What are liver function tests. How are liver panels used in medical care. Which components are typically included in a liver panel. When should you consider getting a liver function test. Where can you obtain a liver panel.

The Importance of Liver Function Tests in Medical Diagnostics

Liver function tests, also known as liver panels, play a crucial role in assessing the health and functionality of one of our body’s most vital organs. These tests provide valuable insights into various aspects of liver health, helping healthcare professionals diagnose, monitor, and manage liver-related conditions.

A liver panel typically involves multiple measurements taken from a blood sample, usually drawn from a vein in the arm. The comprehensive nature of these tests allows for a thorough evaluation of liver health, making them an essential tool in modern medical diagnostics.

Key Components of a Liver Panel

While the specific components of a liver panel may vary depending on the healthcare provider’s requirements, several core measurements are commonly included:

• Aspartate aminotransferase (AST)
• Alanine aminotransferase (ALT)
• Alkaline phosphatase (ALP)
• Bilirubin
• Albumin

Each of these components provides unique insights into liver function and overall health. For instance, elevated levels of AST and ALT can indicate liver cell damage, while abnormal bilirubin levels may suggest issues with bile flow or red blood cell breakdown.

Additional Measurements for Comprehensive Assessment

In some cases, healthcare professionals may include additional measurements to gain a more comprehensive understanding of liver health:

• Gamma-glutamyl transferase (GGT)
• 5′ nucleotidase (5′-NT)
• Total protein
• Globulins
• Prothrombin time
• Lactate dehydrogenase (LDH)

These supplementary tests can provide valuable information about specific liver functions, protein levels, and blood clotting abilities, offering a more detailed picture of liver health.

Applications of Liver Function Tests in Medical Care

Liver function tests serve multiple purposes in healthcare, making them an invaluable diagnostic tool. Here are some of the primary applications:

1. Diagnosis of liver diseases
2. Evaluation of disease severity
3. Screening for liver abnormalities
4. Monitoring treatment effectiveness
5. Assessing medication side effects

By providing a comprehensive overview of liver health, these tests enable healthcare professionals to make informed decisions about patient care and treatment strategies.

Diagnosis and Disease Severity Assessment

While a liver panel alone cannot definitively diagnose liver diseases, it plays a crucial role in the diagnostic process. The test results can help identify the type of liver problem a patient may be experiencing, especially when combined with other clinical information and symptoms.

For patients with known liver conditions, liver function tests can provide valuable insights into the severity of the disease. This information is essential for developing appropriate treatment plans and monitoring disease progression over time.

Screening and Monitoring

Liver panels are often included as part of routine medical check-ups, typically within a broader comprehensive metabolic panel. This screening approach allows for the early detection of potential liver issues, even in the absence of noticeable symptoms.

For patients undergoing treatment for liver conditions, regular liver function tests can help monitor the effectiveness of the treatment. Additionally, these tests are valuable for monitoring potential side effects in patients taking medications that may impact liver health.

Recognizing the Need for Liver Function Tests

Understanding when to get a liver function test is crucial for maintaining optimal health. Several factors may indicate the need for a liver panel:

• Presence of liver disease symptoms
• Monitoring of existing liver conditions
• Evaluation of medication side effects
• Routine health check-ups

Common symptoms that may warrant a liver function test include jaundice (yellowing of the skin and eyes), nausea, vomiting, diarrhea, dark-colored urine, light-colored stool, and fatigue. However, it’s important to note that many of these symptoms can be associated with other health issues, making consultation with a healthcare professional essential.

The Importance of Professional Guidance

Given the complexity of liver function and the potential overlap of symptoms with other health conditions, it’s crucial to seek professional medical advice when considering a liver panel. A healthcare provider can assess your individual circumstances and determine whether a liver function test is necessary as part of an overall health evaluation or for monitoring specific conditions.

Obtaining a Liver Function Test

Liver function tests are typically performed in medical settings such as clinics, hospitals, doctor’s offices, or specialized laboratories. The process for obtaining a liver panel may vary depending on your location and healthcare system:

1. Doctor’s referral: Your healthcare provider may order a liver panel based on your symptoms, medical history, or as part of routine check-ups.
2. Online purchase: Some companies offer liver panel tests that can be purchased online, followed by a referral to a nearby participating laboratory for sample collection.
3. Walk-in laboratories: Certain diagnostic facilities may offer liver function tests without a doctor’s referral, although it’s generally recommended to consult with a healthcare professional for proper interpretation of results.

Regardless of the method chosen, it’s essential to follow any pre-test instructions provided, such as fasting requirements, to ensure accurate results.

Interpreting Liver Function Test Results

Understanding the results of a liver function test is crucial for both patients and healthcare providers. While normal ranges may vary slightly between laboratories, there are general guidelines for interpreting liver panel results:

• AST: 5 to 40 units per liter of serum
• ALT: 7 to 56 units per liter of serum
• ALP: 20 to 140 units per liter of serum
• Bilirubin: 0.1 to 1.2 mg/dL
• Albumin: 3.4 to 5.4 g/dL

It’s important to note that these ranges are general guidelines, and individual results should always be interpreted by a healthcare professional in the context of a patient’s overall health, medical history, and other relevant factors.

