A 55-year-old homeless male presents with gynecomastia, spider angiomata, and testicular atrophy. What is the typical pattern of liver enzymes in the suspected condition?
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The diagnosis of liver disease secondary to alcohol use can be challenging. Often patients are not forthcoming about intake. Certain physical and laboratory findings can be helpful. Dependence on alcohol is not found in all those with alcoholic liver disease. Aspartate aminotransferase (AST) is double alanine aminotransferase (ALT) in more than 80% of patients with alcoholic liver disease.
Gamma-glutamyltransferase is the best indicator of recent alcohol intake but the enzyme is also found in organs other than the liver and can be increased secondary to other causes.
Elevated alkaline phosphatase is seen in diseases of liver and bone. It is not specific to alcohol injury.
Elevated bilirubin also is found in many liver diseases. It is not specific to alcohol injury.