Investigating abnormal liver blood tests (Investigation of abnormal liver function tests (LFTs))
The set of blood tests, scans and sometimes a biopsy used to find out why your liver blood tests are abnormal, and whether anything needs treating.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Liver blood tests show that something may be affecting the liver; they do not, on their own, say what or how serious.
- One mildly abnormal result is common and often not serious, but a persistent or marked abnormality should be properly investigated rather than just repeated.
- The work-up is usually a staged set of blood tests, often an ultrasound, and sometimes a fibrosis scan or biopsy, spread over weeks.
- Ask what the result changes and what the plan is if it stays abnormal; avoid clinics that promise instant answers from a single panel.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can identify a treatable cause, such as a medicine, viral hepatitis or an iron problem
Relying on a single liver panel to 'rule out' liver disease — normal tests do not exclude all liver problems.
A few minutes; you can carry on as normal straight away. A little bruising is common.
A named contact and clear process for receiving every result.
A few minutes; you can carry on as normal straight away. A little bruising is common.
Initial liver blood test results are usually back. Your doctor explains the pattern and whether more tests are...
A liver screen, ultrasound or fibrosis scan may be arranged. Results are pieced together rather than judged one at...
A cause is found, monitoring is arranged, or you are reassured and given a plan to recheck later. Some people are...
What does investigating abnormal liver blood tests involve?
Liver blood tests (often called LFTs, or liver function tests) measure substances in your blood that can rise or fall when the liver is irritated, blocked or working less well. Common ones include ALT and AST, ALP and GGT, bilirubin and albumin. When one or more comes back outside the usual range, your doctor looks at the pattern to work out what to check next.
It is very common to have a liver blood test that is not normal, and this does not always mean you have a serious or lasting liver problem. A single result rarely gives a diagnosis on its own. Most people end up having several tests, looked at together alongside your symptoms, alcohol history, medicines, weight and other risk factors.
The aim of the investigation is to find a cause, judge whether there is any scarring, and decide whether you need treatment, monitoring, or simply reassurance and a repeat test later. The most common reasons for persistently abnormal liver blood tests are fatty liver disease, alcohol, and viral hepatitis.
This guide explains the usual steps, not a diagnosis. What you actually need depends on your results and your doctor's assessment.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Mildly abnormal versus markedly abnormal results
| Situation | What usually happens |
|---|---|
| Mild, one-off rise, no symptoms | Often repeated and a liver screen arranged; lifestyle review; recheck later if low-risk |
| Persistently abnormal | Full liver screen, ultrasound and fibrosis scoring; referral if needed |
| Markedly abnormal or with symptoms | More urgent assessment, often specialist referral, sometimes same-week |
| Jaundice, confusion or signs of liver failure | Urgent, same-day medical assessment |
These are general patterns. Your own plan depends on the exact results, your history and your doctor's judgement.
Preparing for your test
- Ask whether you need to fast (some tests, such as lipids or glucose, may need it) and whether to take your usual medicines.
- Bring a full list of medicines, supplements and herbal remedies, as many can affect liver blood tests.
- Be ready to give an honest alcohol history, including a typical week; this genuinely changes which tests are needed.
- Mention recent infections, foreign travel, tattoos, new medicines or possible exposure to hepatitis.
- Bring any previous liver blood test results, so changes over time can be seen.
- Tell your doctor about a family history of liver, iron or autoimmune conditions.
- If you might be pregnant, say so, as this affects some tests and any later scans or biopsy.
What happens
The first step is usually a blood test, taken from a vein in your arm, which takes only a few minutes. Depending on the pattern, your doctor may add a wider 'liver screen' to look for specific causes, and calculate a fibrosis score from your results.
Many people then have an ultrasound scan of the liver, which is usually not painful and uses sound waves to look at the liver, bile ducts and gallbladder. If scarring is a question, you may be offered a specialist stiffness scan such as FibroScan.
A smaller number of people go on to a liver biopsy, MRI or referral to a liver specialist (hepatologist) or gastroenterologist. Throughout, your doctor is building a picture from several results together, rather than relying on any single number.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Relying on a single liver panel to 'rule out' liver disease — normal tests do not exclude all liver problems.
- Repeating the same panel over and over without investigating a persistent abnormality.
- Using blood tests alone to stage scarring; this needs a fibrosis score, scan or sometimes biopsy.
- Treating an isolated, mildly abnormal result in a well person as proof of serious disease.
Delay or rearrange if…
- You have a current infection or recent illness that may temporarily affect results — though marked abnormalities should not be delayed.
- You have just started or stopped a medicine known to affect the liver, which may need rechecking.
- Results are needed urgently because of jaundice, severe pain or signs of liver failure — in which case do not wait, seek same-day care.
- You are unable to give an accurate alcohol or medicine history that the result depends on.
