Hepatitic or Cholestatic? – ICST

Hepatitic or Cholestatic?

Patients with abnormal liver blood tests should be categorised into Hepatitic abnormalities and Cholestatic abnormalities, although these patterns are a sliding scale of abnormality.

Hepatitic pattern:

  • Diseases of the liver parenchyma, including viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, metabolic liver diseases
  • Increase in the AST and ALT predominantly, more abnormal than the ALP is abnormal

 

Cholestatic pattern:

  • Diseases of the biliary system or space occupying lesions
  • Increase in the ALP above the limits of normal, and more abnormal than the ALT is abnormal
  • The GGT is also abnormal

 

Mixed pattern:

  • Combination of the ALP, AST and ALT elevated equally, where neither is predominant but both are elevated abnormally
  • This pattern should be investigated as if they are Hepatitic pattern

Hepatitic or Cholestatic?

Patients with abnormal liver blood tests should be categorised into Hepatitic abnormalities and Cholestatic abnormalities, although these patterns are a sliding scale of abnormality.

Hepatitic pattern:

  • Diseases of the liver parenchyma, including viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, metabolic liver diseases
  • Increase in the AST and ALT predominantly, more abnormal than the ALP is abnormal

 

Cholestatic pattern:

  • Diseases of the biliary system or space occupying lesions
  • Increase in the ALP above the limits of normal, and more abnormal than the ALT is abnormal
  • The GGT is also abnormal

 

Mixed pattern:

  • Combination of the ALP, AST and ALT elevated equally, where neither is predominant but both are elevated abnormally
  • This pattern should be investigated as if they are Hepatitic pattern
Mark as Understood

Resources

All-Wales Abnormal Liver Blood Test Pathway

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