ARE CLUES IN THE HISTORY AND CLINICAL EXAMINATION NECESSARY TO ASSESS ALT/AST LEVELS?
A recent study sought for identifying any benefit of routine LLTs, i.e., AST, ALT, total bilirubin, or alkaline phosphatase, in 268 consecutive, chronically ill, geriatric patients presenting for acute care from a long-term care facility. All were without jaundice, right upper quadrant pain, pruritus, bruising, or evident signs of chronic liver disease. The degree of LLTs abnormality during admission was compared to the clinical diagnosis at the time of discharge. The levels normalized within two days in 26 of these patients, 25 of whom had a history of vascular disease (96%). All but one of the 268 patients were discharged without further evaluation. Over one year of follow-up, no patient returned for a liver-related problem. Based on these findings, only those patients with LLTs levels that are twice normal and which do not normalize within two days warrant further evaluation. Authors concluded that transient LLTs abnormalities may be due to decreased liver perfusion[7]. CARDIOVASCUL
