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tweet guide to...Abnormal liver function tests (LFTs) 𝘸𝘪𝘵𝘩𝘰𝘶𝘵 𝘫𝘢𝘶𝘯𝘥𝘪𝘤𝘦
For GPs & non-Gastroenterology colleagues.
Sense check by @docdai
For a #GastroTwearl on jaundice (bilirubin >50) see QT below
#GastroTwearls 1/4 https://twitter.com/ukgastrodr/status/1357048317964918788
1st step: Liver screen
History:
Alcohol
Weight
or
hx inc OTC
recent travel
USS (or 
CT if unwell &/or weight loss)
Hep B sAg, hep C ab, HIV (hep A & E + EBV if unwell)
Serum IG &
: AMA SMA ANA tTG IgA
Ferritin & clotting
#GastroTwearls 2/4
History:Alcohol
Weight
or hx inc OTCrecent travelUSS (or CT if unwell &/or weight loss)Hep B sAg, hep C ab, HIV (hep A & E + EBV if unwell)Serum IG &
: AMA SMA ANA tTG IgAFerritin & clotting#GastroTwearls 2/4
If negative liver screen
“Fatty liver” on scan
Likely NAFLD
Calculate FIB4
or NAFLD fibrosis score
If LOW risk
Manage risk factors
“What is good for the
is good for the liver”
If MODERATE / HIGH risk
Follow local pathway
#GastroTwearls 3/4
“Fatty liver” on scan
Likely NAFLD
Calculate FIB4
or NAFLD fibrosis score
If LOW risk Manage risk factors “What is good for the is good for the liver”If MODERATE / HIGH risk
Follow local pathway
#GastroTwearls 3/4
Other considerations:
Isolated bilirubin (<50), this could be Gilbert’s syndrome!
Rpt LFTs with bilirubin split
Isolated ALP, is GGT ?
If not then could be from
If cancer refer in 
2WW
Use A & G / liaise with
Gastro/Hep team if unsure
#GastroTwearls 4/4
Isolated
bilirubin (<50), this could be Gilbert’s syndrome!Rpt LFTs with bilirubin split
Isolated
ALP, is GGT ? If not then could be from
If cancer refer in 2WWUse A & G / liaise with
Gastro/Hep team if unsure#GastroTwearls 4/4
