Liver Function Tests

Episode overview

Abnormal liver function tests can feel like a mess—until you learn the pattern. In this episode of Surgery Shelf Prep, we break down how to approach elevated liver labs the way the shelf wants: fast, organized, and high-yield. Chris and Mars walk through the three major liver injury patterns: cholestatic, hepatocellular, and mixed. You’ll learn how to use the lab pattern to narrow the differential, when to order a right upper quadrant ultrasound first, how to spot dangerous causes like ascending cholangitis or acute liver failure, and how to avoid common traps like isolated bilirubin or isolated aspartate aminotransferase elevation. We cover how alkaline phosphatase points to obstruction, why gamma glutamyl transpeptidase helps confirm liver origin, the meaning of the aspartate aminotransferase to alanine aminotransferase ratio, when massive transaminase elevation suggests ischemia or drug toxicity, and how albumin and international normalized ratio reflect liver synthetic function.