What are liver function tests. How are liver function tests used to diagnose liver disease. When should you get liver function tests. What do abnormal liver test results mean. How are liver function tests performed. What are the most common liver function tests. How can you improve your liver function test results.

What Are Liver Function Tests?

Liver function tests, also known as LFTs or liver panel, are a group of blood tests that assess the health and functionality 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 these components, healthcare providers can gain valuable insights into the liver’s condition and detect potential liver disorders or damage.

The liver, a large organ located in the upper right abdomen, plays a crucial role in many bodily functions. It filters toxins from the blood, produces essential proteins and enzymes, aids in hormone balance, stores vitamins, and generates bile for fat digestion. Given its importance, monitoring liver health through regular testing is vital for overall well-being.

Common Components of Liver Function Tests

A typical liver function test panel includes several key measurements:

• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Alkaline phosphatase (ALP)
• Total bilirubin
• Direct bilirubin
• Albumin
• Total protein

Each of these components provides specific information about liver health and function. For instance, ALT is primarily found in liver cells and is considered the most sensitive indicator of liver cell damage. AST, while also present in the liver, can be found in other tissues like heart and muscle, making it less liver-specific but still valuable in assessing liver health.

Additional Tests for Comprehensive Liver Assessment

In some cases, healthcare providers may request additional tests to gain a more comprehensive understanding of liver function:

• Gamma-glutamyl transferase (GGT)
• Prothrombin time (PT)
• P3NP (Procollagen III N-Terminal Propeptide)
• ELF (Enhanced Liver Fibrosis) test
• Urine tests

These supplementary tests can provide further insights into specific liver conditions or help monitor the progression of known liver diseases.

Why Are Liver Function Tests Performed?

Liver function tests serve multiple purposes in healthcare:

1. Screening for liver disorders
2. Diagnosing specific liver conditions
3. Monitoring existing liver diseases
4. Assessing the effectiveness of treatments
5. Evaluating potential liver damage from medications or substances

Healthcare providers may recommend liver function tests when patients exhibit symptoms suggestive of liver problems, such as jaundice, abdominal pain, or unexplained fatigue. Additionally, these tests are often part of routine health check-ups, especially for individuals with risk factors for liver disease.

Risk Factors Warranting Liver Function Tests

Several factors may increase the likelihood of requiring liver function tests:

• Excessive alcohol consumption
• Family history of liver disease
• Exposure to hepatitis viruses
• Obesity or metabolic syndrome
• Use of certain medications known to affect liver function
• Occupational exposure to liver-toxic substances

Individuals with these risk factors may benefit from regular liver function testing as part of their preventive healthcare routine.

How Are Liver Function Tests Performed?

Liver function tests are typically conducted through a simple blood draw. A healthcare professional will collect a blood sample from a vein in your arm using a small needle. The process is generally quick and involves minimal discomfort.

After collection, the blood sample is sent to a laboratory for analysis. The laboratory technicians will measure the levels of various liver enzymes and proteins in the blood using specialized equipment.

Preparing for Liver Function Tests

In most cases, liver function tests do not require special preparation. However, your healthcare provider may give you specific instructions based on your individual circumstances. These may include:

• Fasting for a certain period before the test
• Avoiding certain medications or supplements
• Refraining from alcohol consumption for a specified time

It’s crucial to follow any instructions provided by your healthcare team to ensure accurate test results.

Interpreting Liver Function Test Results

Interpreting liver function test results requires expertise and consideration of various factors. The results are typically compared to reference ranges, which can vary depending on factors such as age, sex, and the specific laboratory performing the test.

Abnormal results don’t always indicate liver disease, as other factors can influence these values. Conversely, normal results don’t guarantee the absence of liver problems. Healthcare providers consider the entire clinical picture, including symptoms, medical history, and other diagnostic tests, when interpreting liver function test results.

