Posthepatic

Triphasic

Choledocholithiasis

Sclerosing Cholangitis

My patient has an incidental lesion

Ultrasound

Cyst Hyperechoic Lesion

CT MR

Triphasic

BenignFocal Nodular Hyperplasia

HemangiomaAdenoma

MalignantHCC

Cholangiocarcinoma

Metastasis

Characterizing Incidental Lesion

Thank you