Patients who should be admitted to hospital as an emergency include those who are systemically unwell with red-flag symptoms such as:
- ALT more than 500
- Significant coagulopathy
Patients should be referred for an urgent outpatient appointment if they are systemically well, but have red flag symptoms. When making an urgent referral, it is important that a liver aetiological screen is also organised to check for blood borne and hepatic viruses.
Some patient will have abnormal liver blood tests as a result of an intercurrent illness such as a viral or bacterial infection, or after the commencement of a new medication. If these patients are not systemically unwell and have no red flag symptoms, they should have a repeat liver blood test to check the abnormal liver blood test resolves without the need for intervention.
Some patients will have abnormal liver blood tests from a non-liver cause, including:
- Elevated bilirubin due to Gilbert syndrome
- Isolated elevated ALP can be due to vitamin D deficiency
- Underlying malignancy
- Raised ALT can be due to muscle injury from myositis or rhabdomyolysis