Increased liver enzyme activities are sensitive indicators of hepatic disease, but their limited specificity can make their interpretation a challenge. A stepwise approach to diagnosing the source of increased liver enzyme activity involves characterization of the clinical picture, identification of the predominant enzyme activity pattern, elimination of common extrahepatic diseases, and a systematic diagnostic workup for hepatobiliary disease. Comprehensive hepatobiliary testing includes a completeblood count, biochemical profile, and urinalysis; coagulation and liver function tests; abdominal imaging; bile cytology and culture; and liver biopsy for histopathology culture, and metal analysis.
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