Elevated liver enzymes referral checklist

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.

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.

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.

References

• BC Guidelines Abnormal liver chemistry (opens in a new tab)

Something out of date or unclear? Suggest an update. Leave out any patient details.