Interpreting Abnormal Liver Blood Tests or LFTs – Guidelines
These guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG with input from a wide number of groups including the RCGP and the British Liver Trust.
They deal specifically with the management of abnormal liver blood tests in adults in both primary and secondary care under the following subheadings:
- What constitutes an abnormal liver blood test?
- What constitutes a standard liver blood test panel?
- When should liver blood tests be checked?
- Does the extent and duration of abnormal liver blood tests determine subsequent investigation?
- Response to abnormal liver blood tests.
Patient information factsheets
Download and print out copies of our patient-friendly factsheets on:
Alcohol-related liver disease (ARLD) is liver damage that is caused by drinking too much alcohol. There are several stages of ARLD ranging from mild to severe. This factsheet sets out how alcohol damages the liver, how patients can prevent the damage from getting worse, what happens following an ARLD diagnosis and links to further support.Download here >
Non-alcohol related liver disease (NAFLD) is caused by a build up of fat in the liver. It is estimated that one in three people in the UK have NAFLD. This factsheet sets out how alcohol damages the liver, how patients can prevent the damage from getting worse, what happens following a NAFLD and links to further support.Download here >
RCGP liver disease toolkit
The aims of the British Liver Trust/RCGP Liver Clinical Priority Project are to raise awareness of liver disease as an increasingly important cause of morbidity and mortality in the UK and to provide resources to support its optimal management in primary care.
These articles are produced by the RCGP and provide opportunities for 'bite-sized' learning.
This top tips document supports implementation of recommendations in the NICE guideline on cirrhosis in over 16s in July 2017.
Practical implications for primary care: NICE guideline NG49. Non-alcoholic fatty liver disease assessment and management (2016). This top tips document supports implementation of recommendations in the NICE guideline on non-alcoholic fatty liver disease in July 2016.
Clinical News, Dr Jez Thompson, British Liver Trust/RCGP Clinical Champion Liver Disease
This section provides links to national guidance and resources focusing on the management of liver disease
- NICE NG49 non-alcoholic fatty liver disease guidance (2016)
- NICE NG50 cirrhosis in over 16s guidance (2016)
- BSG LFT guidance 2017
- NICE PH43 hepatitis B and C testing guidance (2013)
- NICE CG165 hepatitis B (chronic): diagnosis and management (2013)
- SIGN 115 management of obesity guidance (2013)
- NICE CG189: obesity guidance (2014)
- NICE CG115: Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (2011)
- The Liver Disease Delivery Plan for Wales (2015).
- Lancet Commission: Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis (2014)
- Lancet Commission: Implementation of the Lancet Standing Commission on Liver Disease in the UK (2015)
- Lancet Commission: New metrics for the Lancet Standing Commission on Liver Disease in the UK (2016)
- Caring for people with liver disease: a competency framework for nursing (revised edition 2015)
- Scottish Medicines Consortium
- WHO Hepatitis C fact sheet
- WHO Hepatitis B fact sheet
- Shooting Up: Infections among people who inject drugs in the UK
- Public Health England guidance and resources for GPs and patients: towards Hepatitis C elimination - patient re-engagement exercise
Recommended Read Codes for primary care
Read Codes for liver disease are suggested for both SystmOne and EMIS/Vision users. Good use of the Read codes will support effective audit.
- Liver investigations [PDF]
- Non-alcohol-related fatty liver disease [PDF]
- Alcohol-related liver disease [PDF]
- Other liver disease diagnoses [PDF]
- Viral hepatitis [PDF]
Review your practice - Ideas for audit and reflection?
These links contain ideas and suggestions to help you reflect on your clinical practice relating to liver disease. Are you equipped to identify patients with risk factors for liver disease and to help them reduce their risk? Are you equipped to identify and manage early liver disease?
- Practice checklist are all the right things in place for you to prevent and manage liver disease[DOC]
- Clinical audit ideas: identification and management of NAFLD [DOC]
- Clinical audit ideas: identifying and managing cirrhosis in primary care [DOC]
- Clinical audit ideas: reducing the risk of liver disease in those with high alcohol consumption[DOC]
- Clinical audit ideas: managing hepatitis C in primary care [DOC]
- Clinical audit ideas: managing hepatitis B in primary care [DOC]
- Personal reflections: managing neonatal jaundice [DOC]
This section contains articles and resources for primary care practitioners on liver disease, its impact, its risk factors and prevention, its early diagnosis and its management.
- Liver disease in the UK, an overview [PDF]
- Cirrhosis and its management in primary care [PDF]
- Non-alcohol-related fatty liver disease and its management [PDF]
- Alcohol-related liver disease and its management [PDF]
- Hepatitis B infection [PDF]
- Hepatitis C infection [PDF]
- PHE Patient re-engagement exercise for those who have been diagnosed with hepatitis C [PDF]
- Prolonged neonatal jaundice and its management [PDF]
- LFT blood testing and investigations in liver disease (summarising the British Society of Gastroenterology guidelines 2017) [PDF]
- Getting the most out of Liver Blood Tests [PDF]RCGP Annual Conference & Exhibition session slides
Resources are currently being developed for the following areas:
- Hepatocellular carcinoma
- End of life care in liver disease
- Care after a transplant
- Other viral hepatitis: A D and E
- Hepatic encephalopathy
- Hepatitis A and B immunisation
- Other liver diseases (including autoimmune and metabolic diseases)
Patient leaflets on different liver conditions
The British Liver Trust has a full range of leaflets on the whole range of liver diseases that can be downloaded for free. The full range of leaflets can be downloaded for free here or your patient can order a free hard copy by calling 01425 481320.
Liver disease often has no symptoms in the early stages. The British Liver Trust has developed a range of materials covering the risk factors for liver disease and the signs and symptoms of liver disease. They are free to order and include posters and leaflets for display in GP surgeries
This section provides links to resources specifically aimed at commissioners.
A financial case for action on liver disease has been developed by the Foundation for Liver Research and this report has been endorsed by the lancet commission on liver disease.
There is public health information for Scotland relating to:
There is information on the prevalence of a range of liver diseases in Wales.
In England NICE has produced a quality standard for the management of liver disease . This quality standard covers identifying, assessing and managing chronic liver disease in children, young people and adults, and cirrhosis in young people and adults. It describes high-quality care in priority areas for improvement.
NHS England has published a policy statement on the management of chronic Hepatitis C in patients with cirrhosis.
The Foundation for Liver Research has compiled customised liver disease profiles for each of the 533 parliamentary constituencies in England:
- Profiles for constituencies with names beginning a-s
- Profiles for constituencies with names beginning t-z
Public Health England has developed an atlas that shows variation in healthcare for people with liver disease England
The British Liver Trust Love Your Liver campaign aims to raise awareness of the risk factors, prevent liver disease and improve early diagnosis.
Visit our section on how to get involved in Love Your Liver campaign as a healthcare professional.
Love Your Liver encourages adults to take three simple steps to good liver health – reduce alcohol consumption, improve diet and exercise, and reduce the risk of contracting viral hepatitis.
The British Liver Trust has developed a range of materials covering the risk factors for liver disease and the signs and symptoms of liver disease. They are free to order and include posters and leaflets for display in GP surgeries.
Order your Love Your Liver resources here.
As part of RCGP/British Liver partnership, our Clinical Champion has written a number of articles and also presented at the RCGP main conference. Some of the articles are below:
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