Tests for hepatotoxicity: usefulness in screening workers.

General tests of hepatotoxicity must be selected to identify all seven different types of exposure effect--cytotoxicity, cholestasis, fibrosis, vascular injury, metabolic dysfunction, impairment of the reticuloendothelial system, and carcinogenesis--whereas specific tests need only identify one or more. The liver's multifunctional character requires using sets of tests that include blood, urine, breath, isotopic, sonic, radiological, histological, and genetic tests. In this paper, traditional studies (eg, enzymes, proteins) are reviewed for medical screening and biological monitoring for specificity, sensitivity, selectivity, and cost-effectiveness. Status of newer tests (eg, clearance, radioisotopic assay, scans) will be reviewed, and developing tests (eg, molecular, genetic) for occupational use will be introduced. Practical application of these tests will be reviewed regarding clinical evaluations, interpretation, and triage. Finally, the medical-socioeconomic implications at initial medical screening and during subsequent monitoring will be illustrated.