Chronic mild-to-moderate elevation in ALT AST

(<15× ULN)

• Viral hepatitis: ✓ HBsAg, anti-HBs, anti-HBc, anti-HCV, IgM anti-HAV

• NAFLD: consider BMI, ✓ lipid panel, HbA1c, liver U/S or elastography

• Other etiologies of cirrhosis (qv)

Hemochromatosis: ✓ TIBC, serum iron, serum ferritin

Wilson disease: serum ceruloplasmin, urine Cu

α-1 antitrypsin (can cause liver disease w/o lung involvement)

• Chronic autoimmune hepatitis ✓ ANA, ASMA, anti-LKMA, IgG, SPEP

• TSH (both hypo & hyperthyroidism associated with abnormal LFTs), celiac disease

• If workup negative, consider biopsy