ALP – Cholestatic LFTs with normal bilirubin

Data gathering

  • Hepatotoxic drugs
  • Alcohol, illicit drug use
  • Blood transfusions
  • New sexual partners
  • FH
  • Metabolic syndrome
  • BMI


Clinical management

  • Repeat within 1 month with GGT
    • elevated GGT suggests liver aetiology – otherwise consider bone aetiology and check vitamin D
  • If persistently raised, consider
    • USS abdo/liver
    • Bloods: HBV, HCV, Autoantibodies, Ferritin, Transferrin saturation, Caeruloplasmin, Immunoglobulins, a1-antitrypsin, USS abdo/liver
      • normal
        • manage in primary care
          • lifestyle advice and repeat LFTs in 1 year
      • abnormal
        • Refer to Hepatology
          • (need to rule out – viral hepatitis, alcoholic liver disease, PSC, PBC, autoimmune hepatitis, gallstone disease, hepatic vascular disorders, hepatic metabolic disorders, hepatic malignancy, biliary malignancy)