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THE DIAGNOSTIC PROCESS3 

Fig. 3.1  A guide to using the ‘overview of assessment’. 

Evidence of chronic liver disease?

Full clinical assessment + LFTs, FBC, U+E, coagulation screen

1 See Further assessment ofchronic liver disease (p. 181)

Fever / rigors / RUQ pain?

Dilated bile ducts on USS?Seekunderlyingcause

Yes

No

Normal liver enzymes, PT, albumin?2 Likely haemolysis or Gilbert’s syndromeYes

No

Evidence of cholestasis?3

Suspect acute cholangitisYes

Extrahepatic cholestasisYes

ALT >500 U/L, ↑PT or featuresof encephalopathy?4 Acute viral/autoimmune hepatitis or

toxic/ischaemic liver injuryYes

No

No

Yes

No

No