Alternatives to discuss
- Watchful waiting with a repeat test, for an isolated mild abnormality in someone at low risk.
- A standard NHS primary-care pathway, including fibrosis scoring and referral when indicated.
- Lifestyle change first (alcohol, weight, diabetes control) where fatty liver or alcohol is the likely cause.
- Direct specialist referral if results are markedly abnormal or symptoms are present.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can identify a treatable cause, such as a medicine, viral hepatitis or an iron problem
- Helps judge whether there is liver scarring (fibrosis) and how urgent things are
- Can provide genuine reassurance when results settle or a clear, low-risk explanation is found
- Guides lifestyle changes (alcohol, weight, diabetes control) that can improve fatty liver
- Avoids unnecessary worry and over-testing by following a sensible, staged plan
- Picks up the minority who need specialist treatment before problems progress
Risks & complications
- An abnormal result that turns out to be mild, temporary or not serious, causing avoidable worry
- Needing repeat blood tests over weeks or months before things are clear
- Bruising or soreness where blood is taken
- Inconvenience and several appointments
- An unclear ('borderline') result that neither confirms nor rules out a problem
- Incidental findings on a scan (for example a harmless cyst) that lead to more tests
- Being referred on, with the anxiety of waiting, when the cause is ultimately minor
- Missing or delaying a serious diagnosis if results are not followed up properly
- False reassurance from a normal panel when a problem is still developing
The main pitfalls are not the blood test itself but how results are acted on: repeating a panel without investigating a persistent abnormality, or treating one normal result as a clean bill of health. Ask what your specific pattern suggests, what the next step is, and when you will be reviewed.
Published figures to discuss
Liver blood tests are a screening tool, not a diagnosis. They can be abnormal in healthy people and normal in early or patchy liver disease, so false reassurance and incidental abnormalities are the main issues rather than a numeric complication rate. Because thresholds, panels and populations differ, robust single percentages for 'false positives' or 'false negatives' are not meaningful here, and any further-test risks belong to the specific scan or biopsy used.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Transient mild liver-test abnormality | Common after intercurrent illness, alcohol, medicines or strenuous exercise | Repeating tests can be appropriate, but persistent abnormalities need a structured liver screen. | Intelligent Liver Function Testing (iLFT) — PMC reviewncbi.nlm.nih.govSource-linked context |
| Significant liver disease with normal or near-normal blood tests | Recognised, especially in compensated cirrhosis or intermittent disease | Normal ALT does not always mean no fibrosis; risk factors and non-invasive fibrosis tests matter. | Intelligent Liver Function Testing (iLFT) — PMC reviewncbi.nlm.nih.govSource-linked context |
| Advanced fibrosis among people with metabolic fatty liver disease | A minority overall, higher with type 2 diabetes, obesity and older age | FIB-4, ELF or transient elastography are used to find higher-risk patients. | Intelligent Liver Function Testing (iLFT) — PMC reviewncbi.nlm.nih.govSource-linked context |
| Urgent obstructive or inflammatory liver disease | Uncommon but important | Jaundice, fever, severe pain, confusion, bleeding or very abnormal clotting need urgent assessment. | Intelligent Liver Function Testing (iLFT) — PMC reviewncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from a blood test. What matters afterwards is understanding what the results mean, what further tests are planned, and when you will hear about them.
- Waiting, sometimes for weeks, while the full picture is built up
- Being asked to repeat blood tests to see if things settle or change
- Mild bruising where blood was taken
- Being given lifestyle advice (alcohol, weight, diabetes) while tests continue
- Not getting a single clear answer immediately, which is normal in liver investigation
Aftercare
- Make sure you know how and when you will get each set of results, and who to contact if you do not hear.
- Ask for your results in writing or via your record, so you can track changes over time.
- Follow any lifestyle advice given, especially around alcohol and weight, as these often matter.
- Keep any scan or specialist appointments, and chase them if they do not come through.
- Review your medicines and supplements with a clinician or pharmacist, as some affect the liver.
- Tell your doctor if you develop jaundice, severe tummy pain, confusion or vomiting blood while waiting.
- Ask when a repeat test is due if you are being monitored rather than treated.
- Up-to-date list of medicines, supplements and herbal remedies
- An honest note of typical weekly alcohol
- Any previous liver blood test results gathered
- Clarity on whether you need to fast
- A note of the plan: what test is next and when
- Agreed way to receive results and who to contact with questions
- A diary date for any repeat test or scan
⚠ Get urgent help if…
- Yellowing of the skin or whites of the eyes (jaundice) — seek urgent medical advice
- Dark urine and pale stools
- Severe pain in the upper right side of the tummy, especially with fever or shivering
- Confusion, drowsiness or unusual sleepiness
- Vomiting blood or passing black, tarry stools — call 999 or go to A&E
- Easy bruising or bleeding, or marked swelling of the tummy or legs
- Severe, persistent itching
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A 'good' result depends on what is found. For many people the cause is fatty liver or alcohol, and the most important outcomes are an accurate fibrosis assessment and a clear plan, rather than a single normal number. For others, a specific, treatable cause such as viral hepatitis or an iron disorder is identified.
