A Paradigm Shift in the Outpatient Approach to Liver Function Tests | SMJ

dx.doi.org/10.1097/SMJ.0b013e31821e8ff5

Page Value

$ 0.1

Moz Rank BackLinks 0
Alexa Rank -1 Internal URL 22
Page Authority 0 External URL 87
Title A Paradigm Shift in the Outpatient Approach to Liver Function Tests | SMJ
Description The American Gastroenterological Association (2002), Canadian Medical Association (2005), and the Centers for Disease Control and Prevention (2006) released guidelines to screen patients with mild elevations of liver enzymes for hepatitis B and hepatitis C. Mildly elevated liver enzymes were defined as less than five times the upper limit of normal, but above the normal reference range. The...
Keywords
Domain dx.doi.org
IP 172.67.72.147 104.26.9.237 104.26.8.237 2606:4700:20::ac43:4893 2606:4700:20::681a:8ed 2606:4700:20::681a:9ed
Path /10.1097/SMJ.0b013e31821e8ff5
Location United States Illinois Chicago Cloudflare, Inc. (AS13335 Cloudflare, Inc.)
Page Link Analyse
Internal URL
(22)
External URL
(87)
JavaScript File
  • https://www.googletagmanager.com/gtag/js?id=UA-243778-10
  • https://sma.org/wp-includes/js/jquery/jquery.min.js?ver=3.6.0
  • https://sma.org/wp-includes/js/jquery/jquery-migrate.min.js?ver=3.3.2
  • https://sma.org/wp-content/plugins/easy-social-icons/js/cnss.js?ver=1.0
  • https://sma.org/wp-content/plugins/sfwd-lms/includes/gutenberg/lib/../assets/js/frontend.blocks.js?ver=3.2.0
  • https://sma.org/wp-content/plugins/uncanny-learndash-toolkit/src/assets/frontend/dist/bundle.min.js?ver=3.3.1
  • https://sma.org/wp-content/plugins/uncanny-toolkit-pro/src/assets/dist/frontend/bundle.min.js?ver=3.5.2
  • https://sma.org/wp-content/plugins/woocommerce/assets/js/jquery-blockui/jquery.blockUI.min.js?ver=2.7.0-wc.5.6.0
  • https://sma.org/wp-content/plugins/woocommerce/assets/js/frontend/add-to-cart.min.js?ver=5.6.0
  • https://sma.org/wp-content/plugins/wp-user-avatar/assets/flatpickr/flatpickr.min.js?ver=5.8
  • https://sma.org/wp-content/plugins/wp-user-avatar/assets/select2/select2.min.js?ver=5.8
  • https://sma.org/wp-content/plugins/js_composer/assets/js/vendors/woocommerce-add-to-cart.js?ver=6.2.0
  • https://sma.org/wp-content/plugins/woocommerce-table-rates/assets/js/scripts.js?ver=5.8
  • https://sma.org/wp-content/themes/sma_2020/js/load-more-v2.js?ver=5.8
StyleSheet File
  • https://sma.org/wp-content/plugins/easy-social-icons/css/font-awesome/css/all.min.css?ver=5.7.2
  • https://sma.org/wp-content/plugins/easy-social-icons/css/font-awesome/css/v4-shims.min.css?ver=5.7.2
  • https://sma.org/wp-content/plugins/easy-social-icons/css/cnss.css?ver=1.0
  • https://sma.org/wp-includes/css/dist/block-library/style.min.css?ver=20151214
  • https://sma.org/wp-content/plugins/woocommerce/packages/woocommerce-blocks/build/wc-blocks-vendors-style.css?ver=5.5.1
  • https://sma.org/wp-content/plugins/woocommerce/packages/woocommerce-blocks/build/wc-blocks-style.css?ver=5.5.1
  • https://sma.org/wp-content/plugins/sfwd-lms/includes/gutenberg/lib/../assets/css/blocks.style.css?ver=3.2.0
  • https://sma.org/wp-content/plugins/uncanny-toolkit-pro/src/blocks/dist/blocks.style.build.css?ver=3.5.2
  • https://sma.org/wp-content/plugins/donations-for-woocommerce/css/frontend.css?ver=20151214
  • https://sma.org/wp-content/plugins/learndash-stripe/assets/css/learndash-stripe-style.css?ver=1.2.2
  • //sma.org/wp-content/plugins/sfwd-lms/themes/legacy/templates/learndash_quiz_front.min.css?ver=3.2.0
  • //sma.org/wp-content/plugins/sfwd-lms/assets/css/style.min.css?ver=3.2.0
  • //sma.org/wp-content/plugins/sfwd-lms/assets/css/front.min.css?ver=3.2.0
