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Use R Score For Pattern Classification
- Use the R score to classify liver injury as hepatocellular, cholestatic, or mixed by comparing ALT to ALP ratios.
- Calculate R = (ALT/ALT ULN) ÷ (ALP/ALP ULN) and interpret >5 hepatocellular, 2–5 mixed, <2 cholestatic.
Initial Tests For Acute Hepatocellular Injury
- For acute hepatocellular injury, check hepatitis A, B, C serologies and acetaminophen level promptly and review medications thoroughly.
- Also consider ischemia, autoimmune hepatitis, and get bilirubin to gauge severity; higher bilirubin implies worse injury.
How To Evaluate Suspected Autoimmune Hepatitis
- If you suspect autoimmune hepatitis, order ANA, IgG, and anti–smooth muscle antibody as part of the workup.
- Refer to hepatology before starting treatment; tissue biopsy is often required to confirm and guide therapy.