Pro tips

• Must be in pairs (AST/ALT) or ALP/GGT
• hepatocellular/cholestatic will cause each other eventually, bigger numbers of pair = primary insult
• ALT/AST doesn't tell you how many healthy (transaminase releasing) hepatocytes there are, only how many are dying
• chronic liver failure can have normal transaminases

Calculate R factor to find if hepatic, mix, cholestatic

<2 cholestatic

5 heaptic

Hepatic damage - increased AST/ALT

• acute >10x ULN
• chronic <10x ULN
• alcohol suggestive with AST:ALT >2 (can be without)
• failure if decreased albumin and increased bilirubin, plus;
  • FBC: decreased platelets
  • coags: increased PT/INR
  • UEC: decreased urea (and decreased Na if hepatorenal)