What do liver function tests measure? How can they help diagnose liver problems? Get answers to these questions and more in this informative article.

Understanding Liver Function Tests

Liver function tests, also known as a liver panel or hepatic function panel, are a group of blood tests that provide insight into the health and functioning of the liver. These tests measure various enzymes, proteins, and other substances in the blood that are produced or processed by the liver. By analyzing the levels of these substances, healthcare providers can gain valuable information about potential liver problems or disorders.

Key Components of Liver Function Tests

Liver function tests typically include the following components:

• Albumin: A protein produced by the liver that helps maintain fluid balance in the body. Low levels can indicate liver disease, malnutrition, or other conditions.
• Total Protein: A measure of all proteins in the blood, including those produced by the liver. Low or high levels can signal various health issues.
• Prothrombin Time (PT): Measures how long it takes the blood to clot, which is affected by the liver’s production of clotting factors.
• Alkaline Phosphatase (ALP): An enzyme found in various parts of the body, including the liver and bones. Elevated levels can indicate liver or bile duct problems.
• Alanine Transaminase (ALT): An enzyme primarily found in the liver, which can increase when liver cells are damaged.
• Aspartate Aminotransferase (AST): An enzyme found in the liver and muscles, and can help detect or monitor liver problems.
• Gamma-Glutamyl Transferase (GGT): An enzyme mostly found in the liver, which can increase with liver damage or bile duct issues.
• Lactate Dehydrogenase (LDH): An enzyme involved in energy production, which can be elevated in various conditions, including liver disease.
• Bilirubin: A waste product produced by the breakdown of red blood cells, which can build up in the blood when the liver is not functioning properly, leading to jaundice.

What Do Liver Function Test Results Mean?

Abnormal liver function test results can indicate a variety of liver-related issues, such as hepatitis, cirrhosis, liver cancer, or bile duct blockages. However, it’s essential to understand that these tests alone cannot provide a definitive diagnosis. They are often used as a starting point to identify potential problems, which then require further investigation and evaluation by a healthcare provider.

Why Are Liver Function Tests Ordered?

Liver function tests may be ordered for several reasons, including:

1. Screening for liver disease or damage: These tests can help detect liver problems, even before symptoms appear.
2. Monitoring existing liver conditions: Liver function tests can be used to track the progress of a known liver disease or the effectiveness of treatment.
3. Investigating symptoms: If a person is experiencing symptoms like fatigue, abdominal pain, or jaundice, liver function tests can help determine the underlying cause.
4. Checking for side effects of medications: Some medications can affect liver function, so these tests may be used to monitor for any adverse effects.
5. Evaluating overall health: Liver function tests are often included in routine checkups or comprehensive health screenings.

Interpreting Liver Function Test Results

Interpreting liver function test results requires a careful analysis of the individual components and their significance. Healthcare providers will typically consider the patient’s medical history, symptoms, and other clinical information to determine the underlying cause of any abnormal results. It’s important to note that normal ranges for these tests can vary depending on the laboratory and the individual’s age, sex, and other factors.

Complementary Blood Tests for the Liver

In addition to the standard liver function tests, healthcare providers may order other blood tests to gather more information about liver health, such as:

• Comprehensive Metabolic Panel: This panel includes some of the same substances measured in the liver panel, as well as other key markers of overall health.
• A/G Ratio: This ratio compares the levels of albumin (A) to globulin (G) in the blood, which can provide insights into liver function and other conditions.

When to Seek Medical Attention

If you have received abnormal liver function test results, it’s important to follow up with your healthcare provider for further evaluation and appropriate treatment. Liver problems can potentially lead to serious complications if left untreated, so it’s crucial to address any concerns or abnormalities promptly.

Liver Function Tests: What to Expect

This page was reviewed under our medical and editorial policy by

Toufic Kachaamy, MD, Chief of Medicine, City of Hope Phoenix.

This page was reviewed on May 26, 2023.

In some cases, a doctor may order a blood sample to check the health of the patient’s liver. Through liver function tests, the blood is analyzed for an array of liver enzymes, proteins and other substances.