The Significance of Abnormal Results

Abnormal liver function test results can indicate various liver conditions or other health issues affecting liver function. Some potential causes of abnormal results include:

• Hepatitis (viral, alcoholic, or autoimmune)
• Cirrhosis
• Fatty liver disease
• Liver cancer
• Medication-induced liver damage
• Biliary obstruction

It’s crucial to remember that abnormal results don’t always indicate a severe liver problem. Factors such as recent alcohol consumption, certain medications, and even intense exercise can temporarily affect liver function test results. This is why follow-up testing and professional interpretation are essential for accurate diagnosis and treatment planning.

The Role of Liver Function Tests in Preventive Healthcare

Beyond their diagnostic and monitoring capabilities, liver function tests play a significant role in preventive healthcare. Regular liver panels can help detect potential liver issues before they progress to more serious conditions, allowing for early intervention and better health outcomes.

Lifestyle Modifications and Liver Health

For individuals with abnormal liver function test results or those at risk of liver disease, healthcare providers may recommend lifestyle modifications to improve liver health:

• Reducing alcohol consumption
• Maintaining a healthy diet
• Exercising regularly
• Managing weight
• Avoiding exposure to toxins

These lifestyle changes, combined with regular monitoring through liver function tests, can significantly impact overall liver health and reduce the risk of developing serious liver conditions.

Advancements in Liver Function Testing

As medical science continues to advance, new developments in liver function testing are emerging. These innovations aim to provide more accurate, comprehensive, and accessible liver health assessments:

Non-Invasive Imaging Techniques

While blood tests remain the primary method for assessing liver function, non-invasive imaging techniques are increasingly being used to complement these tests:

• Fibroscan: This ultrasound-based technique measures liver stiffness, providing information about liver fibrosis and cirrhosis.
• Magnetic Resonance Elastography (MRE): This advanced imaging method combines MRI technology with sound waves to assess liver tissue stiffness and detect early stages of liver disease.

These imaging techniques, when used in conjunction with traditional liver function tests, can provide a more comprehensive picture of liver health and aid in early detection of liver diseases.

Genetic Testing for Liver Diseases

Advancements in genetic testing have opened new avenues for identifying individuals at risk for certain liver conditions. Genetic markers associated with diseases such as hemochromatosis, Wilson’s disease, and alpha-1 antitrypsin deficiency can now be detected through specialized genetic tests.

While these genetic tests are not typically part of routine liver function panels, they can provide valuable information for individuals with a family history of liver disease or those showing unexplained liver function abnormalities.

The Future of Liver Health Assessment

As our understanding of liver function and disease processes continues to grow, the field of liver health assessment is likely to see further advancements:

• Biomarker discovery: Researchers are constantly working to identify new biomarkers that can provide more specific and sensitive indicators of liver health and disease.
• Artificial intelligence in diagnostics: Machine learning algorithms are being developed to analyze complex liver function test data, potentially improving the accuracy and speed of liver disease diagnosis.
• Personalized medicine approaches: As we gain a better understanding of how individual genetic and environmental factors influence liver health, more personalized approaches to liver function testing and treatment may emerge.

These ongoing developments highlight the dynamic nature of liver health assessment and underscore the importance of staying informed about the latest advancements in liver function testing.

Empowering Patients Through Education

Understanding liver function tests and their implications is crucial for patient empowerment and active participation in healthcare decisions. Here are some key points for patients to keep in mind:

• Regular check-ups: Even in the absence of symptoms, periodic liver function tests can be valuable for maintaining overall health.
• Open communication: Discuss any concerns about liver health with your healthcare provider, including family history, lifestyle factors, and medication use.
• Follow-up care: If abnormal results are detected, work closely with your healthcare team to determine the appropriate next steps, which may include additional testing or lifestyle modifications.
• Lifestyle choices: Recognize the impact of diet, exercise, and alcohol consumption on liver health, and make informed decisions to support your liver function.

By staying informed and proactive about liver health, individuals can play an active role in preventing liver disease and maintaining overall well-being.

Liver function tests remain a cornerstone of liver health assessment, providing valuable insights into this vital organ’s performance. As medical science continues to advance, these tests will likely become even more sophisticated, offering increasingly detailed and personalized information about liver health. By understanding the importance of liver function tests and staying informed about advancements in liver health assessment, individuals can take proactive steps towards maintaining optimal liver function and overall health.

Liver Panel Test – Testing.com

Test Quick Guide

A liver panel is a test with multiple measurements that help assess the health and function of the liver. The test is conducted with a blood sample that is normally taken from a vein in your arm.

