Pattern recognition — hepatocellular vs cholestatic vs mixed.
ASTALTALPGGTBilirubin (T/D)AlbuminPT/INR
Hepatocellular pattern (ALT/AST ≫ ALP)
Common causes
- • Viral hepatitis
- • Drug/Toxin (paracetamol)
- • Alcohol
- • NAFLD
- • Autoimmune hepatitis
- • Ischaemic hepatitis
Significance: ALT >1000 suggests viral/drug/ischaemic; AST:ALT >2 suggests alcohol.
Differential diagnosis
- • Acute viral hepatitis
- • Paracetamol toxicity
- • AIH
- • Wilson disease
Next investigations
- • HBsAg, anti-HCV, IgM anti-HAV/HEV
- • Paracetamol level
- • USG abdomen
- • ANA, ASMA, IgG
Red flags
- • INR >1.5 + encephalopathy = acute liver failure
- • Rising bilirubin with falling transaminases
Cholestatic pattern (ALP/GGT ≫ ALT)
Common causes
- • Biliary obstruction
- • PBC / PSC
- • Drug-induced
- • Infiltrative disease
Significance: Identify intra- vs extra-hepatic — USG first.
Differential diagnosis
- • Choledocholithiasis
- • Pancreatic head ca
- • Cholangitis
- • PBC
Next investigations
- • USG abdomen
- • MRCP
- • AMA (for PBC)
- • Tumour markers (CA 19-9)
Red flags
- • Charcot triad (fever, jaundice, RUQ pain) = cholangitis
- • Painless jaundice + weight loss
Educational support only — not a substitute for clinical judgment.