This group of tests is also known as:

• Liver panel
• Liver profile hepatic function panel
• LFT

These laboratory tests can indicate liver problems, possibly caused by cancer or another disease, but they can’t definitively diagnose cancer and are often an indicator of something that needs a workup, rather than being a diagnostic tool on their own.

What the liver function panel analyzes

Liver function tests are typically performed at a lab using a blood draw. The lab test measures several protein indicators, including:

Albumin: Low albumin levels can result from malnutrition, liver disease such as cirrhosis (scarring of the liver), kidney or thyroid disease, or an infection. High albumin levels may signal severe diarrhea or dehydration.

Total protein: As with albumin, low levels of total protein may indicate issues such as liver and kidney disease. High total protein levels may suggest the presence of multiple myeloma (a blood cancer) or infections with viral hepatitis or human immunodeficiency virus (HIV).

Prothrombin time (PT): PT measures how long the plasma (the liquid part of the blood) takes to clot. The liver makes coagulation factors that aid clotting, so slow clotting time (a high PT) may be associated with liver disease or damage.

A liver panel tests blood levels of several enzymes, including:

ALP (alkaline phosphatase): The liver, bones, kidneys and digestive system contain this enzyme, which also occurs in smaller amounts in the rest of the body. Elevated levels may not always be clinically significant, but in some cases may indicate serious diseases such as bone metastases, Hodgkin lymphoma, a bacterial infection or heart failure. A high ALP also may result from mononucleosis (viral infection), a blocked bile duct, bone disorders or liver disease, such as cirrhosis and hepatitis (inflammation of the liver). ALP levels may be higher in children and pregnant women. Some drugs, including birth control, can affect ALP levels.

ALT (alanine transaminase): This enzyme mainly occurs in the liver, and it flows into the blood when liver cells get damaged. ALT levels can reveal a liver problem before symptoms, such as jaundice (a yellowing of the skin and eyes), become noticeable. ALT used to be called SGPT (serum glutamic-pyruvic transaminase).

AST (aspartate aminotransferase): Level changes in AST, an enzyme in the liver and muscles, can help detect or follow liver problems. It’s also called SGOT or serum glutamic oxaloacetic transaminase test.

Gamma-glutamyl transferase: This enzyme is also found mostly in the liver, though it’s present throughout the body. Liver damage causes it to leak into the bloodstream, so high levels may mean the patient has liver disease or a bile duct injury. It’s also called GGT, gamma-glutamyl transpeptidase, gamma-GT, GGTP and GTP.

Lactate dehydrogenase: This enzyme is used throughout the body in energy production. High levels can indicate tissue damage, such as liver or kidney disease, injury to the heart or other muscles, pancreatitis, some infections and some cancers, including lymphoma and leukemia. It’s also known as LD, LDH or lactic acid dehydrogenase.

Bilirubin: A hepatic panel also measures levels of total bilirubin, a waste product. This yellowish substance is part of bile, a digestive juice produced by the liver and stored in the gallbladder before being released into the small intestine. When the liver isn’t working well, bilirubin can build up in the blood and cause jaundice. High levels of bilirubin may signal liver or gallbladder disease, bile blockage, or red blood cell production problems. However, it’s important to check with a doctor, because high bilirubin levels can also be the result of taking certain medications or eating certain foods. With a severe blockage of the bile duct, the stool may become clay-colored, as bilirubin may not be reaching the stool in quantities high enough to turn the stool its normal color.

Other blood tests for the liver

A doctor may order other blood tests along with a liver panel to gather more information on the patient’s health. These may include a comprehensive metabolic panel, which looks at some of the same substances as the liver panel, but adds glucose, calcium, sodium, potassium, chloride, carbon dioxide and BUN (blood urea nitrogen).

Total protein measurement in a comprehensive metabolic panel often includes examining the patient’s A/G ratio, which compares amounts of the two main forms of protein in the blood, albumin and globulins. A high A/G ratio can indicate the existence of leukemia and some genetic disorders. A low A/G ratio can be a sign of liver or kidney disease or an autoimmune disease.