A liver panel can be used to help diagnose and monitor liver diseases. It can also provide information about other health conditions that affect the liver, such as viral or alcoholic hepatitis. If you are taking medications that can impact the liver, the test results can determine whether side effects are occurring.

About the Test

Purpose of the test

The liver panel has many applications in medical care. While sometimes called a liver function test, it is better understood as a method of detecting liver disease and/or other health problems, including many that involve the liver.

Some of the specific ways that a liver panel can be used include:

• Diagnosis: Although a liver panel alone is not able to diagnose liver diseases, its measurements can help identify the type of problem if you have symptoms of liver conditions. The test can also help in the diagnostic process of other health concerns.
• Evaluating disease severity: A liver panel can help determine the extent of illness if you have known liver problems.
• Screening: You may have a liver panel as part of broader blood testing, known as the comprehensive metabolic panel, during routine medical checkups. If screening is abnormal, it may warrant more specific follow-up testing.
• Monitoring: Follow-up testing can provide information about how well treatment for liver problems is working. A liver panel can also monitor for side effects when you take medications that can impact liver health.

What does the test measure?

As a panel test, the liver panel involves multiple measurements. When the test is ordered, doctors can modify exactly which measurements to take.

For this reason, there is not a universal standard for what is measured on a liver panel. Nevertheless, some components of the test are more common. In most cases, a liver panel includes the following measurements:

• Aspartate aminotransferase (AST): This is a type of protein called an enzyme that is found in the liver as well as many muscles and organs.
• Alanine aminotransferase (ALT): This is an enzyme found primarily in the liver.
• Alkaline phosphatase (ALP): This is an enzyme found in the liver, bones, and other tissues in the body.
• Bilirubin: Bilirubin is a yellow-colored waste product that is the result of the normal breakdown of red blood cells. The liver works to remove bilirubin from the body.
• Albumin: Albumin is the most abundant protein in the blood and is made by the liver which prevents fluids from leaking out of the bloodstream.

Additional measurements may be added to a liver panel if the doctor believes they can provide more information to evaluate your situation. These measures may be tested on an initial liver panel, or included in repeat testing after an abnormal result on a previous test.

• Gamma-glutamyl transferase (GGT): An enzyme found in the liver and other organs.
• 5’ nucleotidase (5’-NT): An enzyme that exists in the liver and other organs.
• Total protein: Measures the sum of all proteins in the blood.
• Globulins: A class of proteins in the blood.
• Prothrombin time: A protein made by the liver that facilitates normal blood clotting and measures how long it takes for the blood to clot.
• Lactate dehydrogenase (LDH): An enzyme found in tissues throughout the body.

When should I get a liver panel?

There are many reasons you might decide to get a liver diagnostic test, or why a health care professional will order the lab test for you. This test can detect liver disease and other health problems involving the liver. You might be taking medications with liver damage as a side effect, and the test can measure whether the prescription is having a negative impact on your health. A liver panel can also be done as part of a metabolic panel during a routine medical visit.

A doctor might recommend a liver panel if you show common symptoms like jaundice (yellowing of the skin and eyes), nausea and vomiting, diarrhea, dark-colored urine, light-colored stool, or fatigue. The tricky thing is, aside from jaundice, these symptoms can easily be written off as “something else.”

That’s why it’s really important to consult with your doctor, who can advise whether a liver panel is necessary as part of an overall medical checkup or because of specific circumstances, such as monitoring cirrhosis or medication side effects.

Finding a Liver Panel

How can I get a liver panel?

Liver panel testing is performed in a medical setting such as a clinic, hospital, doctor’s office, or lab. Your doctor may order the liver panel, or you can purchase the test online and be referred to a nearby participating lab for the sample. Most liver panel testing happens with a blood draw and laboratory analysis. But there is a type of rapid, on-site point-of-care test that can measure certain components of the liver panel. It is not comprehensive.

Can I take the test at home?

There are at-home liver panel tests that can determine liver function by screening for proteins and enzymes like albumin, globulin, ALP, ALT, and GGT. These tests use a finger-prick sample and include materials to collect and send your specimen to the lab.

You can order a liver panel from home and get tested in a lab. Or, your doctor can prescribe the liver panel.

The at-home liver panel test is focused on liver function but does not provide the comprehensive results that an expanded liver panel does. It also tests for direct bilirubin and total bilirubin (waste produced by the liver), and AST, an enzyme found in the liver and other tissues.

How much does the test cost?

If you get a liver test ordered by a doctor, your insurance policy may cover the cost of the appointment and lab analysis. There may be a copay or deductible, however. If you order the test online, you can submit the receipt for potential reimbursement. You can find affordable liver panel testing that ranges in price from $39 to $79.

Before you order your own test from a lab or arrange a doctor-ordered liver panel, ask about costs, insurances accepted, copays, and deductibles. Be sure to refer to your doctor, lab, and health plan for details on test costs and insurance coverage.

