Abstract：
:Mild elevations in levels of the liver enzymes alanine transaminase and aspartate transaminase are commonly discovered in asymptomatic patients in primary care. Evidence to guide the diagnostic workup is limited. If the history and physical examination do not suggest a cause, a stepwise evaluation should be initiated based on the prevalence of diseases that cause mild elevations in transaminase levels. The most common cause is nonalcoholic fatty liver disease, which can affect up to 30 percent of the population. Other common causes include alcoholic liver disease, medication-associated liver injury, viral hepatitis (hepatitis B and C), and hemochromatosis. Less common causes include α(1)-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease. Extrahepatic conditions (e.g., thyroid disorders, celiac disease, hemolysis, muscle disorders) can also cause elevated liver transaminase levels. Initial testing should include a fasting lipid profile; measurement of glucose, serum iron, and ferritin; total iron-binding capacity; and hepatitis B surface antigen and hepatitis C virus antibody testing. If test results are normal, a trial of lifestyle modification with observation or further testing for less common causes is appropriate. Additional testing may include ultrasonography; measurement of α(1)-antitrypsin and ceruloplasmin; serum protein electrophoresis; and antinuclear antibody, smooth muscle antibody, and liver/kidney microsomal antibody type 1 testing. Referral for further evaluation and possible liver biopsy is recommended if transaminase levels remain elevated for six months or more.
journal_name
Am Fam Physicianjournal_title
American family physicianauthors
Oh RC,Hustead TRsubject
Has Abstractpub_date
2011-11-01 00:00:00pages
1003-8issue
9eissn
0002-838Xissn
1532-0650pii
d9031journal_volume
84pub_type
杂志文章abstract：:Adult immunization rates have fallen short of national goals partly because of misconceptions about the safety and benefits of current vaccines. The danger of these misconceptions is magnified during pregnancy, when concerned physicians are hesitant to administer vaccines and patients are reluctant to accept them. Rou...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2003-07-15 00:00:00
abstract：:Portal hypertension is a frequent consequence of liver disease, especially alcoholic cirrhosis. Unabated elevations in portal pressure may presage an esophageal variceal hemorrhage. Propranolol or isosorbide therapy is effective in the prophylaxis of variceal bleeding. In patients with acute variceal hemorrhage, endos...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-04-01 00:00:00
abstract：:So many topical antifungal agents have been introduced that it has become very difficult to select the proper agent for a given infection. Nonspecific agents have been available for many years, and they are still effective in many situations. These agents include Whitfield's ointment, Castellani paint, gentian violet,...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1996-10-01 00:00:00
abstract：:Thyroid function tests, radioiodine uptake and scintiscanning, and antithyroid antibody titers are the main laboratory tests useful in the management of goiter. Scintiscanning and ultrasonography aid in differentiating a functioning adenoma from a "cold" solid nodule--a crucial distinction since the incidence of cance...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1983-11-01 00:00:00
abstract：:The physical examination requires careful palpation of pulses and measurement of blood pressure, evaluation of heart sounds (including detection of the third heart sound) and appreciation of clicks and murmurs. Combined with the chest x-ray and electrocardiographic findings, these steps usually lead to the most common...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1985-04-01 00:00:00
abstract：:Some skin conditions, such as blistering diseases, guttate and pustular psoriasis, exfoliative erythroderma, reactive erythemas and acute contact dermatitis have an acute onset and require prompt intervention. Acute vesicular or weeping dermatoses are best treated with cool, wet compresses and topical lotions, whereas...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1986-11-01 00:00:00
abstract：:Tic disorders and Tourette's syndrome are conditions that primary care physicians are likely to encounter. Up to 20 percent of children have at least a transient tic disorder at some point. Once believed to be rare, Tourette's syndrome is now known to be a more common disorder that represents the most complex and seve...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1999-04-15 00:00:00
abstract：:Family physicians can effectively help their patients stop smoking by using brief intervention and simple office organizational procedures. Intervention involves asking all patients about smoking, advising smokers to stop, assisting with self-help materials, establishing a date for quitting, possibly prescribing nicot...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1990-10-01 00:00:00
abstract：:Substantial advances have been made in the management of inflammatory bowel disease. Mesalamine and olsalazine are new anti-inflammatory agents that may serve as alternatives to corticosteroids and sulfasalazine, which have been the mainstays of medical therapy. These new agents are available in oral, enema and suppos...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1993-03-01 00:00:00
abstract：:Ginger (Zingiber officinale) is one of the more commonly used herbal supplements. Although often consumed for culinary purposes, it is taken by many patients to treat a variety of conditions. Ginger has been shown to be effective for pregnancy-induced and postoperative nausea and vomiting. There is less evidence to su...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2007-06-01 00:00:00
abstract：:Hawthorn medicinal extract has long been a favored herbal remedy in Europe. The active components of this slow-acting cardiotonic agent are thought to be flavonoids and oligomeric procyanidins. The most studied hawthorn extracts are WS 1442 and LI 132. Reviews of placebo- controlled trials have reported both subjectiv...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2010-02-15 00:00:00
abstract：:Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acet...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2011-06-01 00:00:00
abstract：:Natural supplements are widely used in the United States and, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. St. John's wort acts as a weak selective serotonin reuptake inhibitor with fewer side effects. S-Adenosylmethionine (SAMe) has enough of an antid...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-09-01 00:00:00
