Series: Lab medicine in primary care Biochemical liver function tests
W Stuart A Smellie and Stephen D Ryder consider two common scenarios of “abnormal” liver test results that may be seen in primary care
“Abnormal”liver results (bilirubin or enzymes produced by the liver) are a common finding in the investigation of patients presenting with non-acute illness and often raise questions about the need for, and timing of, further investigation. Although the management of overt liver disease will usually include referral to a secondary care specialist, the thresholds for referral and further investigation in clinically silent situations can be unclear.
A 27 year old man presented to his general practitioner with a one week history of fever and malaise. On examination he appeared slightly jaundiced and was febrile (38.5°C). He had no evidence of pharyngitis, cervical lymphadenopathy, or organomegaly.
A full blood count was reported as haemoglobin 142 g/l, increased white cell count (10.4¥109/l), and a lymphocytosis (5.1¥109/l). Routine chemistry had been done at the same time and showed urea, creatinine, and electrolytes within laboratory reference ranges, raised bilirubin (42 mmol/l) with normal aspartate and