Taking a Liver Panel Test

A liver panel requires drawing blood from a vein in your arm. The procedure is routine and performed in a medical office, clinic, hospital, or lab. There are some at-home tests available that involve a skin prick, but they are not as thorough as a liver panel from a lab.

Before the test

Plan on fasting for up to 12 hours before you take a liver panel test, only drinking water during this time. Also, be sure your doctor knows what medications you are taking because some prescription drugs and over-the-counter medications or dietary supplements can interfere with the test. Your doctor will provide specific guidelines on which medications and for how long to avoid them before a liver panel blood draw.

Not all liver panels require preparation. For example, an expanded liver panel you order online and go to a lab for testing does not require fasting. The comprehensive liver panel you can order online for lab testing does require fasting for 12 to 14 hours.

For at-home finger-prick liver tests, be sure to read the instructions carefully so you know whether the preparation is required.

During the test

A routine blood draw is all that is required to perform a liver panel. With a small needle, blood is drawn from a vein in your arm into a vial and analyzed by a lab. The phlebotomist will carefully clean the area first with antiseptic, and you might feel a sting when the needle is inserted or removed. You could experience mild bruising or soreness after the test like if you were getting blood drawn for any other medical panel. The entire process takes no more than five minutes.

At-home tests require a finger prick. The kit will include a lancet or small needle. You’ll get a test strip where you apply the blood drops, and then secure it in the provided packaging to send to the lab. It takes less than a minute to gather your sample and prepare the dry blood card for the lab. Remember, test kit instructions vary, so it’s important to read all instructions before obtaining your blood sample.

After the test

There are no restrictions after getting blood drawn for a liver panel, but if you fasted for 12 to 14 hours prior to the lab test, you will probably feel weak or fatigued. Consider bringing a snack for after your test. You can return to standard activities. Other than changing an adhesive bandage, there’s little to no recovery.

Liver Panel Test Results

Receiving test results

Depending on what type of liver panel you get, you can expect test results within one to two business days for an expanded panel that measures enzymes and proteins. It many take one to two days for a comprehensive panel that assesses enzymes and proteins to determine liver function, including GGT and LD. The comprehensive panel is also called hepatic function testing.

Lab result times can vary, so ask the clinician in advance how long it will take. Even at-home tests that use a finger prick to collect a blood sample will take a few business days from the time the lab receives your sample before you get results.

The speed of results can also depend on how you get them. Labs deliver results in a number of ways, including confidential phone calls, secure emails, or via an app.

Interpreting test results

Your liver panel test results will depend on the type of test. You will see some reference ranges to understand what levels are considered abnormal. Always discuss these results with a medical professional so you can ask questions and gain a clear understanding of the report, its information, and the next steps.

There are five common measures your liver panel test results will reveal.

• Bilirubin: Total bilirubin will show whether levels are raised due to a metabolic disorder or liver disease. In infants, it can indicate whether support is needed to address a liver that is not functioning properly.
• Albumin: This protein can be a marker for liver function and reduced albumin could indicate sepsis, inflammatory disorders, and other liver problems.
• ALP: Higher levels of ALP can be found in those with liver and bone disease.
• AST and ALT: These are liver enzymes and elevation can indicate liver-related issues. ALT can be an indicator of liver cell injury.
• GGT: This is used in the diagnosis and treatment of liver disease and in the evaluation of patients with alcoholism.

When test results are abnormal, doctors often look for certain patterns of abnormalities in the specific levels that were detected.

• Conditions involving acute or chronic liver damage often show disproportionate increases in ALT and AST compared to ALP.
• Bile duct obstruction is more often associated with a disproportionate increase in ALP compared to ALT and AST.
• Disorders affecting the normal processing of bilirubin may be demonstrated by elevated bilirubin with normal levels of ALT, AST, and ALP.
• Health conditions originating outside the liver are more common when abnormal albumin or prothrombin time occurs with otherwise normal results.

Your doctor will look at these test results and take into account your health, symptoms, and medical and family history. Any drugs you take are also considered since some medications can impact test results. Liver panel results are complex, so always review results with a medical professional who understands your case and can answer your questions. Here are some to ask:

• Was any part of my test result abnormal?
• If there was an abnormal result, can you explain what was found and what it may mean?
• If results were normal, will I need to have this testing again at any point in the future?
• Are there any follow-up tests that may be beneficial given my test results?

• CMP Blood Test (Comprehensive Metabolic Panel)
  Learn More
• Alanine Aminotransferase (ALT)
  Learn More
• Alkaline Phosphatase (ALP) Test
  Learn More
• Albumin Blood Test
  Learn More
• Total Protein, Albumin-Globulin (A/G) Ratio Test
  Learn More
• Bilirubin Test
  Learn More
• GGT Blood Test (Gamma Glutamyl Tranferase/Transpeptidase)
  Learn More
• Lactate Dehydrogenase (LDH) Test
  Learn More
• PT/INR Test (Prothrombin Time and International Normalized Ratio)
  Learn More

Resources

• National Library of Medicine: Liver Diseases
• National Institute of Diabetes and Digestive and Kidney Diseases: Liver Disease
• American Liver Foundation: Diagnosing Liver Disease

Sources

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Alcohol-related liver disease – Diagnosis

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.

