Liverpool - Hepatology, Referral Guidelines

Abnormal Liver Function Tests (LFTs)

Initial Work Up

• Hepatitis serology
  • Hep A IgM, Hep B sAg,
  • Hep B cAg, HCV Ab
• Immunoglobulins
• Autoantibodies (ANA, SMA, AMA)
• Iron studies
• Copper and caeruloplasmin
• Lipid profile
• Blood glucose
• BMI
• Ultrasound upper abdomen
• Alcohol history

 
For known Hepatitis C

• HCV genotype & viral load
• Psychiatric history

For known Hepatitis B

• Hep B eAg, Hep B eAb

Jaundice

Initial Work Up

• LFTs
• Hepatocellular (elevated transaminases)
  • EBV, CMV, HAV, HBV, HCV
• Cholestatic (elevated ALP & GGT)
• Abdominal ultrasound
• FBE
• U&Es
• If isolated raised bilirubin
  • haemolysis screen
• If isolated raised bilirubin:
• Prothrombin time/INR
• Immunoglobulins
• Autoantibodies (SMA, AMA)
• Clinical evidence of encephalopathy
  • Abdominal ultrasound
  • CT where appropriate