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The abnormality chosen is:
an elevated ASPARTATE AMINOTRANSFERASE (SGOT/AST) level greater than 40 U/L. Elevations of this enzyme usually reflects hepatocellular injury. AST is more ubiquitous than ALT and is also found in large quantities in the myocardium, skeletal muscle, kidney, brain, red blood cells, and the lung. AST is therefore somewhat less specific as an indicator of liver disease. High levels of AST may also be seen with myocardial infarction, myocarditis, skeletal muscle trauma/diseases (polymyositis, certain muscular dystrophies, etc.), hypothyroidism, CHF, acute renal infarcts, acute pulmonary infarcts, hemolytic anemia, megaloblastic anemias, pancreatitis, burns, skin or muscle necrosis or convulsions. When the cause is acute hepatic injury, greatly elevated levels approximating 1,000 U/L are seen with acute viral hepatitis (A and B), toxic hepatitis (consider medications especially acetaminophen toxicity) and shock (hypoperfused) liver; whereas, the differential for hepatic causes of milder elevations (2 to 5 times normal) is much more extensive and includes: chronic viral hepatitis infection (B and C), hemochromatosis, alcoholic liver disease, fatty liver, nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, Wilson's disease, alpha-1 antitrypsin deficiency, celiac sprue and medication ingestion. Common medications which cause mild transaminasemia include: NSAID's, aspirin, oral contraceptives, antibiotics, antiepileptic medications, statins, methotrexate, and antituberculosis medications. Porphyria cutanea tarda can cause elevated transaminases but there are usually other symptoms of the disease other than transaminasemia. The AST/ALT ratio should be calculated in cases of mild transaminasemia. If this ratio is greater than two or three to one, alcoholic liver disease should be suspected. The AST/ALT and AST/Platelet ratios may be used to monitor progression of known liver injury towards cirrhosis in patients with chronic liver diseases such as chronic hepatitis B or C, hemochromatosis, etc. An AST/ALT ratio greater than 1.3 or an AST/Platelet ratio greater than 1.5 are indicative of possible underlying cirrhosis or progressive liver injury. The work-up of asymptomatic mild elevated AST is usually fruitless even when liver biopsy is used. When there is an isolated elevation of the AST in the presence of a normal ALT, the source of elevation is less clear. In this instance ancillary labs may help determine the etiology. If a cardiac source is suspected, LDH isoenzymes (LDH1>LDH2), CPK isoenzymes (CPK-MB elevation) as well as elevated troponin levels may indicate prior recent infarction or myocardial injury. Ancillary tests which would indicate a muscular etiology would include an elevation of CPK-MM and aldolase levels.