Referrals
Elevated liver enzymes referral checklist
Baseline investigations, red flags, and referral note elements for elevated liver enzymes.
Last reviewed 2026-01-05|liver | hepatic | workup
Jump to
Minimum pre-referral workup
- Repeat ALT, AST, ALP, GGT, and bilirubin.
- INR and albumin for synthetic function.
- Hepatitis B and C serologies.
- Medication, supplement, and alcohol review.
- Liver ultrasound for persistent abnormalities.
Urgency tier
- Jaundice or rapidly rising bilirubin.
- INR elevation, encephalopathy, or confusion.
- Very high transaminases or severe abdominal pain.
- Ascites or signs of decompensated liver disease.
- Immunosuppression with suspected acute hepatitis.
Referral packet checklist
- Lab trend summary and pattern (hepatocellular vs cholestatic).
- Alcohol intake, metabolic risk factors, and medication list.
- Viral serology results and imaging findings.
- Symptoms (pruritus, fatigue, RUQ pain).
- Relevant comorbidities or family history.
Pre-referral optimization tasks
- Stop non-essential hepatotoxic exposures when clinically safe.
- Counsel on alcohol abstinence until reassessment.
- Reinforce urgent return precautions for jaundice, confusion, or severe abdominal symptoms.