This is because the condition causes few obvious symptoms in the early stages.

If a doctor suspects ARLD, they’ll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption.

It’s important to be totally honest about how much and how often you drink alcohol. This is to avoid further unnecessary testing, which could lead to a delay in the treatment you need.

Blood tests

Blood tests used to assess the liver are known as liver function tests.

But liver function tests can be normal at many stages of liver disease.

Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver.

A low level of serum albumin suggests your liver is not functioning properly.

A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage.

Find more information on liver blood tests on the Lab Tests Online website

Further testing

If your symptoms or liver function test suggest an advanced form of ARLD (either alcoholic hepatitis or cirrhosis), you may need further tests.

Imaging tests

Scans may be needed to produce detailed images of your liver.

This may include:

• an ultrasound scan
• a CT scan
• an MRI scan

Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred.

Liver biopsy

During a liver biopsy, a fine needle is inserted into your body (usually between your ribs).

A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope.

The biopsy is usually carried out under local anaesthetic, either as a day case or with an overnight stay in hospital.

Your liver tissue will be examined to determine the degree of scarring in the liver and the cause of the damage.

Endoscopy

An endoscope is a long, thin, flexible tube with a light and a video camera at one end. 

During an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach.

Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis.

Page last reviewed: 20 September 2022
Next review due: 20 September 2025

Complete laboratory examination of the liver

Comprehensive laboratory examination of the liver, including indicators of protein, fat and pigment metabolism, markers of viral hepatitis and tumor marker alpha-fetoprotein (AFP).

Synonyms Russian

Complete laboratory examination of the liver, screening for liver diseases.

English synonyms

Laboratory liver panel, Tests to diagnose liver diseases, Liver check-up.

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

• Do not eat for 12 hours before the test, you can drink pure non-carbonated water.
• Exclude physical and emotional overexertion within 30 minutes prior to the study.
• Do not smoke for 30 minutes before the test.

General information about the study

The liver is the largest gland in the human body. This organ performs about 5,000 different functions, the main of which are the synthesis of proteins, including albumin, globulins and blood coagulation proteins, hormone metabolism, detoxification of harmful substances and metabolic products, the synthesis of cholesterol and glucose, the storage of vitamins and iron, and many others. No wonder, then, that the liver is so prone to disease. Liver diseases can have different etiologies (hereditary metabolic disorders, intoxication, diabetes mellitus, viral infection, autoimmune disorders) and are very common among the population.

Laboratory diagnostics plays a leading role in assessing the condition of the liver. Especially convenient for the doctor and the patient is a comprehensive analysis that includes all laboratory markers of liver diseases.

1. To assess the synthetic function of the liver, the concentration of the following clinical and laboratory markers is examined: albumin, blood coagulation factors (coagulogram) and cholesterol.

• Albumin is the main blood protein that performs a transport function and maintains oncotic pressure. In violation of the synthetic function of the liver, the concentration of this protein, as a rule, decreases. It should be noted that this decrease is observed in severe liver diseases, such as fulminant hepatitis and severe liver failure. On the contrary, with torpid or latent liver diseases (hepatitis C, alcoholic hepatitis), the level of total protein may remain within the normal range. In addition, changes in albumin concentration can be observed in many other diseases and conditions, such as starvation, malabsorption, nephrotic syndrome, infectious diseases, and others.
• Quick prothrombin (another name is prothrombin time) and international normalized ratio (INR, INR) are the main indicators used to assess the external pathway of blood coagulation (fibrinogen, prothrombin, factor V, VII and X). The liver is the main source of synthesis of these factors, and diseases of this organ can be accompanied by a violation of the coagulation mechanism and lead to increased bleeding. Clinically significant disorders of blood coagulation are observed in the late stages of liver disease.
• Cholesterol can be synthesized in almost any cell of the body, but most of it (up to 25%) is synthesized in the liver, from where this compound enters the systemic circulation as part of very low density lipoproteins (VLDL) or into the gastrointestinal tract as part of bile acids . Hypercholesterolemia is a characteristic feature of hepatic cholestasis observed in cholelithiasis, primary sclerosing cholangitis, viral hepatitis, primary biliary cirrhosis, and some other diseases. Hypocholesterolemia has less clinical significance. Different fractions of cholesterol are associated with different effects on human health. Thus, low-density lipoprotein cholesterol (LDL-C) is a well-known risk factor for heart disease, while HDL-C is considered one of the protective factors.