Common Patterns in Liver Function Test Results

Certain patterns in liver function test results can suggest specific liver conditions:

• Elevated ALT and AST: May indicate hepatocellular damage, such as in viral hepatitis or alcoholic liver disease
• Increased ALP and GGT: Often associated with bile duct obstruction or cholestatic liver diseases
• Elevated bilirubin: Can suggest various liver or bile duct problems, including Gilbert’s syndrome or hepatitis
• Low albumin or total protein: May indicate decreased liver synthetic function, as seen in advanced liver disease

Healthcare providers use these patterns, along with other clinical information, to guide further diagnostic steps or treatment decisions.

Factors Affecting Liver Function Test Results

Several factors can influence liver function test results, potentially leading to abnormal values even in the absence of liver disease. Understanding these factors is crucial for accurate interpretation of test results:

1. Medications: Certain drugs can affect liver enzyme levels without causing liver damage
2. Alcohol consumption: Recent alcohol intake can temporarily elevate liver enzymes
3. Exercise: Intense physical activity may cause transient increases in some liver enzymes
4. Diet: Consuming a large meal before the test can affect certain parameters
5. Body weight: Obesity can lead to fatty liver disease and altered test results
6. Gender and age: Reference ranges may vary based on these factors
7. Pregnancy: Hormonal changes during pregnancy can affect liver function test results

Healthcare providers take these factors into account when interpreting liver function test results, often recommending repeat testing or additional diagnostic procedures to confirm or rule out liver disease.

Improving Liver Function Test Results

For individuals with abnormal liver function test results, several lifestyle modifications and interventions may help improve liver health:

• Limiting alcohol consumption or abstaining completely
• Maintaining a healthy weight through diet and exercise
• Avoiding unnecessary medications and supplements
• Getting vaccinated against hepatitis A and B
• Managing underlying conditions like diabetes or high cholesterol
• Increasing intake of liver-friendly foods, such as fruits, vegetables, and whole grains
• Staying hydrated by drinking plenty of water

It’s important to note that these measures should be undertaken under the guidance of a healthcare provider, especially if liver disease has been diagnosed or is suspected.

Natural Supplements for Liver Health

Some natural supplements have shown potential benefits for liver health, although more research is needed to confirm their efficacy:

• Milk thistle: May have protective effects on liver cells
• N-acetyl cysteine (NAC): Could help in certain types of liver damage
• Turmeric: Possesses anti-inflammatory properties that may benefit liver health
• Artichoke leaf: May support liver function and bile production

Always consult with a healthcare provider before starting any supplement regimen, as some supplements can interact with medications or have adverse effects on liver function.

Monitoring Liver Health: Beyond Liver Function Tests

While liver function tests are valuable tools for assessing liver health, they are not the only means of monitoring liver function. Healthcare providers may use a combination of methods to evaluate and track liver health over time:

1. Imaging studies: Ultrasound, CT scans, or MRI can provide visual information about liver structure and detect abnormalities
2. Liver biopsy: In some cases, a small sample of liver tissue may be examined to diagnose specific liver conditions
3. Elastography: Non-invasive techniques like FibroScan can assess liver stiffness, indicating fibrosis or cirrhosis
4. Genetic testing: May be recommended for certain inherited liver disorders
5. Regular physical exams: Can help detect early signs of liver problems, such as an enlarged liver

A comprehensive approach to liver health monitoring, combining various diagnostic tools and regular check-ups, provides the most accurate assessment of liver function and overall health.

Emerging Technologies in Liver Function Assessment

Research is ongoing to develop new, more sensitive methods for assessing liver function:

• Breath tests: Analyzing volatile organic compounds in exhaled breath to detect liver dysfunction
• Advanced imaging techniques: Such as magnetic resonance elastography (MRE) for more precise evaluation of liver fibrosis
• Biomarker panels: Combining multiple blood-based markers for improved diagnostic accuracy
• Artificial intelligence: Using machine learning algorithms to interpret complex liver function data

These emerging technologies hold promise for earlier detection of liver diseases and more personalized treatment approaches in the future.

Liver Function Tests – Understand the Test

Also Known As

Liver Function Tests

LFTs

Liver panel

Hepatic function tests

Formal Name

Hepatic Function Panel

At a Glance

Why Get Tested?

To screen for and monitor liver disease

When To Get Tested?