If a patient has one or more risk factors for liver cancer, his or her doctor may recommend an alpha-fetoprotein tumor marker (AFP) test. It measures a substance produced by cancer cells or normal cells reacting to cancer; the test can signify cancer of the liver, testicles or ovaries. High AFP levels also can indicate hepatitis, cirrhosis or other liver disease.

The care team may also order liver imaging with an ultrasound, CT scan or MRI to look at the liver, the bile duct and gallbladder. A specialized noninvasive test to look for cirrhosis or fibrosis may also be ordered, such as a FibroScan^®. Sometimes, a liver biopsy is needed to determine the reason for the abnormal liver tests.

Risk factors for liver cancer:

• Long-term infection with hepatitis B or C. Hepatitis C is more common in the United States, and it often doesn’t cause symptoms for many years. Hepatitis B usually does initially cause symptoms, such as jaundice and feeling sick, but doesn’t always become a chronic infection for most people.
• Cirrhosis
• Non-alcoholic fatty liver disease
• Long-term alcohol abuse
• Obesity
• Smoking
• Type 2 diabetes
• Hereditary hemochromatosis (metabolic disease)

What to expect during a hepatic function panel test

There’s no preparation for a liver panel, unless the doctor wants to expand the procedure to include a comprehensive metabolic panel, in which case the patient would need to avoid eating and drinking for eight to 12 hours before the test.

The blood sample may be taken by a phlebotomist, an expert in drawing blood. A small needle is inserted into a vein, usually in one of the patient’s arms. A thin plastic tube connects the needle to one or more vacuum test tubes. These are sent to a laboratory for processing and compared to reference ranges.

Risks of liver function tests

The patient may feel discomfort when the phlebotomist inserts the needle into the vein, and the patient may develop a bruise at the needle site.

Benefits of liver function tests

A liver panel may indicate a patient has cancer before he or she experiences symptoms. Liver cancer often doesn’t produce symptoms until it’s advanced beyond early stages. These tests can also be useful for monitoring how the liver cancer is responding to treatment, and if it may be progressing.

Liver function test results

A liver panel can only indicate that a patient may have cancer or another condition. Follow-up testing is usually required.

If test results suggest that a patient has cancer, it could be in the liver or elsewhere in the body. It may be cancer that originated in the liver and bile system, called primary tumors, or spread from another location, called secondary tumors or metastases.

Secondary liver tumors occur more often than primary liver tumors. The most common type of cancer that spreads to the liver is colorectal cancer, followed by breast and pancreatic cancers.

In addition to primary and secondary liver tumors, a liver panel may suggest that a patient has multiple myeloma, lymphoma or leukemia.

Testing for Liver Disease | VCA Animal Hospital

What tests are suggested for the diagnosis of liver disease?

Generally, the following screening tests are recommended when liver disease is suspected in a pet: a complete blood count (CBC), a serum biochemical profile, and a urinalysis.

What might these tests indicate if my pet has liver disease?

These screening tests may support the presence of liver disease or a reduction in the functional capacity of the liver but they are not necessarily specific for liver disease.

The complete blood count (CBC) involves the evaluation of the red blood cells, the white blood cells, and the platelet components of a blood sample. A hematology (blood) analyzer will provide your veterinarian with the total numbers of these cells, and evaluation of a blood smear will allow your veterinarian to look at the physical characteristics of these cells.

“One of the most dramatic features of liver disease is icterus, which is the accumulation of a yellow pigment in the blood and tissues.”

One of the most dramatic features of liver disease is icterus, which is the accumulation of a yellow pigment in the blood and tissues. Icterus is recognized as jaundice, which is seen as a yellow discoloration to the skin, mucous membranes, or sclera (whites of the eyes). In addition to being a feature of liver disease, icterus can occur due to the destruction of red blood cells (a condition known as hemolysis). Obviously, it is important to try to differentiate between these two causes of icterus.

The CBC will also allow your veterinarian to determine whether red blood cell numbers are within the normal range. This can be done by an actual count of the total number of red blood cells, or by determination of the hematocrit or the packed cell volume. These latter two measurements essentially determine the proportion of the blood that is occupied by the red blood cells. If these parameters are within the normal range then hemolysis is unlikely.