2. In diseases accompanied by a violation of the integrity of hepatocytes (for example, viral hepatitis), hepatic intracellular enzymes are released into the blood and their concentration in the blood increases. This laboratory phenomenon is called cytolysis syndrome. In clinical practice, the liver enzymes ALT and AST are examined to diagnose cytolysis.

• ALT and AST are transaminases that catalyze the transfer of amino groups between amino acids. Although these enzymes can also be found in many other tissues and organs (heart, skeletal muscle, kidneys, brain, red blood cells), changes in their concentration in the blood are more often associated with liver disease, which leads to their name – hepatic transaminases. ALT is a more specific marker of liver disease than AST. With viral hepatitis and toxic liver damage, as a rule, the same increase in the level of ALT and AST is observed. In alcoholic hepatitis, liver metastases, and cirrhosis, there is a more pronounced increase in AST than ALT.

3. To exclude obstruction of the biliary tract by gallstones or tumors (liver, pancreas, papilla of Vater), the total concentration of bilirubin and its fractions, total alkaline phosphatase and gamma-HT are examined.

• Bilirubin is a pigment formed during the breakdown of hemoglobin and some other heme-containing proteins in the liver, spleen and bone marrow. It exhibits toxicity to the nervous system and must be eliminated from the body in the bile or urine. Excretion of bilirubin is a multi-step process in which the liver plays a major role. There are two main fractions of bilirubin: direct and indirect. When bilirubin binds to glucuronic acid, conjugated bilirubin is formed in the liver. Since this type of bilirubin can be determined directly with a direct laboratory test, it is also called direct bilirubin. Bilirubin that has not undergone conjugation with glucuronic acid is called unbound. In laboratory conditions, it is not possible to investigate the level of unbound bilirubin: its concentration is calculated based on the concentrations of total and bound bilirubin. For this reason, this type of bilirubin is also called indirect. Total bilirubin consists of both fractions. An increase in the level of bilirubin can be observed in many liver diseases, but the greatest value of this marker lies in the differential diagnosis of jaundice. Hemolytic (prehepatic) jaundice is characterized by an increase in total and indirect bilirubin. For hepatic jaundice, an increase in both fractions (direct and indirect bilirubin) and total bilirubin is typical. Obstructive (subhepatic) jaundice is characterized by an increase in total and direct bilirubin.

• Alkaline phosphatase, ALP is an enzyme found in the membrane of the biliary pole of hepatocytes, as well as in bone tissue and intestinal cells. The concentration of total alkaline phosphatase is increased in almost 100% of cases of extrahepatic obstruction of the biliary tract. As a rule, complete obstruction is accompanied by a significant increase in total alkaline phosphatase (more than 3-5 times). With intrahepatic obstruction, the level of total alkaline phosphatase also increases, but not so sharply (less than 3 times). It should be noted that an increase in total alkaline phosphatase can also be observed in other diseases, such as bone disease, myocardial infarction and sarcoidosis. Therefore, in order to confirm that liver disease is the cause of the increase in the level of total alkaline phosphatase, it is advisable to conduct an additional study – an analysis for gamma-HT.

• Gamma-glutamyl transpeptidase, gamma-GT is also a membrane-bound liver enzyme that catalyzes the transfer of the gamma-glutamyl group of glutathione to other molecules. Gamma-HT is currently the most sensitive marker of liver disease. An increase in gamma-HT levels is the earliest sign of liver damage. An increase in the concentration of gamma-HT can be observed in all liver diseases, but the greatest value of this marker is in the diagnosis of biliary tract obstruction. With obstruction of the biliary tract, the concentration of gamma-HT increases by 5-30 times. The study of the level of gamma-HT allows you to make sure that the increase in total alkaline phosphatase is caused precisely by liver disease, and not by other causes, primarily diseases of the skeletal system. As a rule, with obstruction of the biliary tract, there is a parallel increase in the level of gamma-HT and total alkaline phosphatase. High levels of gamma-HT are characteristic of liver metastases and alcoholic cirrhosis. In viral hepatitis, there is a moderate increase in the level of gamma-HT (2-5 times). It should be noted that an increase in total ALP and gamma-HT is also observed in obstruction of the biliary tract caused by diseases of the pancreas (cancer of the pancreatic head).

4. The liver is one of the organs in which iron is stored. In the presence of a genetic defect in iron metabolism (primary hemochromatosis), as well as in chronic iron overload (secondary hemochromatosis: multiple blood transfusions, chronic hemolytic anemia), there is an excessive accumulation of iron in the liver and other tissues, which ultimately leads to the development of liver failure. When examining a patient with signs of liver failure, one should always be aware of hemochromatosis. To exclude it as a cause of liver damage, the level of iron in the blood is examined. It is elevated in hemochromatosis.

