Tutorial presented by Dr Tom Pembroke, Consultant Hepatologist, Cardiff and Vale University Health Board, and Senior Lecturer at Cardiff University

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