Normal liver blood tests are reassuring but do not completely rule out liver disease, because the liver can be affected before the numbers change. Equally, an abnormal result does not prove serious disease. The value of the investigation is the overall picture: the pattern of tests, the scan, the fibrosis score and your history, taken together.
Liver blood tests reflect a moment in time and can change. If you are being monitored, results may be rechecked after a few weeks, months or, for low-risk fatty liver, a couple of years. A normal set today does not guarantee normal results later, and a one-off abnormal result may settle. Your clinician will advise how often you need rechecking based on the cause and any scarring.
Related tests, treatments or support
Liver blood tests are usually interpreted alongside other tests done at the same time: a full blood count and clotting, an ultrasound, a fibrosis scan, and screening for diabetes and cholesterol, which often travel with fatty liver. In some people a liver biopsy is the test that ties the picture together.
Follow-up & long-term care
Follow-up depends on the cause. You may be given lifestyle advice and a repeat blood test date, referred to a liver specialist or gastroenterologist, or simply reassured. Make sure you know who is responsible for chasing each result and what should happen if a test is abnormal, borderline or normal.
- Repeat liver blood tests at the interval your clinician advises if you are being monitored
- Periodic fibrosis assessment (scan or score) if you have fatty liver or another chronic cause
- Ongoing attention to alcohol, weight and diabetes control where these are relevant
- Vaccination and specialist follow-up if viral hepatitis is found
Repeat, follow-on and what comes next
- Repeat testing is common and expected; results often need to be seen over time before they are clear.
- Borderline or fluctuating results may need rechecking weeks later rather than immediate action.
- A normal follow-up panel does not always close the matter if risk factors or symptoms persist.
- Some people are referred on for a scan, fibrosis assessment or specialist opinion to settle uncertainty.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and clear process for receiving every result.
- Written results you can keep and compare over time.
- An explicit plan for normal, abnormal and borderline outcomes, including referral routes.
- Sensible lifestyle advice where alcohol, weight or diabetes is relevant.
- A defined recheck interval if you are being monitored rather than treated.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- How many and which blood tests are needed (a basic panel versus a full liver screen)
- Whether imaging is added, such as an ultrasound or a specialist fibrosis scan (FibroScan)
- Whether a specialist (hepatologist or gastroenterologist) consultation is included
- Who reports the scan and how quickly results are turned around
- Whether a liver biopsy or MRI is needed for unclear cases
- The number of follow-up appointments and repeat tests over time
- Which specific blood tests are included and whether a full liver screen is covered
- Whether an ultrasound or fibrosis scan is included, and who reports it
- The specialist consultation fee, if a referral is part of the package
- What happens, and what it costs, if results are borderline and more tests are needed
- Whether follow-up appointments and repeat tests are included
- How and when you receive written results
- What happens if you need referral back into NHS care
On the NHS? Investigating abnormal liver blood tests is standard NHS care; private testing is sometimes used for faster scans or a specialist opinion, but the same staged approach applies.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being sold a single 'liver test' as a complete check without explaining its limits.
- No plan for what happens if a result is normal, abnormal or borderline.
- False reassurance from a normal panel when symptoms or risk factors are present.
- No clarity on who follows up results and how you will be told.
- No discussion that staging scarring needs more than blood tests.
Marketing red flags
- 'One blood test rules out liver disease' or 'complete liver check' claims.
- Promising an instant diagnosis from a single panel.
- Offering broad 'liver detox' or supplement packages alongside testing.
- Not mentioning that normal results do not exclude all liver disease.
- No clear pathway for abnormal or uncertain results.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What pattern do my results show, and what are the most likely explanations?
- What is the next test, and what will the result actually change?
- What happens if the next result is normal, abnormal or borderline?
- Do I have any sign of liver scarring, and how will you check for it?
- Should I change anything now — alcohol, medicines, weight — while we investigate?
- Who is responsible for following up each result, and how will I be told?
- When should I be rechecked, and what symptoms mean I should seek help sooner?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
I have one slightly abnormal liver result — should I be worried?
Do abnormal liver blood tests mean I have liver damage?
Will I need a liver biopsy?
Can I get this investigated on the NHS?
How long until I know what is going on?
Should I stop drinking alcohol while being investigated?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: British Liver Trust — Liver blood tests British Liver Trust — Full liver screen blood tests BSG/BASL — Guidelines on the management of abnormal liver blood tests NHS — Jaundice (when liver problems become urgent) Intelligent Liver Function Testing (iLFT) — PMC review
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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