Podcast - Understanding abnormal LFTs: the puzzle finally solved

Podcast description The video version of this podcast can be found here: https://youtu.be/IaId_nNbO-c?si=0FF7A5J7iPxocdBdThis episode refers to guidelines on the management of abnormal liver function tests by the British Society of Gastroenterology and a number of NHS organisations in the UK. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the interpretation of an abnormal liver function tests, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the information consulted. You must always use your clinical judgement. There is a podcast version of this and other videos that you can access here:Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk My summary guide can be downloaded here:· https://1drv.ms/b/s!AiVFJ_Uoigq0mQ8MRxaNYnA1_pzh?e=H2U7rS The resources consulted can be found here:BSG- British Society of Gastroenterology:· bsg.org.uk/clinical-resource/guidelines-on-abnormal-liver-blood-tests· Guidelines on the management of abnormal liver blood tests (bsg.org.uk)o First published on:o BMJ article:o Guidelines on the management of abnormal liver blood tests | Gut (bmj.com)Southeast London pathway:· Microsoft Word - Abnormal liver function test pathway-explanatory.docx (selondonccg.nhs.uk)North and East Devon pathway:· Management of Abnormal LFTs in Asymptomatic Adults - North & East (devonformularyguidance.nhs.uk)North Bristol· https://www.nbt.nhs.uk/sites/default/files/Investigation%20of%20Adult%20Patients%20with%20Abnormal%20LFT%20in%20Primary%20Care.pdfWest Hampshire:· Liver Blood Test Pathway | GP Portal (westhampshireccg.nhs.uk)Medscape:· Liver Blood Tests: How to Interpret Abnormal Results (medscape.co.uk)Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the interpretation of abnormal liver function tests or LFTs, including initial follow up management, always focusing on what is relevant in Primary Care only. And for that I will summarise the British Society of Gastroenterology guidelines on LFTs. They were first published in the BMJ and the relevant links are in the episode description. Although the full guideline covers both adults and children, in today’s episode I will be focusing only on adults. At the end, I will also tell you how to access my summary of the recommendations, which will be based not only on the BSG but also on a number of NHS bodies in the UK. The links to them are in the episode description and it’s worth having a look as they have flowcharts and other information that you may find useful. Right, there is a lot of information to cover, so let’s jump into it.The three the most common causes of liver disease are alcohol-related liver disease, non-alcoholic fatty liver disease and viral hepatitis, although autoimmune liver disease is also a significant cause.Liver disease develops silently and at earlier stages liver enzymes may be normal. If they are high, the degree of abnormality is not necessarily related to the severity of the underlying condition and this is why many patients are not diagnosed until they have developed significant liver fibrosis.In many cases if used in isolation, LFTs are neither very specific or sensitive and they are better at assessing liver fibrosis if incorporated into algorithms or ratios.What constitute LFTs? Well, the LFTs standard panel can vary from hospital to hospital. Although we call them LFTs, not all the tests assess liver function. For example, high liver enzymes point towards liver injury; bilirubin, albumin and INR give information on liver function, while platelets can give information on the level of liver fibrosis. So, let’s have a look at a number of these tests.Bilirubin is ...