I am Dr. Arjun Prakash, a Consultant Gastroenterologist specializing in liver diseases. A frequent reason for patients presenting in an anxious manner to my clinic over the years has been a letter or message from their GP with a liver blood test result, e.g., “Your liver blood tests have come back slightly abnormal.”
That is enough to send people into a spiral. Let me show you what it means, what I see in clinical practice, and when you actually have to take action.
What Does an Abnormal Liver Test Actually Mean?
Liver function test (LFT) is a simple test of the blood that looks for the amount of various enzymes and proteins that the liver produces (such as ALT, AST, bilirubin, alkaline phosphatase, albumin). The return of any of these outside the normal range is indicated as an abnormal liver test.
But, this rings a bell with me that I give to all my patients: If the test comes back abnormal, it is not a diagnosis. It’s a cue that must be understood in the context.
A mild elevation of ALT, for example, may be due to a few weeks of overindulgence in food and fluids, a recently prescribed medication, or even to strenuous exercise immediately prior to the test. However, if the results are frequently outside the normal range, this should never be ignored.
The Patients I See Most Often
I see a true cross-section in my clinic of people who have abnormal liver test results. Here are a couple of typical patterns:
The “routine check-up surprise”
A patient visits for a general check-up, usually prior to initiating a new drug, and their liver enzymes are elevated. They don’t experience any symptoms at all. This is the stage where early fatty liver disease is frequently detected.
The long-term medication user
Some drugs, such as long-term medication users and some antibiotics and anti-epileptics, can alter liver enzymes with time. When I see an abnormal liver test, I always look at the patient’s medication list very closely.
The ‘I just wasn’t feeling right’ patient
Sometimes, people present with some vague tiredness, a little discomfort in the upper abdomen, or with nausea; then a blood test shows that the liver is under stress. These patients typically develop liver disease at an early stage, where we can make an impact.
Common causes of abnormal liver tests include:
In practice, I encounter several of these types of situations quite frequently:
- Non alcoholic fatty liver disease (NAFLD): This is one of the most common conditions I see and one that I see more in patients who have obesity, type 2 diabetes, and metabolic syndrome.
- Alcohol-related liver injury (not necessarily heavy drinkers): Liver enzymes can even become elevated with moderate alcohol consumption and other risk factors.
- Viral hepatitis (B or C):Occasionally, found during a routine test.
- Autoimmune liver disease:these are not usually obvious and often are not picked up by a specialist assessment.
- Injury from medications/supplements: including herbs, which patients often don’t report unless prompted.
What I Do Next: The Specialist Workup
If a patient is presenting with the same abnormal liver tests for several months, I am not going to repeat the same blood test. I built a picture.
The first thing I do is take a detailed history, alcohol, meds, family history, BMI, and symptoms. Next, I usually order other specific blood tests and, often, an ultrasound of the liver to inspect the liver’s architecture.
I will make a FibroScan, a non-invasive test that assesses liver stiffness, in many cases, particularly if fatty liver or early liver fibrosis is suspected, which will provide a much better indication of whether or not scarring is present.
This staged, thorough approach means we get to the right answer faster and, more importantly, patients leave, knowing exactly what’s going on, not just that “something is off.”
Can an Abnormal Liver Test Be Reversed?
This is probably the question I get asked most. And the truth is, it depends on the cause, but in many cases, yes.
When the abnormal liver test is related to lifestyle (diet, alcohol, weight), the liver can get well again with a change in lifestyle. I’ve seen patients with really high enzymes come down to normal ranges with diet and weight loss alone in three to six months.
In cases where liver disease is caused by viral hepatitis, autoimmune disease, or advanced fibrosis, the treatment is more specific and requires specialist management. Early referral is where it comes into play.
A Final Word
An abnormal liver test does not necessarily indicate liver failure. What this means is that your liver is talking to you. My role, and my team’s role, is to listen carefully, investigate thoroughly, and ensure clarity about what’s happening and what needs to be done. Book Your Consultation!
The liver is resilient, but it does best when you don’t ignore the warning signs.
Book a consultation or screening today: Click Here.
To book a private liver or gut consultation or second opinion, Get in touch with us.
Had a great experience with us? We’d love to hear your thoughts! Click here to leave a Google review.
