Order sets for use in the event of abnormal liver function tests and suspected viral hepatitis.
This information does not replace the detailed pathways that are available to guide clinicians on the management of abnormal LFTs.
Case finding hepatitis B and C
Hepatitis B surface Ag positive
- FBC, INR, LFT (including AST), HBV viral load, Hepatitis C Ab, Hepatitis D Ab, HIV, AFP
Hepatitis C Ab positive
FBC, INR, LFT, AST, TFT, HCV viral load, HCV genotype, Hepatitis B sAg, HIV.
Extended LFT Screen (ALT repeated after 1 month is still raised)
FBC, INR, LFT (including GGT and AST), HB sAg, HCV Ab, autoantibodies, ferritin/iron studies, caeruloplasmin (only for patients <40yr), immunoglobulins, alpha-1 antitrypsin.
ALT>300: an acute hepatitis screen
Hepatitis A IgM – Acute hepatitis screen
Hepatitis B core antibody, IgM – Acute hepatitis screen
Hepatitis B surface Ag – Acute hepatits screen
Hep C Ab – Acute hepatitis screen
Liver autoantibodies, immunoglobulins, FBC, LFT, AST, GGT
Consider also drug induced injury.
Fatty liver on ultrasound
- FBC, LFT, AST
- Calculate Fib-4
Fib-4 > 3.25 → high risk of advanced fibrosis → refer to secondary care.
If ELF test is available
- Fib-4 1.3-3.25 → Request ELF test
For fatty liver (aka NASH):
- ELF > 9.8 → High risk of advanced fibrosis → refer to secondary care.
For those drinking harmful amounts of alcohol and at risk of fibrosis:
- ELF > 10.5 → High risk → refer to secondary care.
If low risk of fibrosis, repeat LFTs and calculate Fib-4 annually.