abstract：:Federally funded health centers and the National Health Service Corps (NHSC) depend on family physicians (FPs) and general practitioners (GPs) to meet the needs of millions of medically underserved people. Policy makers and workforce planners should consider how changes in the production of FPs would affect these prog...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2005-07-15 00:00:00
abstract：:A clear perception of the psychologic factors affecting both the physician and the patient can greatly influence the course of therapy in diabetes. Genuine, realistic assessment and acceptance of the limitations inherent in physician-patient interactions will lead to considerably more satisfying personal and professio...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1988-04-01 00:00:00
abstract：:Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2011-10-15 00:00:00
abstract：:Coxsackievirus B infection is common in children and young adults, usually causing mild symptoms in the gastrointestinal or upper respiratory tract. However, some patients develop pleurodynia, carditis or aseptic meningitis. This viral infection can be serious in the fetus and fatal in the newborn. Coxsackievirus B in...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1988-11-01 00:00:00
abstract：:An educational dialog founded on open communication between clinician and patient is necessary for a successful partnership in asthma care. Educating patients in self-management of asthma has become a major challenge in primary care practice. The process should begin at the time of diagnosis and should be integrated i...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-07-01 00:00:00
abstract：:During the past decade, continuous ambulatory peritoneal dialysis has emerged as a successful alternative to hemodialysis in the treatment of chronic renal failure. Performed continuously, peritoneal dialysis achieves total transfer comparable to hemodialysis and removes peptides faster. Studies have shown that surviv...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1989-11-01 00:00:00
abstract：:Although clinical evaluation remains the cornerstone in the diagnosis of multiple sclerosis, magnetic resonance imaging (MRI) has emerged as the ancillary study of choice. An important diagnostic tool, MRI can also be used to assess disease load, activity and progression, and distinguish between acute and chronic lesi...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1993-08-01 00:00:00
abstract：:Although VDRL and RPR tests are excellent screens for syphilis, false-positive reactions do occur. A positive VDRL or RPR test must be confirmed with an FTA-ABS test. Patients with positive serologic tests should have a thorough physical examination to determine the stage of syphilis. A patient with a low-titer VDRL o...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1988-01-01 00:00:00
abstract：:The safety of vaginal birth after cesarean (VBAC) delivery has been documented. Fetal and neonatal morbidity is not increased, and the mortality rate is less than one in 2,000 deliveries. Maternal morbidity and mortality rates for VBAC delivery are significantly lower than those for repeat cesarean section. Family phy...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1988-06-01 00:00:00
abstract：:The process of identifying and evaluating the common causes of vaginal bleeding during pregnancy changes as the pregnancy progresses to term. The most common identifiable causes of vaginal bleeding during early pregnancy include spontaneous abortion and ectopic pregnancy. Pelvic ultrasound and quantitative beta-human ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1995-02-15 00:00:00
abstract：:Left ventricular hypertrophy is more common in hypertensive individuals than in normotensive persons. Its presence in hypertensive patients is associated with an increased incidence of ventricular arrhythmias, myocardial infarction, congestive heart failure, stroke and cardiovascular mortality. Echocardiography is mor...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1992-08-01 00:00:00
abstract：:Contrast sensitivity vision testing is the new technology in visual screening. Easy to administer and quick to perform, contrast sensitivity vision testing appears to be cost-effective for use by family physicians. It is a more sensitive indicator of ocular disease than traditional Snellen acuity testing and may detec...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1992-02-01 00:00:00
abstract：:Hydrofluoric acid is widely used in both industrial and household settings. The acid may cause insidious burns that can be very destructive. If the burns are not treated appropriately, the continued action of the free fluoride ion leads to liquefaction necrosis of the affected soft tissues, bony erosion and, ultimatel...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1992-04-01 00:00:00
abstract：:The incidence of syphilis is increasing, predominantly among urban heterosexuals. Early recognition is important in preventing progression of the disease and transmission of Treponema pallidum to the fetus. Untreated primary syphilis is characterized by intervals of active disease punctuated by periods of latency. Not...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1994-10-01 00:00:00
abstract：:Despite the widespread use of propoxyphene products as analgesics, there is no profile of a typical abuser of propoxyphene. Propoxyphene is structurally related to methadone and has central nervous system effects similar to those of opioids. The patient with dependence needs professional help in withdrawing from propo...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1985-09-01 00:00:00
abstract：:Medical problems associated with prematurity are frequently complex, and a multidisciplinary approach is often required. Some common problems include the following: (1) anemia, which can be reduced by iron supplementation, (2) cerebral palsy or mental retardation as a result of intraventricular hemorrhage or periventr...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1998-05-15 00:00:00
abstract：:Clinically significant gastroesophageal reflux occurs in one in 500 infants. Symptoms resolve in 60 to 80 percent of infants by 18 months of age. Thickened formula and position changes are often recommended. Medication and surgical intervention may be needed in refractory cases. ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1991-03-01 00:00:00
