e-learning | Managing abnormal liver function tests

5th September 2019 by Louise Hudman

e-learning | Managing abnormal liver function tests

This is a guideline on managing abnormal LFT that was published in 2017 by the British Society of Gastroenterology, but as it so useful I thought it worth summarising it.

Key learning points for me:

  • We should be investigating nearly all abnormal LFTs further and shouldn’t use the duration or the degree of the abnormality to decide whether to investigate further.
  • Severe liver disease can present despite normal LFTs.
  • 84% of abnormal LFTs will still be abnormal in 1 months time.
  • 50% of abnormal LFTs found in GP are not further investigated. It is thought that this leads to late presentations for lots of people.
  • 20% of LFTs come back abnormal and less than 10% of these are caused by pre-existing liver disease. So we have our work cut out.

Flow chart advising how to manage a patient with abnormal LFTs

This image is reproduced in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license; click image to go to original.

When we get an abnormal LFT result, what should we do?

Firstly look at the context. Is it a longstanding result? Is the patient well? Is there a known condition or medication contributing.

For example, normal LFT in someone with NAFLD may not be reassuring. It is their risk score that really determines what you do next. Their risk score may still be raised, even with normal LFT.


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