Step 1 of the All-Wales Abnormal Liver blood tests pathway focuses on the cause of the abnormality. There are many reasons why liver blood tests can be abnormal, and the first step should focus on the urgency which action is required.

Patients should be admitted if they:

• Have red flag features of jaundice, weight loss, abdominal mass
• AND are systemically unwell

Patients should be referred urgently to hepatology outpatients if they:

• Have red flag features of jaundice, weight loss, abdominal mass
• BUT are systemically well

Patients should have a repeat LFT if they:

• Have evidence of a viral or bacterial infection
• OR have recently been started on a new medication

Patients should follow a different investigative and treatment pathway if they:

• Have evidence of non-liver causes of abnormal liver blood tests, including vitamin D deficiency and Gilbert’s syndrome