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Chiropractic Research Review

What Do You Do With Abnormal Liver Tests?

Many doctors order standard tests for liver function in patients who have non-specific symptoms like fatigue, weight loss and dyspepsia. In cases of mild abnormal laboratory results, there is often an absence of other signs of liver disease.

It is often assumed that these abnormal liver chemistry values are caused by excess alcohol consumption.

The purpose of this study was to follow-up all patients who had mildly elevated liver function tests analyzed by a particular lab in England over a six-month period. After 12-21 months, the patient files were re-examined to see if there had been any follow-up by physicians on the values that were twice the upper limit of the local reference range.

The lab processed over 8200 tests in the six month period, resulting in 933 patients with abnormal values. Of these, full follow-up data was obtainable in 873 cases. Further investigation had been performed by physicians in 531 patients with known liver disease. Of the remaining patients, no further testing was performed in 58%. Upon further testing of this group, 62% had an identifiable diagnosis requiring hospital intervention, including communicable viral hepatitis and chronic liver disease.

Conclusion: The authors stress that patients with persistently abnormal test results should be referred for further testing in order to avoid delayed or missed diagnoses.

Take Note: The authors point out that the sample of patients requiring retesting actually highlighted instances in which diagnosis was delayed; however, it also pointed out when appropriate referral had not been performed.

Sherwood P, Lyburn I, Brown S, et al. How are abnormal results for liver function tests dealt with in primary care? Audit of yield and impact. British Medical Journal 2001: 322, pp 276-8.

Chiropractic Research Review

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