Abnormal Liver Function Tests (LFTs)

Abnormal liver blood tests are common incidental finding on ‘routine’ blood tests, not necessarily related to the presenting symptom(s).

The LFTs consist of a collection of liver enzymes (or proteins). The pattern and level of liver enzymes provide some clues to a possible liver condition or underlying diagnosis.

Abnormal Liver Function Tests (LFTs)

Abnormal LFTs may indicate a specific liver disease process e.g. ongoing liver cells damage or impaired function of liver.

The improvement or normalisation of LFTs however don’t always equate to full recovery to a normal liver. The liver has the ability to regenerate, to provide an increased reserve of functioning cells, but established architectural damage of liver may be present. A liver biopsy is an useful but invasive test, to help make a diagnosis and assess the damage.

Once a diagnosis is made, the focus will be an assessment of any established liver damage. The options include non-invasive blood tests (ELF), scoring systems derived from simple clinical and labarotory parameters (NAFLD score), or a liver fibroscan. These tests are invaluable in the assessment of liver scarring (fibrosis or cirrhosis).

Liver Ultrasound

Upside: The test is quick, painless and easily repeatable.
Downside: Not specific for disease (coarse liver echotexture may be fatty infiltration or significant fibrosis). Operator dependent. Body habitus limitation.

Liver Biopsy

Upside: This provides detailed information in assessment of liver architectural damage and may offer diagnostic clue to underlying liver condition.
Downside: Invasive. Potential complications. Patient discomfort. Sampling error.

Liver Fibroscan

This is a specialised liver scan using the principle of ultrasound.

Upside: The test is quick, painless and easily repeatable.
Downside: Validated for specific liver conditions. Assess scarring (fibrosis or cirrhosis) or build-up of fat (steatosis). No specific information on underlying liver disease state or function. Sampling error. Body habitus limitation.

Pragmatic Approach to Incidental Mild LFTs Abnormalities

Repeat the LFTs after:

  • Omission of suspected medications or supplements
  • A period (about 2 months) of alcohol abstinence
  • Healthy lifestyle changes – diet, exercise and/ or weight loss
  • Interventions for metabolic syndrome or hyperlipidaemia


  • A liver blood screen including viral hepatitis B&C, autoimmune liver antibodies and ferritin
  • A liver ultrasound
  • Specialist assessment if persistent significant (arbitrarily more than 2 – 2.5 times upper limit of normal) liver enzyme(s) elevation

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