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Liver Function Testing in primary care

Points to consider / Introduction PDF
Requesting liver function tests
Interpretation of liver function tests
People who require specialist referral for disturbed liver function
Management of specific conditions
Appendices
References
Also see Best Tests: Liver function testing

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Points to consider

While reading this document, you may like to consider the following points and how you manage these situations within your day to day practice.

  • When are LFTs indicated?
  • How are isolated borderline LFT results managed?
  • Is LFT monitoring necessary for people on statins?
  • What are the best tests of liver failure?
  • Who is at risk of chronic hepatitis?
  • How is acute hepatitis managed in primary care?
  • Is non-alcoholic liver disease a benign condition?
  • What is the role of GGT in screening for excessive alcohol in take?

Introduction

The majority of liver problems are managed in primary care, with referral to secondary care usually reserved for a specific range of conditions. Consequently, most liver function testing is initiated and interpreted in primary care.

Knowing when to test is a challenge in primary care. Testing asymptomatic people or those with vague symptoms may return results just outside the reference range making it unclear how to proceed with follow up testing.

Interpretation of liver function tests (LFTs) is not always easy. Patterns of test results across several parameters are usually more useful than single parameters. Also, levels of LFT results are not always a good indication of disease severity. For example, some LFTs may be normal in advanced liver failure but results may be markedly increased in acute hepatitis, from which most patients will recover well.

This difficulty in interpreting LFTs means that, as for all laboratory tests, they must be considered carefully in the context of clinical findings, previous liver function tests and other test results.

The purpose of this document is to provide guidance to primary care clinicians in the use of liver function testing. For an overview of individual liver function tests see Appendix 1.

This is a consensus document, as there is no unanimous international agreement on liver function testing protocols.

We thank the members of the advisory panel for their expertise and guidance in the development of this resource:

  • Associate Professor Ed Gane (Hepatologist, NZ Liver Unit, Auckland DHB)
  • Dr Catherine Stedman (Hepatologist, Canterbury DHB)
  • Dr Cam Kyle (Clinical Biochemist, Diagnostic Medlab)
  • Dr Neil Whittaker (GP, Nelson)

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