ALT – Hepatitic LFTs with normal bilirubin

Data gathering

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

Clinical management

• ALT < 300
  • Repeat within 1 month with AST, GGT, FBC
  • 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 (?viral hepatitis, alcoholic liver disease, PSC, PBC, autoimmune hepatitis, gallstone disease, hepatic vascular disorders, hepatic metabolic disorders, hepatic malignancy, biliary malignancy)

• ALT > 300
  • Discuss with gastroenterology oncall and consider urgent tests