5. Viral hepatitis (B and C) is very common in the general population. Often they are asymptomatic or with minimal symptoms (weakness, heaviness in the right hypochondrium) and therefore remain unrecognized. On the other hand, over time, chronic hepatitis can lead to the development of liver cirrhosis and hepatocellular carcinoma. For this reason, all patients should be tested for hepatitis, especially those at risk for these diseases (living in a region with a high prevalence of viral hepatitis B and C, including in Russia, injecting drug use, homosexual sexual contacts, hemodialysis, HIV – infection, change of sexual partners, etc.). This comprehensive analysis included the main markers of hepatitis: antibodies to hepatitis C virus (anti-HCV) and hepatitis B surface antigen (HBsAg).

6. If liver cancer is suspected, the level of alpha-fetoprotein (AFP) is examined. AFP is a tumor marker for hepatocellular carcinoma. In this disease, the level of AFP, as a rule, exceeds 400 ng / ml.

This comprehensive analysis allows you to comprehensively assess the condition of the liver and exclude its underlying diseases. In some situations, however, additional research may be required.

What is research used for?

• For evaluation of function and early diagnosis of liver diseases.

When is the test ordered?

• At a preventive examination;
• in the presence of symptoms of diseases of the liver, gallbladder and bile ducts: pain or discomfort in the right hypochondrium, nausea, stool disorders, darkening of urine color, jaundice, edema, increased bleeding, fatigue;
• when observing a patient receiving hepatotoxic drugs for any disease (methotrexate, tetracyclines, amiodarone, valproic acid, salicylates).

What do the results mean?

Reference values ​​

For each indicator included in the complex:

• [03-007] Coagulogram No. 1 (prothrombin (according to Quick), INR)
• [06-003] Alanine aminotransferase (ALT)
• [06-004] Serum albumin
• [06-010] Aspartate aminotransferase (AST)
• [06-013] Gamma-glutamyl transpeptidase (gamma-GT)
• [06-017] Serum iron
• [06-036] Bilirubin total
• [06-037] Bilirubin direct
• [06-045] General alkaline phosphatase
• [06-048] Cholesterol, total
• [07-009] anti-HCV, antibodies
• [07-025] HBsAg
• [08-016] Alpha-fetoprotein (alpha-FP)
• [30-002] Bilirubin indirect

Important Notes

• To obtain an accurate result, follow the test preparation guidelines;
• the results of the study are evaluated taking into account additional anamnestic, instrumental and laboratory data.

Also recommended

[40-085] Viral hepatitis B. Control of viral activity before treatment

[40-091] Viral hepatitis C. Tests before treatment interferon and Ribavirin

[13-022] Antibodies to the microsomal fraction of the liver and kidneys (anti-LKM)

[13-021] Anti-mitochondrial antibodies (AMA)

[13-068] Antibodies to autoimmune liver disease antigens (antibodies to liver-kidney microsomes type 1 (LKM-1), mitochondrial pyruvate decarboxylase complex (PDC/M2) ), cytosolic antigen (LC-1) and soluble liver antigen (SLA/LP))

[13-069] Extended serology of autoimmune liver diseases

[12-005] Cytological examination of material obtained during surgery

Who appoints a study?

Therapist, general practitioner, infectious disease specialist, gastroenterologist, hepatologist.

Literature

1. McPhee S.J., Papadakis M. CURRENT Medical Diagnosis and Treatment / S. J. McPhee, M. Papadakis; 49 ed. – McGraw-Hill Medical, 2009.
2. Chernecky C. C. Laboratory Tests and Diagnostic Procedures / C.S. Chernecky, V.J. Berger; 5th ed. – Saunder Elsevier, 2008.
3. Fauci et al. Harrison’s Principles of Internal Medicine/A. Fauci, D. Kasper, D. Longo, E. Braunwald, S. Hauser, J. L. Jameson, J. Loscalzo; 17 ed. – The McGraw-Hill Companies, 2008.

Basic biochemical parameters

Comprehensive laboratory examination, including all the main biochemical blood parameters and allowing to evaluate the function of the liver (ALT, AST, total bilirubin), kidneys (urea, creatinine), as well as the metabolism of carbohydrates (glucose), lipids (total cholesterol ) and proteins (total protein).

Synonyms Russian

Main biochemical parameters of blood.

Synonyms English

Biochemical profile, Basic biochemical blood tests.

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

• Do not eat for 12 hours before the test, you can drink pure non-carbonated water.
• Exclude physical and emotional overexertion within 30 minutes prior to the study.
• Do not smoke for 30 minutes before the test.

General information about the study

Basic biochemical blood parameters allow for a comprehensive assessment of the functions of various organs and systems. Together with a general blood test (CBC) and a general urinalysis (OAM), this comprehensive study is included in the “clinical minimum” of tests, which is performed almost every time a patient visits a doctor. The analysis is screening and includes baseline indicators that can be used to assess the main functions of the human body and suspect the most common diseases.

1. To assess liver function, the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (ALT) and total bilirubin are examined.

