History taking
Example of explanation to patient:
Andy, based on your test results, there are some signs that suggest your liver might be experiencing a bit of stress. Given that your weight is on the higher side and you don’t have any other symptoms, one possibility to consider is non-alcoholic fatty liver disease (NAFLD). This is a condition where fat builds up in the liver, even without alcohol being a factor.
The good news is that NAFLD can often be managed by making healthy lifestyle changes, such as losing weight, eating a balanced diet, and getting regular exercise. These changes can help reduce the fat in your liver and improve overall liver health.
Andy, thanks for coming in to chat about your blood test results. One of the tests we did looks at how your liver is working, and a couple of the results were slightly higher than we’d normally expect. This can sometimes be a sign that your liver is under a bit of strain.
Now, you mentioned that you don’t drink much alcohol, which is good. One possible reason for these results, especially since your weight is on the higher side, is something called ‘fatty liver’. That just means there might be a bit of fat building up in the liver.
The reason we want to take this seriously now is because if it’s left untreated for many years, it can sometimes lead to more serious liver problems later on. But the key message is that we’ve picked it up early, and there’s a lot we can do to stop that from happening.
The good news is it’s often something we can improve with healthy lifestyle changes, such as losing weight, eating a balanced diet, and getting regular exercise. These changes can help reduce the fat in your liver and improve overall liver health.
To be on the safe side, I’d like to do a couple more tests and arrange a scan to have a closer look at your liver. It’s nothing to panic about, but it’s worth keeping an eye on now so it doesn’t lead to problems in the future. I can also help you with ideas on how to start eating healthier and moving more, if that would be helpful.
I know you mentioned not enjoying cooking — I can suggest services like Hello Fresh or similar, which provide easy, healthy meal kits that could help.
Management
Learning Point – NAFLD and Abnormal LFTs in Primary Care
Mildly raised liver enzymes, especially ALT and GGT, in an otherwise well adult with risk factors such as obesity or sedentary lifestyle should raise suspicion of non-alcoholic fatty liver disease (NAFLD). This is often picked up incidentally during routine blood tests.
If the patient had a recent viral illness or was on new medication, a repeat test in 1–2 weeks may help determine if it’s a transient rise.
A liver ultrasound and additional tests (e.g. Hepatitis screen, autoimmune panel, metabolic screen) may be appropriate for ongoing abnormal LFTs or when abnormal LFTs are identified for the first time without an apparent cause (this is particularly relevant in asymptomatic patients, as in the case above, where non-alcoholic fatty liver disease (NAFLD) is a possible underlying diagnosis).
Early detection of NAFLD provides a window for intervention through lifestyle change — reducing the risk of long-term progression to fibrosis or cirrhosis.
Understanding LFTs: Key Points for Interpretation
This station reinforces the importance of interpreting LFTs in clinical context and acting early to prevent long-term liver complications.