LAUNCH EVENT RECORDING – The All Wales Abnormal Liver Blood Tests Pathway (08/10/2021) – ICST
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    LAUNCH EVENT RECORDING – The All Wales Abnormal Liver Blood Tests Pathway (08/10/2021)

    On Friday 8th October 2021 we held the launch event for The All Wales Abnormal Liver Blood Tests Pathway.

    Watch the recording of the event here.

    An interactive 1-hour event for all healthcare professionals who interpret liver blood tests and triage patients according to their risk of liver fibrosis. This event provides exclusive access to the authors and key contributors to the development of the All Wales Abnormal Liver Blood Tests Pathway.

    The event was hosted by Vanessa​ Hebditch, Director of Communications & Policy, British Liver Trust, and the expert panel includes:

    • Dr Andrew Yeoman – National Clinical Lead for the Liver Disease Implementation Group and Consultant Hepatologist
    • Dr Dai Samuel – Consultant Hepatologist
    • Dr Tom Pembroke – Consultant Hepatologist
    • Dr Steve Short – Principal General Practitioner (GP)

     

    Thank you to everybody who submitted a question for the Q&A section of the event. Unfortunately a couple of these questions were not answered during the event due to time limitations, but written responses have been submitted by the expert panel:

    When is Synthetic Liver Function Tests done? How about Bilirubin Metabolism?

    Synthetic tests of liver function (PT/INR) are typically done when there is established cirrhosis or if there is severe acute liver dysfunction (ALT persistently >300 and/or jaundice)

    Which is the best liver function test: AST/ALT, Alkaline Phosphatase, Bilirubin, INR. OR is it all of these to be done please?

    Only INR is a liver function test and even then is not completely specific to liver disease. AST/ALT, ALP are liver enzymes rather than function tests. Bilirubin elevations can reflect hepatic synthetic impairment but only when biliary obstruction or Gilberts has been excluded.

    What is a useful 'liver screen' investigation? The value of raised GGT alone with no other abnormalities? Drilling down the raised ALK Phos? Overcoming the barriers in blood test being refused by the labs?

    This is an excellent question. GGT alone does not significantly add anything other than in the case of an isolated ALP in which case a GGT that’s also raised indicates liver rather than bony origin.

    The optimal liver screen is to some extent determined by patient factors such as age and gender. For example there is little point checking ceruloplasmin after the age of 40.

    We are working with the clinical biochemists to develop a single request that will request the necessary things automatically and also avoid duplicates (eg alpha-1 antitrypsin only needs to done once if normal, same for transferrin saturation in men or pull recent autoimmune screens).

    LAUNCH EVENT RECORDING – The All Wales Abnormal Liver Blood Tests Pathway (08/10/2021)

    On Friday 8th October 2021 we held the launch event for The All Wales Abnormal Liver Blood Tests Pathway.

    Watch the recording of the event here.

    An interactive 1-hour event for all healthcare professionals who interpret liver blood tests and triage patients according to their risk of liver fibrosis. This event provides exclusive access to the authors and key contributors to the development of the All Wales Abnormal Liver Blood Tests Pathway.

    The event was hosted by Vanessa​ Hebditch, Director of Communications & Policy, British Liver Trust, and the expert panel includes:

    • Dr Andrew Yeoman – National Clinical Lead for the Liver Disease Implementation Group and Consultant Hepatologist
    • Dr Dai Samuel – Consultant Hepatologist
    • Dr Tom Pembroke – Consultant Hepatologist
    • Dr Steve Short – Principal General Practitioner (GP)

     

    Thank you to everybody who submitted a question for the Q&A section of the event. Unfortunately a couple of these questions were not answered during the event due to time limitations, but written responses have been submitted by the expert panel:

    When is Synthetic Liver Function Tests done? How about Bilirubin Metabolism?

    Synthetic tests of liver function (PT/INR) are typically done when there is established cirrhosis or if there is severe acute liver dysfunction (ALT persistently >300 and/or jaundice)

    Which is the best liver function test: AST/ALT, Alkaline Phosphatase, Bilirubin, INR. OR is it all of these to be done please?

    Only INR is a liver function test and even then is not completely specific to liver disease. AST/ALT, ALP are liver enzymes rather than function tests. Bilirubin elevations can reflect hepatic synthetic impairment but only when biliary obstruction or Gilberts has been excluded.

    What is a useful 'liver screen' investigation? The value of raised GGT alone with no other abnormalities? Drilling down the raised ALK Phos? Overcoming the barriers in blood test being refused by the labs?

    This is an excellent question. GGT alone does not significantly add anything other than in the case of an isolated ALP in which case a GGT that’s also raised indicates liver rather than bony origin.

    The optimal liver screen is to some extent determined by patient factors such as age and gender. For example there is little point checking ceruloplasmin after the age of 40.

    We are working with the clinical biochemists to develop a single request that will request the necessary things automatically and also avoid duplicates (eg alpha-1 antitrypsin only needs to done once if normal, same for transferrin saturation in men or pull recent autoimmune screens).

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      All-Wales Abnormal Liver Blood Test Pathway

      A standardised, efficient approach to the management of abnormal liver blood tests.

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