ALT and AST are enzymes that catalyze the transfer of amino groups between amino acids (transaminases). Although these enzymes can also be found in many other tissues and organs (heart, skeletal muscle, kidneys, brain, red blood cells), changes in their concentration in the blood are more often associated with liver disease, which leads to their name – hepatic transaminases. ALT is a more specific marker of liver disease than AST. With viral hepatitis and toxic liver damage, as a rule, the same increase in the level of ALT and AST is observed. In alcoholic hepatitis, liver metastases, and liver cirrhosis, there is a more pronounced increase in AST than ALT. It should be noted that there is no direct relationship between the degree of liver damage and the level of hepatic transaminases.

Bilirubin is a pigment formed during the breakdown of hemoglobin and some other heme-containing proteins in the liver, spleen and bone marrow. Total bilirubin is a combination of unbound (indirect, associated with albumin) and associated with glucuronic acid (direct) bilirubin. An increase in the level of bilirubin can be observed in many liver diseases, however, the greatest value of this marker lies in the differential diagnosis of jaundice and the diagnosis of biliary tract obstruction. With an increase in the level of total bilirubin, it is advisable to conduct a study of direct bilirubin and calculate the value of indirect bilirubin, as well as to study the concentrations of such markers of biliary tract obstruction as alkaline phosphatase (AP) and gamma-glutamyl transpeptidase (GGTP).

2. Serum creatinine and urea are measured to evaluate kidney function.

Creatinine is the end product of the metabolism of creatine phosphate, an energy substrate produced in the muscles. Creatinine is freely filtered by the glomeruli and is used as an indicator of glomerular filtration rate (GFR) and overall kidney function. Elevated serum creatinine is indicative of reduced GFR and impaired renal function, but can also be seen with dehydration and muscle damage. It should be noted that a change in the level of creatinine is not an early sign of kidney disease: an increase in its level above the upper limit of the norm is observed with a decrease in GFR by as much as 50%. This is especially important when examining elderly patients in whom a progressive decrease in GFR is not accompanied by a deviation in the level of creatinine from the norm due to a decrease in its production in the body of an elderly person. For this reason, serum creatinine is not recommended as the sole measure of renal function. GFR is considered to be the best indicator of kidney function, which can be obtained either from a calculation using serum creatinine concentration (as well as sex, age, race and body size) or using Rehberg’s test.

Urea is an end product of protein metabolism, formed in the liver and excreted by the kidneys. This indicator is traditionally used together with creatinine to assess kidney function, but can also indicate liver disease.

3. Glucose is an integral indicator of carbohydrate metabolism and one of the criteria for diagnosing diabetes mellitus (DM). Regular measurement of fasting blood glucose levels will allow diagnosing diabetes in time and preventing its complications.

4. Total cholesterol – an integral indicator of lipid metabolism and one of the criteria for diagnosing atherogenic dyslipidemias. Regular measurement of cholesterol levels will make it possible to diagnose lipid metabolism disorders in time and prevent such diseases of the cardiovascular system as myocardial infarction. Currently, it is recommended to start measuring the level of total cholesterol at the age of 35 years in men and 45 years in women, or earlier in the presence of several risk factors for cardiovascular diseases (for example, a history of familial hypercholesterolemia aggravated, the presence of a relative with early coronary artery disease). It should be noted that the most accurate information about lipid metabolism will be obtained by performing a lipidogram, which includes, in addition to total cholesterol, other indicators, including the main fractions of blood lipoproteins.

5. Total protein – an integral indicator of protein metabolism. Of greater importance is a decrease in total protein, which can be observed in malnutrition (anorexia, starvation), the presence of chronic infectious (tuberculosis), inflammatory (rheumatoid arthritis) and oncological diseases, as well as impaired liver function (cirrhosis of the liver), kidneys (nephrotic syndrome) and intestinal absorption function (protein-losing enteropathy).

This comprehensive analysis includes basic biochemical parameters and allows you to suspect underlying diseases. Additional laboratory tests may be required for more accurate health information.

It should be noted that the deviation of any indicator from the norm does not always indicate the presence of a disease, and the result of the analysis should be interpreted in conjunction with all available data about the patient.

The most accurate information about the patient’s health status will be obtained by assessing baseline indicators in dynamics, that is, by comparing repeated analyzes. Repeated analyzes are recommended to be performed using the same test systems, that is, in the same laboratory.

What is the study used for?

• For a comprehensive assessment of the patient’s health status;
• for the timely detection of major diseases.

When is the test ordered?

• At the annual examination of the patient;
• when a patient seeks medical care.

What do the results mean?

Reference values ​​

For each indicator included in the complex:

• [06-003] Alanine aminotransferase (ALT)
• [06-010] Aspartate aminotransferase (AST)
• [06-015] Plasma glucose
• [06-021] Serum creatinine (with GFR determination)
• [06-034] Serum urea
• [06-035] Total whey protein
• [06-036] Bilirubin total
• [06-048] Cholesterol, total

Important notes

• The results of the study are evaluated taking into account additional clinical, instrumental and laboratory data.