Interpretation of abnormal liver chemistries in the hospitalized patient

The first step in the evaluation of LCT abnormalities in the hospitalized patient is to obtain a thorough history of presenting illness and to perform a physical examination. The history should focus on determining whether the onset of abnormal tests was gradual or sudden and whether they preceded or occurred after the hospitalization because the timing of the LCT abnormalities is critical to determining the differential diagnoses. A careful inventory of all inpatient and outpatient medications, herbal or dietaries supplements, and over-the-counter medications dating back at least 6 months is essential. Evaluation for evidence of immunosuppression (recent chemotherapeutics, corticosteroids, transplantation, or critical illness) is also necessary. The physical examination often provides clues about the cause (right upper quadrant tenderness, jaundice in hepatitis, or biliary obstruction), chronicity (sequelae of chronic liver disease), or severity (altered mental status in encephalopathy) of disease.