Second line investigations
The following investigations should be performed in a patient with asymptomatic elevation of aminotransferase levels who remains undiagnosed despite first-line investigations:
- reverse-transcriptase PCR for hepatitis C virus RNA
- alpha-1 antitrypsin phenotyping:
- a ZZ phenotype is diagnostic of a deficiency state
- a ZZ phenotype is diagnostic of a deficiency state
- antigliadin and antiendomysial serology:
- presence indicates coeliac disease
- presence indicates coeliac disease
- creatine kinase and aldolase:
- elevation indicates muscle disease
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