Clinical investigations from the RACP

Evaluating patients who have abnormal liver tests

Narci Teoh, Jacob George



The cause of liver test abnormalities can usually be elicited by a detailed history and examination. The pattern and degree of the abnormalities may also provide clues.

Key Points

  • Liver enzyme abnormalities may be physiological or pathological.
  • Any persistent elevation of liver test results must be investigated.
  • The cause of liver test abnormalities in the majority of cases can be determined by eliciting a detailed history and performing a thorough physical examination.
  • Assess the degree as well as the pattern of elevation of liver tests.
  • Serological testing for common causes of liver dysfunction should be undertaken.
  • Upper abdominal ultrasonography is a useful noninvasive imaging procedure.
  • Liver biopsy should be considered in consultation with a gastroenterologist.