Abnormal LFTs on Your Screen? How I Go from ‘This Looks Off’ to a Clear Plan in Under 2 Minutes

Abnormal liver function tests (LFTs) are one of the most common “surprises” in primary care and outpatient practice. Yet for many clinicians, the next steps are highly variable, ranging from watchful waiting to extensive investigation and referral. This post walks through how a structured, app‑based pathway can turn that uncertainty into a consistent, sharable plan in under two minutes.

Why Abnormal LFTs Are So Tricky in Primary Care

Most abnormal LFTs are picked up incidentally, in busy clinics, and often in patients with multiple comorbidities. The result is that interpretation and follow‑up decisions depend heavily on who happens to be looking at the inbox that day. Without a clear pathway, it is easy to either over‑refer or miss early chronic liver disease.

A Real Case: Raised ALT and ALP in a 52‑Year‑Old with Diabetes

Consider a 52‑year‑old with type 2 diabetes and a BMI of 32 whose routine bloods show ALT 95 U/L, ALP 180 U/L and bilirubin 14 µmol/L. It is a familiar picture: there is clearly something to think about, but the “right” next step is not always obvious in the moment. Do you repeat, investigate, image, refer – and on what timescale?

Step‑by‑Step: How I Use LiverCheck on This Result

Step 1 – Entering the Clinical Details and LFT Panel

The first step is simply to bring the result into one place alongside minimal clinical context. In LiverCheck, that means adding basic demographics, key risk factors and the LFT panel (ALT, ALP, bilirubin and others as needed). This alone forces a quick, structured pause instead of a reflex “file and forget” or blanket referral.

Step 2 – Pattern Recognition and Risk Signals

Once the data are entered, the app classifies the pattern of derangement and surfaces relevant signals. It distinguishes hepatocellular, cholestatic or mixed patterns and prompts you to consider red flags and reassuring features. That pattern‑based view mirrors how hepatologists think and helps anchor decisions in physiology, not just numbers.

Step 3 – Following the Evidence‑Based Pathway

On the back of that pattern, the app presents a concise pathway for this scenario. It outlines recommended additional tests, when to repeat bloods, when to consider imaging and at what thresholds referral becomes appropriate. Rather than replacing judgement, it acts as a checklist to reduce omission and make sure key causes and actions are not missed.

Step 4 – Generating a PDF Summary

With a tap, the pathway and interpretation can be turned into a short PDF summary. This document pulls together the abnormal results, the inferred pattern and the suggested next steps in a format that can be read quickly by colleagues. It makes the reasoning behind your plan explicit and easy to revisit.

Step 5 – Sharing the Report with the Team

The PDF can then be saved into local records, attached to a referral or shared within the practice team. That means the next clinician who sees the patient or reviews the inbox can understand how the result was assessed and what the agreed plan is. Over time, this kind of shared documentation helps move a department from ad‑hoc responses to a more standardised approach.

From Variation to Consistency: Why a Standardised Pathway Matters

When each abnormal LFT follows a structured pathway, variation in care narrows and important pathology is less likely to be missed. At the same time, clinicians avoid unnecessary referrals and investigations because they have a clear, reproducible rationale for watchful waiting or limited follow‑up. This combination of safety and efficiency is where digital pathways can add real value.

Try This on Your Next Abnormal LFT

The real test of any tool is whether it helps on a real case, on a real clinic day. Next time an abnormal LFT lands in your inbox, run it through LiverCheck, generate a PDF summary and use it to shape your plan and discussions. If you do, feedback on what worked well – and what you would change – is exactly what will make the pathway stronger for everyone.

**Ready to try LiverCheck?**

Run your next abnormal LFT through it → generate PDF → share with team.

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*Educational tool only – always use clinical judgement.*