Algorithm for the evaluation of asymptomatic raised ALT in an adult

Suggested management plan for evaluation of an asymptomatic raised ALT (1)

If patient is symptomatic or raised alkaline phosphatase then refer. Clinical features of liver disease include spider naevi, palmar erythema, hepatomegaly or spenomegaly, ascites, gynaecomastia, bruising, right upper quadrant pain or tenderness

If asymptomatic raised ALT is > 120 IU/L on initial sample, then some guidance suggests this per se is sufficient to consider immediate seeking of expert advice or referral (2)

If not referred then:

• review alcohol intake/medication. If possible discontinue drugs affecting LFTs and, if appropriate, have the patient abstain from alcohol. If the patient is overweight then encourage weight loss. Exclude diabetes and dyslipidaemia
• repeat LFTs (plus GGT) after one month

Further action dependent on results:

Reference:

1. Pulse (2004); 64 (30);34-6.
2. City and Hackney CCG. Abnormal Liver Function Tests (LFTs) in Adults (Accessed 30/8/19)