Liver disease may occasionally result in changes in the shape of red blood cells. These shape changes include increased numbers of target cells. Normal red blood cells are round in shape and are uniformly red with a small central pale area (this central pallor is noted only in dogs). Target cells are red blood cells that look like a target, with alternating pale and red rings. This feature is thought to occur because of a change in the red blood cell membrane structure caused by liver disease.

Occasionally increased numbers of small red blood cells (microcytes) or spiculated (spike-shaped) red blood cells (acanthocytes) may be found in association with liver disease.

The CBC may indicate the presence of inflammation or infection characterized by an increase in the number of white blood cells.

The serum biochemistry profile requires a separate blood sample, from which the serum (the liquid portion of blood) is separated from the cellular portion of blood. Serum contains many substances including enzymes, proteins, lipids (fats), glucose (sugar), and metabolic waste products.

“The biochemistry profile contains many tests that are helpful in the diagnosis of liver disease.”

The biochemistry profile contains many tests that are helpful in the diagnosis of liver disease. Although changes in the biochemistry profile may be supportive of liver disease, and these changes may suggest certain categories of liver disease, they will not tell us exactly what type of liver disease is present.

The most useful enzymes to measure with suspected liver disease include:

 ALT (alanine aminotransferase). This enzyme is found within individual liver cells. When liver cells are damaged for any reason, an increased amount of the ALT enzyme is released into the blood stream. This increase can be detected in a serum sample. Drugs, including corticosteroids and phenobarbital, may increase ALT values.

AST (aspartate transaminase).  This enzyme is also found within liver cells and is released into the serum when the liver is damaged. Steroid-containing drugs do not result in significant increases in this enzyme. Since other body tissues also contain AST, increases in this enzyme are not liver specific.

ALP (alkaline phosphatase). These are a group of enzymes found on the membranes (outer lining) of liver cells and cells of the bile ducts (the bile ducts carry bile from the liver to the intestine). Liver conditions that result in obstruction of bile flow (termed cholestasis) may result in increased serum ALP concentrations. Other causes of increased serum ALP concentrations include certain drug therapies (especially steroids and anticonvulsants), and some conditions related to skeletal bones.

“In young, rapidly growing dogs, it is normal to see elevations in serum ALP.”

In young, rapidly growing dogs, it is normal to see elevations in serum ALP. It is not normal to see elevations in serum ALP in growing kittens.

GGT (gamma-glutamyltransferase). GGT is an enzyme associated with the membranes of cells from the bile ducts, as well as the membranes of cells from the pancreas and kidneys. Increased GGT production, and therefore increased serum concentrations of GGT, are found in liver conditions that result in cholestasis (impaired bile flow), especially those conditions resulting in increased growth or proliferation of bile ducts. Steroid containing drugs may also increase serum GGT concentrations.

Total Bilirubin. In healthy animals, red blood cells are normally removed from the circulation when they become aged. These red blood cells are broken down into a number of components, one of which is bilirubin. Bilirubin is processed in the liver and subsequently released from the liver into the intestines as a component of bile.

• Hyperbilirubinemia (an increased concentration of bilirubin in blood) can occur from two main sources: either increased destruction of red blood cells or because of some problem with the uptake, processing, or release of bilirubin by the liver. The accumulation of bilirubin in tissues causes the yellow color or jaundice that can be seen with either of these conditions. As discussed in the CBC section, it is important to analyze the red blood cell parameters in order to rule out increased red blood cell destruction as a cause of hyperbilirubinemia.
• Liver diseases that can result in increased bilirubin concentrations in the serum can be divided into problems with the uptake of bilirubin, problems with the internal processing of bilirubin, or problems with the excretion of bilirubin into the bile. Sometimes, by measuring the two different components of total bilirubin (unconjugated and conjugated bilirubin, we can try to determine the location of the problem.
• Other liver enzyme changes may give your veterinarian further clues in the interpretation of bilirubin changes. For example, if the ALT enzyme is markedly increased, it suggests that damage within the liver is contributing to the problem with bilirubin processing. If the GGT enzyme is elevated, this would suggest that there is a problem with excretion of bilirubin from the liver into the bile (cholestasis).

