“You wanted to speak to me about my blood tests — I was only having them before starting a statin”

Abnormal liver blood tests should be interpreted by pattern: hepatocellular (ALT/AST predominant) versus cholestatic (ALP and GGT predominant), plus synthetic function (albumin, INR, bilirubin, platelets). A raised GGT with raised ALP confirms a hepatic source of ALP. The British Society of Gastroenterology recommends a standard liver aetiology screen for abnormal LFTs, including abdominal ultrasound, hepatitis B surface antigen and hepatitis C antibody, autoantibodies (AMA, ANA, ASMA), immunoglobulins, ferritin and transferrin saturation. In a well, middle-aged woman with autoimmune thyroid disease, nocturnal itch and sicca symptoms, a cholestatic pattern suggests primary biliary cholangitis: diagnosis rests on raised ALP plus positive AMA; first-line treatment is ursodeoxycholic acid via hepatology. Always consider drugs and supplements (turmeric has been linked with liver injury) and biliary obstruction (ultrasound). Urgency depends on the clinical picture: painless jaundice in people aged 40 and over warrants a suspected cancer pathway referral for pancreatic cancer; cholangitis features need same-day assessment. Address family experiences directly and explain why the picture differs, without false certainty.