When you have symptoms of a liver disorder such as jaundice or have been exposed to substances that can cause liver damage such as a paracetamol overdose, or routine monitoring of many medications

Sample Required?

A blood sample taken from a vein in your arm

Test Preparation Needed?

On average it takes 7 working days for the blood test results to come back from the hospital, depending on the exact tests requested. Some specialist test results may take longer, if samples have to be sent to a reference (specialist) laboratory. The X-ray & scan results may take longer. If you are registered to use the online services of your local practice, you may be able to access your results online. Your GP practice will be able to provide specific details.

If the doctor wants to see you about the result(s), you will be offered an appointment. If you are concerned about your test results, you will need to arrange an appointment with your doctor so that all relevant information including age, ethnicity, health history, signs and symptoms, laboratory and other procedures (radiology, endoscopy, etc.), can be considered.

Lab Tests Online-UK is an educational website designed to provide patients and carers with information on laboratory tests used in medical care. We are not a laboratory and are unable to comment on an individual’s health and treatment.

Reference ranges are dependent on many factors, including patient age, sex, sample population, and test method, and numeric test results can have different meanings in different laboratories.

For these reasons, you will not find reference ranges for the majority of tests described on this web site. The lab report containing your test results should include the relevant reference range for your test(s). Please consult your doctor or the laboratory that performed the test(s) to obtain the reference range if you do not have the lab report.

For more information on reference ranges, please read Reference Ranges and What They Mean.

What is being tested?

The liver is a large organ located in the upper right-hand part of the abdomen behind the lower ribs. It takes up drugs and toxic substances from the blood and renders them harmless. It produces proteins, including enzymes and blood clotting factors, helps maintain hormone balance and stores vitamins. The liver produces bile, a fluid that is transported through ducts to the gallbladder to be stored and then to the small intestine to help digest fats.

Liver disease can be detected, evaluated and monitored by combinations of up to five tests measured at the same time on a blood sample. These may include:

• Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best test for detecting hepatitis
• Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places, particularly the heart and other muscles in the body
• Total bilirubin – measures all the yellow bilirubin pigment in the blood
• , measures the form made only in the liver and is often requested with total bilirubin in infants with jaundice
• Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked, either inside or outside the liver
• Albumin – measures the main protein made by the liver and tells how well the liver is making this protein
• Total protein – measures albumin and all other proteins in blood, including antibodies made to help fight off infections

Other tests that can help to assess the liver include gamma-glutamyl transferase (GGT), prothrombin time (PT), P3NP, ELF and sometimes urine testing.

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Common Questions

• How is it used?

  Liver blood tests are used to help determine the cause of symptoms such as jaundice that may be due to liver disease. They are also used to screen for potential liver damage, for example in problem drinkers or people exposed to the hepatitis virus, and also to monitor changes if liver blood tests are abnormal.

• When is it requested?

  These tests are used when symptoms suspicious of a liver condition are noticed. These include: jaundice, dark urine and light-coloured stools; nausea, vomiting and diarrhoea; loss of appetite; vomiting of blood; bloody or black stools; swelling or pain in the belly; unusual weight change; and fatigue or loss of stamina. One or more of these tests may be requested when a person has been or may have been exposed to a hepatitis virus; has a family history of liver disease; has excessive alcohol intake; or is taking a drug that can cause liver damage.

• What does the test result mean?

  It is important to note that abnormal results in the individual tests can occur in conditions that do not involve the liver or the bile ducts and that, conversely, normal results can be found in patients with serious liver disease. However, one or more abnormal liver blood test results often point to a diagnosis or to further investigations.

