We're presented with the scenario of a GP aware of the patient's blood results that show elevated Liver Enzymes, as this is the prompt for today's consultation.

Her results are: 

FBC normal, U&E normal

Total cholesterol 4.1, normal LDL, TG, HDL levels

HbA1c 39

ALP 130 (44-147)

ALT  58* (4-36)

GGT 103* (5- 40)

Bilirubin 14 (0-20)

Albumin 38 (35-50)

Being curious about the patient's social context brings in the discussion about coming to terms with losing Terry, her mental health, her diet and alcohol consumption.

Discuss with your trainer: How many units of alcohol is Jennifer consuming? How is this calculated? Many of you won't drink alcohol at all, but many of your patients will do so. Clinicians need to be able to calculate this according to patient information. Fewer patients will drink in clear measures of alcohol units served in Pubs or Clubs.

This brings us therapeutic choices to deal with the presenting issue of abnormal LFTs -  Would it most appropriate to pursue aspects of fatty liver disease? Addressing Safe levels of alcohol consumption? Managing grief?