Common clinical clues and diagnoses for Abnormal LFTs

Common clinical clues and diagnoses for Abnormal LFT’s

Clinical Clue	Diagnosis	Initial test	Additional tests
AST>ALT, MCV	Alcoholic liver disease
Drug / herbal remedy history	Drug induced liver disease
IV /intranasal drug misuse. Blood transfusion. Tattoos	Chronic hepatitis B Chronic hepatitis C	HBs Ag HCV Ab	HBeAg/eAb HBV DNA HCV RNA
Raised ALP + /-	Primary biliary cirrhosis	AMA, IGM
Inflammatory bowel disease	Primary sclerosing cholangitis	ANCA
Other autoimmune disease	Autoimmune hepatitis	ASMA, ANA
Diabetes/joint pain Pigmentation	Haemochromatosis	↑ Serum Fe / TIBC ↑ Trans Sat % ↑ ferritin	Haemochromatosis genotype test
Neurological signs	Wilsons disease	↓Caeruloplasmin	↑ 24hr urinary Copper
Lung disease	Alpha 1 antitrypsin	↓α1 antitrypsin level	α₁ antitypsin phenotype
Metabolic syndrome (BMI, diabetes, hypertension)	Non-alcoholic fatty liver disease

Adult Guidelines