ABSTRACT
Rule out inter-current illness and/or medication as a cause. Also consider lifestyle factors which are modifiable e.g., alcohol. Then, in order to assess if referral is necessary, carry out a full non-invasive liver screen which may include the following:
LFTs including gamma-glutamyl transferase, ALT, AST should be repeated 4–6 weeks after initial abnormal ones
AST:ALT ratio (harmful alcohol scarring)
Clotting studies
Alpha-1 antitrypsin
TSH
Lipids and HbA1c (metabolic syndrome)
FIB-4 score (non-invasive estimate of liver scarring in fatty liver) – repeat 3–5 yearly for monitoring
If they have risk factors for blood-borne infection include hepatitis serology – Hep B surface antigen, Hep C antibodies
Liver autoantibodies including ANAs and antimitochondrial antibodies AMAs (positive in primary biliary cirrhosis) and smooth muscle antibodies (SMAs) and antibodies to liver, kidney, microsome type-1 (LKM-1)
Full blood count (FBC) and ferritin (raised in haemochromatosis) – and a fasting TSAT (percentage of the transferrin iron-binding capacity occupied by iron in the serum) if elevated ferritin
Ceruloplasmin (reduced in Wilson's disease)
Coeliac serology
Immunoglobulins (may be raised in acute hepatitis and autoimmune disease)
Abdominal ultrasound (gallstones, liver metastases, non-alcoholic fatty liver disease – NAFLD)