  • Raised alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values indicate leakage from cells due to inflammation or cell death. Liver disease is more likely when the values of AST and ALT are higher, ALT rising more than AST in acute liver damage such as hepatitis. When there is doubt about the source of the high enzyme levels, a raised creatine kinase (CK) would suggest muscle damage and measurement of troponin will show whether it is the heart that is damaged. Gamma-glutamyl transferase (GGT) can be more sensitive than ALT and AST for detecting liver damage from drugs, obesity and alcohol, and for detecting early rejection after liver transplantation.
  • A raised total bilirubin is usually due to liver disease or blockage of the passage of bile to the gut, for example by gall stones. Bilirubin is made water soluble (conjugated) by the liver and is then excreted in the urine, the stools becoming pale. However, a raised bilirubin can also occur in conditions where the breakdown of red blood cells produces more unconjugated bilirubin than the liver can handle, for example in newborn babies and conditions of abnormal haemoglobin like sickle cell anaemia. If this is suspected, both total and conjugated bilirubin are measured and monitored.
  • Liver disease and blockage of the bile ducts also increase alkaline phosphatase (ALP). This is believed to be due to increased bile duct pressure causing the liver to make more ALP. If there are localised lesions within the liver, for example deposits of cancer cells, then ALP may be stimulated to rise but there may be sufficient normal liver around the deposits to keep bilirubin normal. Bone disease can also increase ALP, for an example fracture or vitamin D deficiency. In patients with a normal bilirubin and a raised ALP, the measurement of gamma-glutamyl transferase (GGT) can help. It tends to rise with liver ALP but is normal in bone disease.
  • Albumin is made only in the liver and may be low when there has been extensive loss of liver tissue in long-standing disease. Other causes of a low albumin include malnutrition (which may accompany alcoholic liver disease), kidney disease, due to loss of protein in the urine, and inflammatory conditions anywhere in the body.
  • Total protein is usually normal in liver disease. The difference between its concentration and that of albumin, called globulin, tends to increase when albumin falls, but very high values are seen most commonly in alcoholic hepatitis and in hepatitis caused by the body producing antibodies against its own liver (autoimmune hepatitis).
  • Patients with liver disease often bruise easily and cuts take a long time to stop bleeding. A long prothrombin time (PT) suggests a deficiency of clotting factors made by the liver or a deficiency of vitamin K which is needed for the factors to work. The deficiency can be the result of severe malnutrition, for example in alcoholism, or the result of blockage of bile passage to the gut. (Bile contains bile salts that are needed for the gut to absorb fat, and vitamin K is fat soluble.) Patients with a long PT may be given an injection of vitamin K and the PT measured again in 24 hours. A quicker PT after the injection indicates a deficiency of vitamin K rather than of clotting factors.

• Is there anything else I should know?

  Depending on the history, examination and results of the liver blood tests your doctor may request one or more further tests including hepatitis virus antibodies A, B and C, alpha-fetoprotein (AFP), alpha-1 antitrypsin (mostly for children), copper, caeruloplasmin, iron and transferrin and smooth muscle antibody. Sometimes imaging scans are requested.

• Why does my doctor want to know what medicines I am taking?

  Many over-the-counter drugs and herbal or dietary supplements have the potential to affect the liver. Excessive paracetamol use and the combination of paracetamol and alcohol for instance can cause severe liver damage, as can exposure to toxins such as poisonous mushrooms.

• Can I have liver disease if I feel fine?

  Yes, liver disease often causes no symptoms or mild nonspecific symptoms, such as fatigue and nausea.

• Can I have abnormal test results and not have liver disease?

  Yes, many conditions including shock, burns, severe infections, trauma, muscle damage from severe exercise and pregnancy can cause one or more of the liver blood tests to be abnormal.

• Why is my family history important?

  Some liver conditions may be inherited, such as haemochromatosis, Wilson’s disease and alpha-1 antitrypsin deficiency. Early detection of these conditions allows them to be treated and managed appropriately.

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Liver Blood Tests – Liver and Gallbladder Disorders

By

Christina C. Lindenmeyer

, MD, Cleveland Clinic

Reviewed/Revised Sep 2021 | Modified Sep 2022

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Topic Resources

Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more in donated blood) and to measure the severity and progress of liver disease as well as the response to treatment.

