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Non-Invasive Liver Screen

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Liver function tests (LFTs) are a useful test for assessing the function of a patients liver and are routinely checked when patients present to a variety of clinical environments (even if there is no suspicion of abnormal liver function). Some reasons for the abnormalities are displayed in the diagram below (download if unable to view correctly on screen):
LFT Mind Map
However, a full liver screen should be undertaken in an attempt to confirm the specific cause of abnormal LFTs. A non-invasive liver screen usual involves an abdominal ultrasound (with a focus on the liver) and a particular set of blood tests. The liver screen blood test includes:

Immunology Bloods

A positive antinuclear antibody (ANA) result is indicative of an immune response causing liver disease (autoimmune hepatitis, SLE). It is worth noting than ANA is not specific and a positive result can also indicate viral hepatitis.

Haematology Bloods

If ferritin levels are raised further evaluation is required through iron studies to identify if iron overload is the cause such as in haemochromatosis. Note that ferritin can also be raised as a result of an acute event.
Coagulation Screen

Virology Bloods

Hep B Serology
A positive result indicates active hepatitis B virus. Hepatitis B can cause any abnormal LFT results, typically a raised ALT.
Hep C Serology
Hepatitis A (Acute Presentation)
Hepatitis E (Acute Presentation)
CMV and EBV (Acute Presentation)

Biochemistry Bloods

A deficient (low) result is indicative of chronic liver disease.
Caeruloplamin (if age < 50)
Thyroid Function Test (TFTs)
Gamma-Glutamyl Transferase (GGT)
Alpha-fetoprotein (AFP)

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