Serum albumin, glucose, urea, and cholesterol determinations. The liver manufactures thousands of substances. Glucose, urea, cholesterol, and albumin are among those substances made by the liver that are routinely measured in a serum biochemistry profile. If there is a severe decrease in liver function, this may be reflected by a decrease in one or more of these substances.

Urinalysis. The kidneys constantly filter the blood to remove toxins and other wastes, and concentrate these extracted materials in the urine. Therefore, we may occasionally see changes in the urinalysis before significant changes are noted with blood testing.

“An increase in the amount of bilirubin in a urine sample may indicate liver disease that is not yet appreciable on a serum biochemistry profile. ”

An increase in the amount of bilirubin in a urine sample may indicate liver disease that is not yet appreciable on a serum biochemistry profile. The presence of specific crystals in urine such as bilirubin crystals or ammonium biurate crystals may also point to underlying liver disease.

Are the serum biochemistry tests always abnormal with liver disease?

No, unfortunately not. Occasionally we may suspect liver disease because of the clinical signs that your pet is exhibiting but any changes on the screening test may be subtle or non-existent.

What other tests are available to us for the diagnosis of liver disease?

Serum bile acid concentrations are used to evaluate the functional capacity of your pet’s liver.

The liver makes bile acids using cholesterol. Bile acids are a major component of bile, which is stored in the gall bladder. Following a meal, the gall bladder contracts, releasing bile into the intestine. After assisting in the processes of digestion, most of the bile acids will be re-absorbed into the blood from the intestines and are subsequently removed from the circulation by the liver.

This normal circulation of bile acids forms the basis for the serum bile acid test. After a 12 hour fast, a blood sample is taken. Your pet is immediately fed a small meal that should stimulate the gall bladder to contract. A second blood sample is taken 2 hours after the meal. The serum bile acid concentration is measured in both samples and the results are compared.

If the liver is functioning normally, the amount of bile acids in both the fasted and post-feeding serum sample will be low.

If liver function is reduced for any reason, the concentration of bile acids in circulation may be increased either in the post- feeding sample or possibly in both samples. Occasionally the difference between the fasting and post-feeding samples may suggest specific disease processes. Usually, increases, especially in the post-feeding samples, only provide further evidence of liver disease. See handout “Bile Acid Tests” for more information.

Are there any tests that will tell me exactly what kind of liver disease my pet has?

Occasionally the combination of these screening tests and a through clinical history and physical examination will suggest a likely cause to the liver disease.

“Testing may include ultrasound examination of the liver and gall bladder.”

However, in most instances further testing is required. This testing may include ultrasound examination of the liver and gall bladder. During this examination, the ultrasonographer may take samples of any free fluid that is detected in the abdominal cavity, may take a biopsy sample, or a fine needle aspiration biopsy of the liver and/or gall bladder if abnormalities are observed. Since the liver produces the proteins involved in blood clotting, it is necessary to determine the amount and functional activity of these proteins before proceeding with any biopsies.

A sample of aspirated material from the gall bladder or liver may be submitted for culture if it is suspected that an infection is causing the liver disease. If there is reason to suspect leptospirosis, a blood sample may be submitted to determine a leptospirosis titre (see handout “Antibody Titers” for further information).

If these other tests are needed to determine what kind of liver disease is present, why bother with the screening tests at all?

Firstly, these screening tests allow us to document whether or not your pet has liver disease. These screening tests are minimally invasive and of much lower cost than the biopsies and ultrasound evaluations discussed above.

Secondly, these tests will allow your veterinarian to monitor how your pet is responding any treatments that are undertaken. Normalization of liver enzymes is a good indicator of response to treatment.

Get tested for liver disease

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screening), find out the prices for a complex of analyzes and pass it in Moscow

Synonyms: Liver function tests. Screening for liver disease.

