Abnormal liver blood tests algorithm Noninvasive liver screen

Abnormal liver blood tests algorithm Non-invasive liver screen (NILS) • HBs. Ag / HCV Ab, Hepatitis E serology, HIV • Autoimmune profile, Immunoglobulins, Coeliac serology, Alpha 1 Antitrypsin • Ferritin (+ iron studies if raised) • Hb. A 1 c, Lipid profile • Copper/Caeruloplasmin (if age <40) Synthetic failure Jaundice, low albumin prolonged INR OR Suspected malignancy Weight loss + Abnormal liver enzymes Urgent Referral Urgent ultrasound and/or Consider urgent referral to secondary care OP or admission History Suspected alcohol misuse? Follow alcohol pathway simultaneously Alcohol history / Metabolic syndrome ? /medication review Risk factors for viral hepatitis? /family history/ comorbidities Mainly hepatitic liver enzymes: Raised ALT/AST Ultrasound + NILS NAFLD? Metabolic syndrome risk factors present ? Abnormal USS appearances and/or positive NILS Follow NAFLD pathway Mainly cholestatic liver enzymes: Raised ALP/GGT Liver enzymes (if isolated ALP rise, confirm ALP of liver origin by checking GGT. If GGT normal, ALP could be due to drugs/bone disease) + Ultrasound + NILS Normal USS/ negative NILS/ no NAFLD risk factors / no alcohol misuse ALT/AST abnormal after 3 months Abnormal USS appearances and/or positive NILS Normal USS/ negative NILS /no alcohol misuse ALP/GGT abnormal after 3 months Isolated raised bilirubin with otherwise normal liver blood tests Most commonly due to Gilbert’s syndrome (unconjugated hyperbilirubinaemia) Repeat LFT’s with conjugated bilirubin and FBC Consider haemolysis: check reticulocytes/LDH/ haptoglobin Gilbert’s syndrome Confirmed, then inform patient and provide information Refer for Specialist input April 2020