Deranged LFTs
Severity
Range
- MildMild rise (< 3× ULN), no jaundice
- ModerateModerate rise (3–10× ULN) or jaundiced
- SevereALT > 1000, INR > 1.5, encephalopathy
💊
Hepatocellular — drugs / toxins Causes
Paracetamol overdose (always check level)Antibiotics — co-amoxiclav, flucloxacillin, isoniazid, nitrofurantoinStatins, amiodarone, methotrexate, valproateHerbal — kava, comfrey; recreational — MDMA, cocaineAlcohol (acute / chronic)
🧬
Hepatocellular — viral / autoimmune Causes
Hepatitis A, B, C, EEBV, CMV (younger patients)Autoimmune hepatitis (ASMA, ANA, IgG)HIV seroconversion
❤️
Ischaemic / vascular Causes
Shock liver (hypotension, cardiac arrest, sepsis)Budd-Chiari, portal vein thrombosisRight heart failure (congestive hepatopathy)Ischaemic hepatitis post-MI / post-PE
🪨
Cholestatic — obstructive Causes
Gallstones — CBD stone, cholangitis, cholecystitisPancreatic / cholangiocarcinoma, ampullary tumourPSC, PBCDrug cholestasis — flucloxacillin, augmentin, OCP, anabolic steroids
⚖️
Metabolic / infiltrative Causes
NAFLD / NASH (commonest mild rise)Haemochromatosis, Wilson's (< 40 y), α1-antitrypsinAmyloid, sarcoid infiltrationPregnancy — HELLP, AFLP, intrahepatic cholestasis
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Isolated bilirubin Causes
Gilbert's (unconjugated, otherwise well)Haemolysis (unconjugated, anaemia + ↑LDH)Dubin-Johnson / Rotor (conjugated, rare)