Laboratory liver panel; Liver function tests; Liver check-up; Liver Function Screening.

Profile composition:

No. 13 Bilirubin total (Bilirubin total)

No. 14 Direct bilirubin (Bilirubin conjugated, bound; Bilirubin direct)

No. 8 ALT (ALT, alanines notransferase, alanine transaminase, SGPT, Alanine aminotransferase)

No. 9 AST (AST, aspartate aminotransferase, AST, SGOT, Aspartate aminotransferase)

No. 15 Gamma-glutamyl transpeptidase (GGT, glutamyl transpeptidase, GGT, Gamma-glutamyl transferase)

No. 36 Alkaline phosphatase (AP , Alkaline phosphatase, ALP)

Profile Profile Brief Liver Examination: Screening

The liver is the largest internal organ. Its main functions include: metabolic, deposition, barrier, excretory, homeostatic, detoxification. The liver is involved in the metabolism of nutrients entering it through the portal vein after absorption in the intestine. It synthesizes most of the proteins in blood plasma. The liver is involved in maintaining blood glucose levels (using glycogen stores or through synthesis), as well as in the metabolism of lipids, a number of hormones and vitamins. This organ plays a crucial role in the neutralization and excretion of potentially toxic endogenous metabolic products and exogenous substances (including bilirubin, hormone metabolites, drugs, etc.), ammonium, which is formed during the metabolism of amino acids, is converted by the liver into urea. The bile produced by the liver is secreted into the intestines, which serves as a pathway for the elimination of waste products of metabolism. Components of bile are important for the processes of intestinal digestion of fats. The reservoir of bile is the gallbladder, located under the liver.

Most liver diseases are directly related to unhealthy lifestyle factors: high-calorie diet, excess consumption of saturated fats (fatty meat, high-fat dairy products), refined carbohydrates (bakery and confectionery products) combined with insufficient physical activity. This can lead to the development of non-alcoholic fatty liver disease.

Alcoholic liver disease develops in 60-100% of people who abuse alcohol. Drug-induced liver injury accounts for about 10% of all adverse reactions due to the use of pharmacological drugs.

Diseases of the gallbladder and biliary tract are no less common (gallbladder dysfunction, chronic non-calculous cholecystitis, chronic calculous cholecystitis, cholelithiasis, etc. ).

In the presence of which symptoms it is advisable to conduct a study “Examination of the liver: screening”

Symptoms of liver diseases in the initial stages may be non-specific. Some diseases are completely asymptomatic. Characteristic signs of liver dysfunction usually appear when a significant part of the organ is affected and may include: general weakness, fatigue, discomfort or aching pain in the right hypochondrium, jaundice, skin itching, abdominal enlargement, drowsiness during the day, insomnia at night, etc. There is also a large the number of additional symptoms, the presence and intensity of which depend on the form of liver pathology, the activity of the disease and the degree of damage to the liver tissue.

The study allows to clarify the cause of liver symptoms, which can be accompanied by both diseases of the organ itself and other pathologies that affect liver function.

Specificity of laboratory diagnostics during the study “Examination of the liver: screening”

The profile includes a set of laboratory tests that allow you to identify the characteristic signs of liver cell damage and impaired liver function.

The study of the content of total bilirubin and its fractions is carried out for the differential diagnosis of jaundice.

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are transaminases, the simultaneous determination of the level of which is widely used in clinical practice. The enzymes ALT and AST are found in almost all cells of the human body. However, the largest amount of ALT is found in hepatocytes, so the level of this enzyme serves as a specific marker of liver damage. In turn, AST, in addition to the liver (in descending order of concentration), is found in the heart and skeletal muscles, kidneys, pancreas, lungs, leukocytes and erythrocytes. In liver diseases, ALT activity is primarily and most significantly increased compared to AST.

Determination of the level of gamma-glutamyl transpeptidase in blood serum is used primarily to detect possible pathology of the liver and biliary tract.

Alkaline phosphatase is found in almost all organs, but its maximum activity is found in the hepatobiliary system, bone tissue, intestines, placenta, lactating mammary gland.