Table 3.

Liver-related diagnoses

Diagnoses	Original tests proposed and retained	Original tests proposed and eliminated	Additional tests proposed and retained	Tests proposed and eliminated
Abnormal liver enzymes cholestatic	ANA AMA RUQ U/S	SPEP	GGT
Hepatitic	HBsAg	SPEP	Stop potential medications
AST/ALT <5x ULN	HCV Ab RUQ U/S, ceruloplasmin if patient <40 ASMA ANA		α1 antitrypsin Iron studies
Hepatitic	IgM Anti-HAV HBsAg
AST/ALT >5x ULN	IgM Anti-HBc HCV Ab ASMA
Hepatitis B	CBC LFTs PT/INR HBeAg Anti HBeAg HBV DNA Screen spouse and family members Decrease or abstain from alcohol HAV vaccination Advise on precautions to prevent transmission		HIV abdominal ultrasound HCV Ab
Hepatitis C	CBC LFTs PT/INR genotype HBsAg AFP and ultrasound if cirrhosis Decrease or abstain from alcohol HAV vaccination HBV vaccination Advise on precautions to prevent transmission		HCV RNA HIV	Fe/TIBC
Fatty liver disease			CBC LFTs PT/INR HBsAg HBsAb Lipids HgbA1c ≥1 imaging study last 12 months
Liver mass			CBC CMP PT/INR HBsAg HCV Ab AFP ≥1 imaging study last 3 months
Cirrhosis			HBsAg HCV Ab AFP Iron studies ANA	AMA Ceruloplasmin α1 Antitrypsin

AFP, alpha-fetoprotein; AMA, anti-mitochondrial antibody; ANA, anti-nuclear antibody; ASMA, anti-smooth muscle antibody; Fe/TIBC, iron/total iron-binding capacity; GGT, gamma-glutamyl transpeptidase; HAV, hepatitis A virus; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HBsAb, hepatitis B surface antibody; HBeAg, hepatitis B eAntigen; HCV Ab, hepatitis C virus antibody; HIV, human immunodeficiency virus; LFTs, liver function tests; SPEP, serum protein electrophoresis; PT/INR, prothrombin time/international normalized ratio; RUQ U/S, right upper quadrant ultrasound; ULN, upper limit of normal.