Dr Jez Thompson highlights five things you need to know about liver function tests in two new videos

 

Deaths due to liver disease are rising rapidly; between 1970 and 2010, the UK standardised mortality rate for liver disease increased by over 400%.1 Primary care has a vital role to play in the prevention and early detection of liver disease, and liver blood tests are an important aspect of this.

In the second of two videos on liver function tests (LFTs), Dr Jez Thompson (GP, Leeds) answers the following questions:

  • when are LFTs indicated?
  • how should ‘abnormal’ results be interpreted?
  • what are the next steps?

Resources

BSG NAFLD Figure 1

British Society of Gastroenterology response to abnormal liver blood tests algorithm2

This figure details the initial response to abnormal liver blood tests. Boxes in yellow indicate the initial evaluation of the clinical presentation. Patients with marked derangement of liver blood tests, synthetic failure, and/or suspicious clinical symptoms/signs should be considered for urgent referral to secondary care (red box). For the remainder, a clinical history alongside evaluation of the pattern of liver blood test derangement will determine choice of pathway and is shown in the grey boxes. A grey box indicates all the tests that should be requested at that stage rather than a hierarchy within it. The presence of metabolic syndrome criteria should be sought to support a diagnosis of NAFLD. For children, the guideline should be consulted for modification of recommendation. Areas of diagnostic uncertainty are indicated in orange boxes and the decision for repeat testing or referral to secondary care will be influenced by the magnitude of enzyme elevation and clinical context. Green boxes indicate final/definitive outcomes for users of the pathway. Abnormal USS may include extrahepatic biliary obstruction due to malignancy, which should result in urgent referral.

BMI=body mass index; ARLD=alcohol-related liver disease; ALT=alanine aminotransferase; AST=aspartate aminotransferase; INR=international normalised ratio; ALP=alkaline phosphatase; GGT=gamma-glutamyltransferase; FBC=full blood count; HbA1c=glycated haemoglobin; LDH=lactate dehydrogenase; NAFLD=non-alcoholic fatty liver disease; USS=ultrasound scan

Newsome P, Cramb R, Davison S et al. Guidelines on the management of abnormal liver blood tests. Gut 2018; 67 (1): 6–19. doi: 10.1136/gutjnl-2017-314924 Reproduced under the terms of the CC BY 4.0 licence.

Want to learn more about this guideline?

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Read the related Guidelines summary

References

  1. Williams R, Aspinall R, Bellis M et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014; 384 (9958): 1953–1997.
  2. Newsome P, Cramb R, Davison S et al. Guidelines on the management of abnormal liver blood tests. Gut 2018; 67 (1): 6–19. doi: 10.1136/gutjnl-2017-314924

 

Keen to learn more?

Liver tissue

Read Dr Thompson’s related article on liver blood tests to understand when to request liver blood tests and how to interpret the results, what actions to take if the results of liver blood tests are abnormal, and approaches to common conditions, including non-alcoholic fatty liver disease.

Liver blood tests: how to interpret abnormal results

Dr Jez Thompson highlights the key recommendations from the British Society of Gastroenterology on liver blood tests and early detection of liver disease

Credit:

Lead image: rasi/stock.adobe.com

Image 1: tonaquatic/stock.adobe.com