Abnormal Liver Function Tests ( LFTs)

Abnormal or deranged Liver Function Tests: Assessment in primary care and further investigations guidance.

Pattern of LFT derangement's - try and recognise the clinical pattern- hepatitic , obstructive , synthetic failure , isolated raised bilirubin with otherwise normal LFTs , alcohol related liver disease.

Hepatitic -Damaged liver cells release liver enzymes, Transaminases ALT→ specific to liver AST→ source liver , heart , skeletal muscles , kidneys, pancreas NAFLD screen / pathway - see topic on A4Medicine and external links

Obstructive -Cause can be different based upon location of blockage. Lumen ( Gallstone in bile duct ) Wall ( cholangiocarcinoma , stricture ) External ( cholecysttis , ascending cholangitis , pancreas ) Alkaline Phosphatase GGT Bilirubin

Synthetic failure -Jaundice , low albumin , prolonged INR OR Suspected Malignancy

Isolated rise in bilirubin-See below and chart on bilirubin + external links Isolated raised Br is most commonly caused by Gilberts syndrome If anaemic consider hemolysis If marked elevation of unconjugated Br- consider rarer causes as Crigler-Najjar syndrome

Liver screen -FBC / Clotting screen / Ferritin U&E / TFT / Glucose / Lipids / Albumin Viral screen ( ABCE ) Immunoglobulin electrophoresis Alpha 1 Antitrypsin Autoantibody screen -ANA , AMA , ASMA ,...