Laboratory tests are generally effective for the following:

• Detecting liver inflammation, damage, or dysfunction

• Assessing the severity of liver injury Liver Injury Liver injuries are characterized in several key ways: People have tenderness and pain in the abdomen that sometimes radiates to the shoulder. Doctors use computed tomography (CT) or ultrasonography… read more

• Monitoring the course of liver diseases and a person’s response to treatment

• Refining the diagnosis

Liver tests are done on blood samples and measure the levels of enzymes and other substances produced by the liver. These substances include

• Alanine aminotransferase (ALT)

• Albumin

• Alkaline phosphatase (ALP)

• Alpha-fetoprotein (AFP)

• Aspartate aminotransferase (AST)

• Bilirubin

• Gamma-glutamyl transpeptidase (GGT)

• Lactate dehydrogenase (LDH)

• 5’-Nucleotidase

Levels of some of these substances measure the presence and degree of liver inflammation (for example, ALT, AST). Levels of other substances measure how well the liver performs its normal functions of making proteins and secreting bile (for example, albumin, bilirubin). What constitutes a normal value for many of these tests can be found in the table Blood Tests Common Medical Tests A large number of medical tests are widely available. Many tests are used for a particular disorder or group of related disorders. Other tests are commonly used for a wide range of disorders… read more . However, some of these values can be higher than normal in people with disorders not related to the liver.

One test of liver function is the prothrombin time (PT), which is used to calculate the international normalized ratio (INR). Both the PT and the INR are measures of the time needed for blood to clot (the liver synthesizes some proteins necessary for blood clotting, called blood clotting factors). An abnormal PT or INR result can indicate an acute or chronic liver disorder. In both acute and chronic liver disorders, an increasing PT or INR typically indicates progression to liver failure Liver Failure Liver failure is severe deterioration in liver function. Liver failure is caused by a disorder or substance that damages the liver. Most people have jaundice (yellow skin and eyes), feel tired… read more .

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

NOTE:


This is the Consumer Version.


DOCTORS:



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Liver and pancreas tests in Krasnogorsk at Krasnaya Zvezda clinic

Liver and pancreas pathologies can greatly impair a person’s quality of life. In order to determine the condition of these important organs, make the correct diagnosis and prescribe adequate treatment, a whole range of tests is used.

What is included in the complex

When conducting this analysis, the following indicators are calculated:

• total protein;
• ALT;
• AST;
• gamma GT;
• pancreatic amylase;
• indirect bilirubin;
• alkaline phosphatase;
• total cholesterol;
• prothrombin index, prothrombin time.

Reception and analysis of biomaterial

The biomaterial for blood test called Liver and Pancreas is recommended to be taken on an empty stomach. This analysis is done 1-3 days.

When should I get tested?

An analysis to check the liver and pancreas is recommended in the following cases:

• nausea, bitter taste in the mouth, vomiting;
• pain in the right hypochondrium;
• the presence of chronic diseases of the gastrointestinal tract;
• pathological processes in the pancreas.

A general examination of the liver can also be done as a preventive measure to prevent the development of severe gastrointestinal diseases. It is recommended to take such an analysis even in the absence of symptoms annually.

Detailed description of the study

With the help of the liver, the human body produces many substances necessary for it, and also neutralizes toxins and poisons that are formed in the body itself and that enter it with food. In addition, this organ produces bile, which is necessary for the digestion process.

The pancreas produces hormones that are involved in protein, carbohydrate and fat metabolism, and secretes pancreatic juice containing important digestive enzymes. Analyzes for examining the liver and pancreas are recommended in case of disruption of the gastrointestinal tract or the presence of chronic diseases of the digestive system, with pain in the abdomen, as well as in the case of long-term use of drugs that have a strong effect on these internal organs.

Interpretation of the result

Total blood protein test helps physicians in diagnosing metabolic disorders, inflammation, cirrhosis and hepatitis. It represents the level of proteins in the blood serum that take part in its coagulation and carry out the transport function. Alanine aminotransferase (ALT) is one of the main enzymes produced in the liver. Its high level in the blood indicates damage to the cells of the heart and liver. Aspartate aminotransferase (AST) is an enzyme whose elevated blood levels can indicate liver damage. Therefore, an AST test is prescribed if a person takes drugs that are dangerous to the liver for a long time.

