Hepatitic or Cholestatic?

Patients with abnormal liver blood tests should be categorised into Hepatitic abnormalities and Cholestatic abnormalities, although these patterns are a sliding scale of abnormality.

Hepatitic pattern:

  • Diseases of the liver parenchyma, including viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, metabolic liver diseases
  • Increase in the AST and ALT predominantly, more abnormal than the ALP is abnormal


Cholestatic pattern:

  • Diseases of the biliary system or space occupying lesions
  • Increase in the ALP above the limits of normal, and more abnormal than the ALT is abnormal
  • The GGT is also abnormal


Mixed pattern:

  • Combination of the ALP, AST and ALT elevated equally, where neither is predominant but both are elevated abnormally
  • This pattern should be investigated as if they are Hepatitic pattern
Mark as Understood


All-Wales Abnormal Liver Blood Test Pathway

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