Differentiating hepatocellular injury from colostatic injury

To determine the type of liver injury, it is important to consider the levels of ALT, AST, and alkaline phosphatase (ALP). An ALT and AST that are several-fold higher than the upper limit of normal, along with a slightly elevated ALP, indicate hepatocellular injury. On the other hand, if the ALP is significantly elevated and the ALT and AST are only mildly elevated, it suggests colostatic injury. Additionally, using the R score (ALT divided by ALP), a value greater than five suggests hepatocellular injury.