  • //sma.org/wp-content/plugins/sfwd-lms/assets/css/jquery.dropdown.min.css?ver=3.2.0
  • //sma.org/wp-content/plugins/sfwd-lms/themes/legacy/templates/learndash_pager.min.css?ver=3.2.0
  • //sma.org/wp-content/plugins/sfwd-lms/themes/legacy/templates/learndash_template_style.min.css?ver=3.2.0
  • //sma.org/wp-content/plugins/sfwd-lms/themes/legacy/templates/learndash_lesson_video.min.css?ver=3.2.0
  • https://sma.org/wp-content/plugins/uncanny-learndash-toolkit/src/assets/frontend/dist/bundle.min.css?ver=3.3.1
  • https://sma.org/wp-content/plugins/uncanny-toolkit-pro/src/assets/dist/frontend/bundle.min.css?ver=3.5.2
  • https://sma.org/wp-content/plugins/woocommerce/assets/css/woocommerce-layout.css?ver=5.6.0
  • https://sma.org/wp-content/plugins/woocommerce/assets/css/woocommerce-smallscreen.css?ver=5.6.0
  • https://sma.org/wp-content/plugins/woocommerce/assets/css/woocommerce.css?ver=5.6.0
  • https://sma.org/wp-content/plugins/wp-user-avatar/assets/css/frontend.min.css?ver=3.1.17
  • https://sma.org/wp-content/plugins/wp-user-avatar/assets/flatpickr/flatpickr.min.css?ver=3.1.17
  • https://sma.org/wp-content/plugins/wp-user-avatar/assets/select2/select2.min.css?ver=20151214
  • https://sma.org/wp-content/plugins/woocommerce-table-rates/assets/css/styles.css?ver=20151214
  • https://sma.org/wp-content/themes/sma_2020/css/wp-orig.css?ver=2.2
  • https://sma.org/wp-content/themes/sma_2020/style.css?ver=1630098501
  • https://sma.org/wp-content/themes/sma_2020/css/header.css?ver=3.1
  • https://sma.org/wp-content/themes/sma_2020/css/news.css?ver=3
  • https://sma.org/wp-content/themes/sma_2020/css/podcasts.css?ver=1.1
  • https://sma.org/wp-content/themes/sma_2020/css/courses.css?ver=4.1
  • https://sma.org/wp-content/themes/sma_2020/css/woocommerce.css?ver=2.3
  • https://sma.org/wp-content/themes/sma_2020/css/forms.css?ver=3.7
  • https://code.jquery.com/ui/1.10.3/themes/smoothness/jquery-ui.css?ver=20151214
  • https://sma.org/wp-content/plugins/oiopub-direct/images/style/output.css?260
  • https://cdnjs.cloudflare.com/ajax/libs/jquery-modal/0.9.1/jquery.modal.min.css
  • /wp-content/themes/sma_2020/scripts/lightbox/css/lightbox.css
Page Text
SearchIn...NewsSMJCoursesPodcastsSMAServicesJoinRenewLoginSkiptocontentAboutLeadershipThePulseeNewsletterPromotionalOpportunitiesResearchandEducationEndowmentFundScholarshipsContactMembershipGroupMembershipMemberConnectPhysicianMD/DOAlliedHealthProfessionalHealthcareManagementResidentMedicalStudentSMAAllianceEducationAbstractsCMEAccreditationLiveEventsMocingbirdOnlineCMEPhysiciansExecutiveMBAPhysicians-in-TrainingPodcastsSMJBioethics&MedicalEducationEmergency&DisasterMedicineMedicine&MedicalSpecialtiesMentalHealthPublicHealth&EnvironmentalMedicineQualityHealthCare,PatientSafety,&BestPracticeSurgery&SurgicalSpecialtiesWomen’s&Children’sHealthInsuranceCommercialInsuranceBusinessAutoInsuranceBusinessOwnersPolicyCrimeInsuranceCyberLiabilityInsuranceKeyPersonInsuranceManagementLiability(D&O)InsuranceMedicalMalpracticeforGroupsPracticeUmbrellaInsuranceWorkers’CompensationInsuranceEmployeeBenefitsDentalInsuranceforGroupsIdentityTheftLifeInsuranceforGroupsLongTermDisabilityInsuranceMedicareShortTermDisabilityInsuranceVoluntaryWorksiteBenefitsVisionInsuranceforGroupsIndividualProductsAirMed®–AirAmbulatoryInsuranceDentalInsuranceforIndividualsDisabilityInsuranceforIndividualIdentityTheftLifeInsuranceforIndividualsMedicalMalpracticeforIndividualsPersonalLinesInsuranceVisionInsuranceforIndividualsRetirementTPA/401KIRAPracticeManagementDellComputerEquipmentEpocratesSubscriptionMarketingServicesReceptionRoomMagazinesTelemedicineServicesTSYS®SecurePaymentsSMJ//ArticleReviewAParadigmShiftintheOutpatientApproachtoLiverFunctionTestsAuthors:ViploveSenadhi,DOAbstractTheAmericanGastroenterologicalAssociation(2002),CanadianMedicalAssociation(2005),andtheCentersforDiseaseControlandPrevention(2006)releasedguidelinestoscreenpatientswithmildelevationsofliverenzymesforhepatitisBandhepatitisC.Mildlyelevatedliverenzymesweredefinedaslessthanfivetimestheupperlimitofnormal,butabovethenormalreferencerange.Therationaleforthisrecommendationwasbasedonmanyfactorsincludingcosteffectiveness,labvariation,andultimately,forbetterpatientcare.ChronichepatitisBandChavevaluesoftransaminasesthatfluctuatebetweennormalandmildlyabnormal.Screeningpatientswithevenmildelevationsoftransaminasesallowsmanychronichepatitispatientstobediagnosedearlyinthecourseoftheirdisease.Diagnosingthesepatientsearlyintheirdiseasecourseleadstobettertreatmentresponse,decreasedprogressiontocirrhosis,lowerviralloadsleadingtodecreasedincidenceofextrahepaticmanifestations,preventionofhepatocellularcarcinoma,anddecreasedlikelihoodoflivertransplantation.Thereareorganizationswhichrecommenddiscontinuinghepatotoxicmedicationssuchasacetaminophenornonsteroidalanti-inflammatorydrugsandreevaluatingthepatientinthreemonths.However,thisrecommendationmissesanumberofhepatitispatientsforthereasonsaforementioned.TheobesityepidemichascloudedthediagnosisofhepatitisB/Caspatientsthathaveobesity,diabetesmellitus,andmetabolicsyndromearenotbeingscreenedduethepresumptivediagnosisofnonalcoholicfattyliverdisease.Notscreeningpatientsinthesettingofobesityisnotcost-effectiveandalsoleadstoincreasedmorbidity,aswewilldiscussinthismanuscript.Additionally,ithasbeenprovenintheliteraturethatitismorecost-effectivetoscreenforhepatitisB/Cinhigh-prevalenceareas,thantoreassessthepatientmonthslater,andpotentiallymissadiagnosisofhepatitisB/C.TheoverallgoalofthisstudyistoincreasescreeningawarenessofpatientswithmildtransaminitiselevationsthroughpublicationinordertodiagnosepatientswithhepatitisBandCpriortothedevelopmentofchronicliverdisease.Thiscontentislimitedtoqualifyingmembers.Existingmembers,pleaseloginfirst.Ifyouhaveanexistingaccountpleaseloginnowtoaccessthisarticleorviewyourpurchaseoptions.Purchaseonlythisarticle($15)Createafreeaccount,thenpurchasethisarticletodownloadoraccessitonlinefor24hours.PurchaseanSMJonlinesubscription($75)Createafreeaccount,thenpurchaseasubscriptiontogetcompleteaccesstoallarticlesforafullyear.Purchaseamembershipplan(feesvary)Premiummemberscanaccessallarticlesplusrecievemanymorebenefits.Viewallmembershipplansandbenefitpackages.References1.SoxHC,BlattMA,HigginsMC,etal. MedicalDecisionMaking.Boston,MA,Butterworth-Heinemann,1988.  2.HaberMM,WestAB,HaberAD,etal.RelationshipofaminotransferasestoliverhistologicalstatusinchronichepatitisC. AmJGastroenterol 1995;90:1250-1257.PubMed 3.GholsonCF,MorganK,CatinisG,etal.ChronichepatitisCwithnormalaminotransferaselevels:aclinicalhistologicalstudy. AmJGastroenterol 1997;92:1788-1792.PubMed 4.MofradP,ContosMJ,HaqueM,etal.ClinicalandhistologicspectrumofnonalcoholicfattyliverdiseaseassociatedwithnormalALTvalues. Hepatology 2003;37:1286-1292.PubMed | CrossRef 5.AGAtechnicalreviewontheevaluationofliverchemistrytests. Gastroenterology 2002;123:1367-1384.  6.HefflerS,LevitK,SmithS,etal.Healthspendinggrowthupin1999:fastergrowthexpectedinthefuture. HealthAff 2001;20:193-202.PubMed | CrossRef 7.YimJY,LokAS-F.ChronichepatitisB:decidingwhentotreat. Hepatology 2006;43:S173-S181.PubMed | CrossRef 8.BertoliniAS,FuscoO,BerardiE,etal.Screeningforchemotherapy-inducedreactivationofhepatitisBvirusinfection:aninstitutionalexperience. JClinOncol 2008;26(suppl).Abstract20563.  