Unità di Gastroenterologia ed Epatologia, Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Pisana
A CLINICAL APPROACH TO A CHILD WITH ELEVATED LIVER ENZYMES, TWENTY YEARS LATER...
Laboratory liver test, Alanine aminotransferase, Aspartate aminotransferase, Gamma glutamyl transpeptidase
Isolated alteration of liver enzyme particularly in an apparently healthy child can be a diagnostic
challenge for the clinician. In this review the Authors provide a guide to alteration
of liver enzyme activity based on four main clinical-biochemical syndromes. “Acute pure
cytolytic syndrome” reflects acute hepatocellular damage as can be observed in infectious,
autoimmune toxic or ischemic hepatitis or in case of acute severe muscular damage. Some
acute hepatocellular damage can be cryptogenic in origin. “Acute mixed cytolytic
syndrome” reflects acute biliary and hepatocellular damage as observed in acute biliary
obstruction of normal or damaged bile tree, viral infections with cholangiotropic viruses,
vasculitic damage of the biliary tree as observed in Kawasaki disease and drug induced
liver injury with cholestatic features. “Chronic pure cytolytic syndrome” can reflect either
chronic muscle or liver damage of different etiology and is generally asymptomatic. Inborn
error of metabolism may account for a large number of cases. Isolated increase in aspartate
aminotransferase suggests macrotransaminasemia. “Chronic mixed cytolytic syndrome”
can be observed in case of persistent bile duct damage of various causes.
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