The following guidance from BNSSG on Remedy offers advice and support for managing abnormal LFTs
https://remedy.bnssg.icb.nhs.uk/adults/hepatology/liver-disease/#i1
Abnormal LFTs/Jaundice
Assessment
A good place to start is to try to consider if jaundice/abnormal LFTs are hepatitic (generally come under medicine) or obstructive (generally come under surgery).
- More likely hepatitic/”intra-hepatic” (medicine):
- History of alcohol use/hepatotoxic meds
- Recent viral illness (eg. CMV/EBV)
- Disproportionately raised ALT
- ALP can also be raised (but usually proportionately less than ALT)
- More likely obstructive/”post-hepatic”:
- Background of gall stones (useful to check ICE for abdo imaging)
- Weight loss/back pain/abdo mass (pancreatic cancer)
- Dark urine/pale stool
- Itch usually more of a feature in obstructive jaundice
- Acute abdo pain suggestive of biliary colic
- Disproportionately raised ALP (but ALT can also be raised)
Weekday Professional Line Management
See the following links:
Obstructive:
- Surgical hot clinic (if stable)
- Surgical admission (if unwell)
- Pancreatic cancer pathway (esp if painless obstructive jaundice/weight loss/back pain)
Hepatitic:
Often don’t need urgent admission unless red flags – features of decompensated liver disease/raised INR/confusion.
Follow the BNSSG Abnormal LFT Pathway (above). In addition to NILS mentioned, ask GPs to consider requesting INR and EBV/CMV.
GP can seek advice from hepatology (via urgent A&G at NBT who reply within 48hrs, or bleep at UHBW) or Hepatology Hot/Urgent Clinic.
Urgent Hepatology Clinics
NBT
The NBT Urgent Hepatology Service is for patients who meet their referral criteria. They will be seen within 4 weeks.
UHBW
Mark referral urgent (BNSSG Referral Service has been reassured that letters are triaged by the hepatologists and patients seen appropriately).