9.AlterHJ,SeeffLB.Recovery,persistence,andsequelaeinhepatitisCvirusinfection:aperspectiveonlong-termoutcome. SeminLiverDis 2000;20:17-35.ViewFullText | PubMed 10.NationalInstitutesofHealthConsensusDevelopmentConferenceStatement.ManagementofhepatitisC:2002. Hepatology 2002;36:S3-S20.  11.MorrowPH,HortobagylGN,RolstonKH,etal.EffectsofhepatitisConthetreatmentofbreastcancer. AnnOncol 2010;21:1233-1236.PubMed | CrossRef 12.MisianiR,BellavitaP,FeniliD,etal.Interferonalfa-2atherapyincryoglobulinemiaassociatedwithhepatitisCvirus. NEngJMed 1994;330:751-756.  13.VanniE,AbateM,GentilcoreE,etal.Sitesandmechanismsofinsulinresistanceinnonobese,nondiabeticpatientswithchronichepatitisC. Hepatology 2009;50:697-706.ViewFullText | PubMed | CrossRef 14.WangL-Y,YouS-L,LuS-N,etal.Riskofhepatocellularcarcinomaandhabitsofdrinkingalcohol,bctclquidchewingandcigarettesmoking:acohortof2416HBsAg-seropositiveand9421HBsAg-seronegativemaleresidentsinTaiwan. CancerCausesControl 2003;14:241-250.  15.DienstagJ,IsselbacherK.Acuteviralhepatitis.In: Harrison'sPrincipleofInternalMedicine.NewYork:McGraw-HillCompanies,2005;1822-1838.  16.GreenRM,FlammS,AmericanGastroenterologicalAssociation.AGAtechnicalreviewontheevaluationofliverfunctiontests. Gastroenterology 2002;123:1367-1384.  17.GianniniEG,EGTestaR,SavarinoV.Liverenzymealteration:aguideforclinicians. CanMedAssocJ 2005;172:367-379.18.SroczynskiG,EstebanE,Conrads-FrankA,etal.Long-termeffectivenessandcosteffectivenessofscreeningforhepatitisCvirusinfection. EurJPublicHealth 2009;19:245-253. LogintoVieworPurchaseCreateaFreeAccountShareIssueJuly,2011Volume104-Issue7ArticleDOI10.1097/SMJ.0b013e31821e8ff5Pages521-525ToolsQuickLinksAboutSMAPromotionalOpportunitiesPrivacyPolicy–TermsofUseTheSouthernMedicalJournalContactSMAContactUs3500BlueLakeDrive,Suite360Birmingham,AL35243[email protected]TollFree:(800)423-4992Telephone:(205)945-1840FaxNumber(205)945-1830StayConnectedSignupforournewsletterSouthernMedicalAssociationisaccreditedbytheAccreditationCouncilforContinuingMedicalEducation(ACCME)toprovidecontinuingmedicaleducationforphysicians.©2020SouthernMedicalAssociation,allrightsreserved.Southern Medical Association is a 501(c)3 Non-Profit organization. EIN: 63-0196615.SMAMenuLogInAbout▽LeadershipSMABylawsThePulsePromotionalOpportunitiesResearchandEducationEndowmentFundScholarshipsContactMembership▽MemberConnectGroupMembershipPhysicianDO/MDAlliedHealthProfessionalHealthcareManagementResidentMedicalStudentSMAAllianceEducation▽CMEAccreditationLiveEventsMocingbirdOnlineCMEPhysiciansExecutiveMBAPhysicians-in-TrainingPodcastsSMJ▽Bioethics&MedicalEducationWomen’s&Children’sHealthMedicine&MedicalSpecialtiesPublicHealth&EnvironmentalMedicineQualityHealthCare,PatientSafety,&BestPracticesSurgery&SurgicalSpecialitiesMentalHealthEmergency&DisasterMedicineInsurance▽CommercialInsuranceEmployeeBenefitsIndividualProductsRetirement▽TPA/401KIRAPracticeManagement▽Dell®ComputerDiscountEpocratesSubscriptionMarketingServicesReceptionRoomMagazinesTelemedicineServicesTSYS®SecurePaymentsTheSouthernMedicalAssociationisaNonProfitOrganization.Yoursupportiscriticaltooursuccess.Membershipgrantsaccesstojournals,coursesandaslewofpremiumbenefits.Pleaseconsidersupportingusbychoosinganoptionbelow:ViewMembershipOptionsMakeATax-DeductableDonationNoThanks,takemetothesiteanddon'tshowmethisagain.
dx.doi.org - Pages
Hot Host
Quickly calculate the estimated worth of your page and build reports as table.Youtube Video Analyticssitemap