Liver: Suggested questions

Last updated: Tuesday, September 27, 2022

These questions may not apply to every patient, but they are a good starting point. They are in addition to our general questions to ask in any clinical situation.

The patient

  • Do they have a liver diagnosis? If yes, this will help you with details of extent of likely dysfunction, duration, prognosis etc. If no, be careful about advising about medicines until a diagnosis and/or cause has been made.
  • What are the signs, symptoms and test results? Look at all LFTs, clotting screen, and symptoms. Are these stable, or changing? Trends are really important. 
  • Ask about the patient's medical history. As pharmacy staff, we often think that medicines both cause and fix all problems, but there can be other causes of the signs and symptoms of liver dysfunction. For example, broken bones may increase ALP levels, CPR may affect the liver. It's important to know about renal function too as this could markedly affect the safe choice and dose of medicines.

Choice of medicine in liver dysfunction

  • What is the indication? You need this information in order to advise about potential alternatives.
  • What is your preferred choice? If the patient didn’t have liver dysfunction, what drug would you want to use? This can help narrow down vague or sprawling questions.
  • Have alternatives been considered? Otherwise you may advise using a medicine that has already been tried unsuccessfully, or suggest using a medicine that is not appropriate for other reasons.

Drug-induced hepatotoxicity

You've already asked about signs and symptoms and the diagnosis (see above), and this is important in helping to determine whether liver dysfunction is drug-related because some medicines cause characteristic presentations. You should also ask:
  • What medicines are being taken? Even if there is one suspect agent already, ask about what else is being taken, or any medicines that have been stopped recently.
  • When were any suspect drugs started? This may help you narrow down the most likely cause from a group of medicines.

Going forward

  • Who else needs to know about the advice you give? For example, you might need to know who can amend the patient's therapy if necessary, counsel the patient, or document your advice in the patient’s notes. 
  • If any monitoring is required, who will do this? Do they know what to do if the liver function changes, and where to go for advice?

The 'questions to ask' from every tutorial on this site have been brought together into a Quick Question Guide that you may want to download for future reference.