Gamma-glutamyltransferase (gamma-GT) is an enzyme whose serum levels help diagnose various diseases of the liver and biliary tract. Pancreatic amylase is an enzyme that is synthesized by the cells of the pancreas. Its content in the blood increases with blockage of the pancreatic ducts caused by the inflammatory process.

Indirect bilirubin is a pigment that is one of the main components of bile. It has a toxic effect on tissues, so its high content may indicate damage to the circulatory system, liver damage, and gallbladder pathology. Alkaline Phosphatase is an enzyme whose levels in the blood can indicate a variety of diseases.

Total cholesterol is a lipid that not only enters the body with food, but is also produced by liver cells. Controlling the level of this substance in the blood reflects the risk of developing atherosclerosis. The prothrombin index and prothrombin time are indicators that indicate for the control of hemostasis, which is necessary when taking anti-clotting drugs and in diagnosing diseases that are at high risk of blood clots.

Contraindications and restrictions

There are no contraindications or restrictions for this test.

Interpretation of the result

You can take tests to examine the liver and pancreas, which allow you to assess the state of these organs and diagnose many serious diseases, in our medical center. Reference values ​​and deviations from the norm of these indicators should be interpreted only by an experienced physician. Therefore, after receiving the results, we recommend making an appointment with a highly qualified gastroenterologist working at the Krasnaya Zvezda clinic.

Reference values ​​

Reference values ​​for this complex of analyzes are as follows:

• total protein 65-85 g/l;
• ALT 0.1-0.68 mmol/hour/L;
• AST 0.1-0.45 mmol/hour/L;
• indirect bilirubin up to 16.5 µmol/l;
• total cholesterol 2.9-5.2 mmol/l;
• prothrombin index 90-105%;
• prothrombin time 11-16 seconds;
• pancreatic amylase and alkaline phosphatase – different for patients of different ages;
• gamma-HT – different for different ages and different sexes.

Liver diagnostics – ALT blood test

Alanine aminotransferase (ALT) is an enzyme found in cells. Its main amount is concentrated in the liver, so the test is used as an indicator of the presence of liver diseases. It is used to diagnose cirrhosis and hepatitis in combination with other tests. The main function of the enzyme in the body is the release of energy from food. Normally, the concentration of the enzyme should not exceed 45 U / l. This rate is set for adults over 18 years of age. In children, normal values ​​vary with age.

Indications for examination

An examination of the liver condition is performed if the patient has the following symptoms:

• fatigue;
• pain in the right hypochondrium;
• jaundice of the sclera and skin;
• enlargement of the abdomen;
• dark urine;
• vomiting and nausea;
• pruritus.

Indicators may increase in the following cases: with the abuse of alcohol, hereditary predisposition to liver disease, viral hepatitis, taking a number of medications. The test is often included in a preventive examination program.

General

Normally, only a small amount of the enzyme can be present in the bloodstream. The release of a large amount of ALT occurs with large-scale cell damage. This organ is located in the abdominal cavity (top right), takes part in many vital processes. The liver is involved in the processing of nutrients, the synthesis of many proteins, the production of bile, and it breaks down toxic substances that are potentially harmful to the body.

An ALT blood test is necessary to check the condition of the liver in patients who are taking drugs that are potentially harmful to this organ and in patients with hepatitis. It should be borne in mind that an increase in the level of this enzyme is not always associated with liver pathologies. It is also found in other organs, so an increase in performance may indicate their pathology.

ALT and AST are the most important liver indications . In many cases, tests for the amount of these enzymes are done at the same time. In the diagnosis, both indicators and their ratio are used (it can be used to determine the cause of liver damage). During treatment, tests are carried out several times at regular intervals to monitor the dynamics of the patient’s condition.

Interpretation of results

Reference values ​​are determined according to the age and sex of the patient. In men, normal values ​​may be higher than in women. As a rule, the results of the study are ready the next day after donating blood. For their interpretation, you must consult a doctor. Self-medication is unacceptable, as it can cause irreparable harm to health.

Reasons for the increase in ALT:

• mononucleosis;
• alcoholism;
• cirrhosis of the liver;
• malignant neoplasm;
• hepatitis;
• heart failure;
• muscle injury;
• kidney damage;
• sunstroke.