Always follow your local guidelines and seek specialist advice. This lecture is only intended as a brief overview.

It can be scary for patients to hear their liver function is abnormal, however the true liver synthetic function tests are INR, albumin and bilirubin, all of which can be abnormal even when the liver is normal. The INR can be elevated due to warfarin, low albumin due to other illness, malnutrition or proteinuria and bilirubin due to gilberts disease or haemolysis.

After looking at liver synthetic function, you need to determine if the abnormal LFTs are predominantly due to a problem with the liver cells or with the bile ducts. Hepatocellular dysfunction can be seen with raised ALT which is an enzyme that is released into the blood stream with liver cell damage. Obstruction or inflammation in the bile ducts causes an increase in alkaline phosphatase and GGT. Bile duct obstruction, cirrhosis, gilberts disease or haemolysis can cause jaundice, an elevation in bilirubin.

Approach to liver function test:

  1. Determine true liver synthetic function (INR, albumin and bilirubin)
  2. Is there liver dysfunction with raised ALT (hepatocellular LFT’s)
  3. Is there biliary dysfunction with raised Alkaline Phosphatase or GGT. (cholestatic LFTs)
  4. If ALT, Alk Phos and GGT are elevated determine if one picture is more dominant or whether there is a “mixed LFT” picture.

Examples of types of LFTs pictures

Alk Phos
++ or normal
++ or normal


Causes of deranged LFTs

Isolated Hyperbillirubinemia
Gilberts disease
Viral hepatitis
Fatty liver disease
Fatty liver disease
Drugs or toxins
Intra-abdominal bleeding
Drugs or toxins
Autoimmune hepatitis
Primary biliary cholangitis
Wilson’s disease
Primary sclerosing cholangitis
Cardiovascular pathology
Right sided heart failure
Non hepatic source (muscle)
Non hepatic source (bone)


Next determine how severe the abnormality is. A detailed overview can be found on . In general:

Increase from upper limit of normal
1 to 2.5
2.5 to
5 to 20
Life threatening


Next determine if this is a new abnormality, like a drug reaction or a long standing like fatty liver disease. Mildly deranged LFTs could be observed and repeated after risk factors are addressed, such as losing weight or reducing alcohol intake. There are many over the counter herbs and supplements that can cause liver damage and patients often do not mention taking these. It is important to specifically ask about herbs, supplements or weight loss products (particularly products with added green tea boosters can damage the liver)

Liver screen
Blood tests
FBC, LFT, UE, coagulation screen, iron studies, hepatitis A, hepatitis b surface antigen, hepatitis b core antibody, hepatitis C antibody.
basic screen as well as: ANA, SMA, AMA, CMV, EBV, HIV, anti liver-kidney antibody, ceruloplasmin, alpha 1 antitripsin, unconjugated bilirubin

A liver ultrasound can exclude gall stone disease and fatty liver disease, although ultrasound can be very unreliable to determine fibrosis/cirrhosis. The best test to assess for liver cirrhosis is a “fibroscan”, which is non-invasive, does not require needles and does not hurt. It sends a small shockwave (feels like a flick with a finger on your skin) through the liver and measures how much the liver vibrates. This fibroscan can be requested through WDHB.

Treatment depends on the severity and underlying cause. Feel free to contact me to discuss if you have any questions or patients you are concerned about.




5 out of 5 stars
posted 6 months ago

Dr Marius has been my lifesaver in terms of some serious pain I was getting in my stomach. He diagnosed what was happening very quickly based on my symptoms and case and he organised treatment for me straight away resulting in instant pain relief. A doctor that genuinely cares with a lot of expertise and goes above and beyond! Thank you so much Marius.

5 out of 5 stars
posted 8 months ago

An absolutely awesome consultant, with an excellent and genuine concern for patient care. I consider myself extremely fortunately to have been referred under his professional care and his treatment, has genuinely improved my quality of life. By far the most supportive and expert gastroenterologist that I have ever had the pleasure of meeting. Thank you for your continued support.

5 out of 5 stars
posted 2 years ago

Dr Marius. I am writing to express my appreciation for all that Dr Marius has been able to do so i have been able to avoid major surgery. I have adenocarcinoma,(cancer in the duodenum). I was offered an extremely invasive operation called Whipple. This involves extensive cutting and rejoining of the liver pancreas and gall bladder with all its aftermath and infection risks. I chose not to have this as i preferred to have quality of life rather than longevity. Sadly i have been up close to...

5 out of 5 stars
posted a year ago

My son Liam has been under the care of Marius for most of this year with some complex issues which are now resolved. Marius was extremely knowledgeable and professional in his care throughout this process, while offering a kind and empathetic approach to both myself and Liam . I would thoroughly recommend him to anyone seeking the services of a Gastroenterologist.

5 out of 5 stars
posted 2 months ago

Dear Reader I have had experience of my stomach chronic infection by HP. My GP has not give me treatment after I have done gastroscopy while I have moderate symptoms. I call Dr Marius clinic, his nurse was realized my situation and contacted Dr Marius. I had phone consultation with Dr Marius. I got my medications to treat stomach infection. That happened just in three weeks ago. I am feeling better now. That is impressive experience and I do appreciate Dr Marius give me the right treatment and...