Elevated LFTs

Causes

  1. Non-Alcoholic Fatty Liver Disease (NAFLD)
  2. Obesity-related liver disease
  3. Alcoholic Liver Disease
  4. Drug-Induced Liver Injury (paracetamol and other drugs)
  5. Hepatitis (A, B, C, and others)
  6. Hemochromatosis
  7. Cirrhosis
  8. Autoimmune Hepatitis
  9. Primary Biliary Cholangitis (PBC)
  10. Primary Sclerosing Cholangitis (PSC)
  11. Gallstones (leading to bile duct obstruction)
  12. Wilson’s Disease
  13. Cancers (liver cancer, bile duct cancer, metastatic cancer)
  14. Heart Failure
  15. Infections (e.g., EBV, CMV, sepsis)
  16. Infiltrative Diseases (e.g., amyloidosis, sarcoidosis)
  17. Genetic Disorders (e.g., Gilbert’s syndrome – isolated hyperbilirubinaemia)
  18. Coeliac Disease
  19. Hypothyroidism
  20. Hyperthyroidism

Investigation

Screening for all causes of elevated liver function tests (LFTs) involves a comprehensive approach, given the wide range of potential underlying conditions. The initial evaluation often starts with a detailed history and physical examination, followed by a series of tests that can be broadly categorized into:

Basic Liver Function Tests

  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
  • Alkaline phosphatase (ALP)
  • Gamma-glutamyl transferase (GGT)
  • Bilirubin (total and direct)
  • Albumin
  • Prothrombin time (PT) / INR

Additional Tests for Further Evaluation

  • Viral hepatitis markers (Hepatitis A, B, C, D, E)
  • Autoimmune liver disease markers (e.g., CRP, ESr, ANA, etc)
  • Iron studies (ferritin, transferrin saturation) for hemochromatosis
  • Coeliac Screen (tTG, DGP, EMA)
  • Ceruloplasmin for Wilson’s disease
  • Alpha-1 antitrypsin level
  • Lipid profile
  • Thyroid function tests (TSH, Free T4)

Imaging Studies

  • Ultrasound of the liver
  • CT scan or MRI of the abdomen

Specialized Testing (based on clinical suspicion)

  • Liver biopsy (for definitive diagnosis of certain conditions)
  • Genetic testing for hereditary liver diseases (haemochromatosis)
  • Endoscopic retrograde cholangiopancreatography (ERCP) for biliary tract diseases
  • Screening for metabolic syndrome components (glucose tolerance test, insulin levels)
  • Drug levels or toxicology screening if drug-induced liver injury is suspected

Other Considerations

  • Alcohol use assessment
  • Review of medications and supplements (prescription, over-the-counter, herbal)

This comprehensive set of tests aims to cover the broad spectrum of infectious, genetic, autoimmune, metabolic, and toxic causes of elevated liver enzymes. The specific tests chosen for an individual patient often depend on clinical judgment, the patient’s history, physical examination findings, and initial test results.