When should I consider referring a patient with abnormal liver function tests to a specialist?

Consider referring a patient with abnormal liver function tests (LFTs) to a specialist in the following situations:

• If the patient is hepatitis B surface antigen (HBsAg) positive, refer to a hepatologist, gastroenterologist, or infectious disease specialist with an interest in hepatology, including pregnant women with HBsAg positivity for assessment within 6 weeks to allow treatment planning NICE CG165.
• If the patient has signs or symptoms of decompensated liver disease (such as ascites, encephalopathy, or gastrointestinal haemorrhage), refer immediately to a hepatologist or gastroenterologist NICE CG165.
• If cirrhosis is diagnosed or strongly suspected, refer the patient to a hepatology specialist for further management NICE NG50.
• Do not rely solely on routine LFTs to rule out cirrhosis; if clinical suspicion remains, consider non-invasive tests or specialist referral NICE NG50.

In summary, abnormal LFTs warrant specialist referral when associated with chronic hepatitis B infection, evidence of liver decompensation, or confirmed/suspected cirrhosis.