GI Investigations · Patient Guide
Abnormal Liver Blood Tests: What Actually Comes Next?
A very common finding with a very structured pathway — and one where the right first response is method, not alarm.
Abnormal liver function tests turn up constantly on routine bloods, and the majority reflect common, manageable causes — fatty liver, alcohol, medication effects — rather than serious disease. What matters is that the finding enters a structured pathway rather than being either ignored or catastrophised. That pathway is well defined, and its first steps are simple.
The standard work-up
Mildly abnormal results are typically repeated after a few weeks alongside a 'liver screen' — blood tests for viral hepatitis, autoimmune markers, iron overload and other specific causes — and an abdominal ultrasound to assess the liver's texture and the bile ducts. The pattern of which enzymes are raised guides thinking: some patterns point at the liver cells, others at the bile ducts, and the bile-duct pattern is where a surgical cause like gallstones enters the frame.
When this test is usually indicated
- Repeat LFTs with a full liver screen after an initial unexplained abnormality
- Abdominal ultrasound as the standard first image of the liver and bile ducts
- Urgent assessment for jaundice, which needs same-week investigation
- MRCP (an MRI of the bile ducts) where duct obstruction or stones are suspected
- Fibrosis assessment (e.g. FibroScan) in confirmed fatty liver disease
When it may not be the right test
- Immediate CT or invasive tests for a mild, isolated first abnormality — repeat and screen come first
- Ignoring persistently abnormal results because you feel well — early liver disease is typically silent
- Endoscopy as a routine response to abnormal LFTs without a specific indication
- Stopping prescribed medication on suspicion without medical review
Honest scope note: persistent liver-cell-pattern abnormalities and confirmed liver disease are led by hepatology and gastroenterology physicians, and referral onward is the right move at that point. The bile-duct pattern is the surgical lane — gallstones causing duct obstruction or gallbladder disease is where Mr Papettas's practice picks the problem up directly.
What happens if you do need it
Where the work-up points at gallstones — a common endpoint — the pathway continues seamlessly: ultrasound confirmation, MRCP if duct stones are suspected, and laparoscopic gallbladder removal where indicated, performed by Mr Papettas with a 0% bile duct injury rate across his audited practice. Where it points at medical liver disease, a properly framed hepatology referral follows, with the work-up already done rather than started from scratch.
Frequently asked questions
My LFTs are mildly raised — is that serious?
Usually not: fatty liver, alcohol and medications explain most mild abnormalities. Persistence on repeat testing is what escalates the work-up, not a single result.
What is a liver screen?
A panel of blood tests for the specific treatable causes — viral hepatitis, autoimmune liver disease, iron overload and others — done alongside the repeat LFTs.
What does the ultrasound look for?
Liver texture (fat, scarring), the bile ducts (dilated ducts suggest obstruction), and the gallbladder — the standard first image for any liver question.
What is MRCP?
A specialised MRI of the bile ducts — the non-invasive way to find duct stones or narrowing when ultrasound raises the question.
When is this a surgical problem?
When the cause is gallstones — in the gallbladder or ducts — the definitive treatment is surgical, and sits within colorectal and general surgical practice.
How is this pathway arranged privately?
Bloods and ultrasound from a first consultation within days — call 01926 935121.
Related reading
Unsure whether you need this test?
Mr Trif Papettas FRCS is a Consultant Colorectal and General Surgeon at Nuffield Health Warwickshire Hospital, Leamington Spa, and a JAG dual-accredited endoscopist. A consultation settles which investigation, if any, your symptoms actually need — and if a test is indicated, it can usually be arranged within days.
Self-referrals welcome · No GP letter required · Self-pay and insured patients seen at Nuffield Health Warwickshire Hospital, Leamington Spa CV32 6RW