What are liver function tests. How are liver function tests performed. What do liver function tests measure. When should you get a liver function test. How can you interpret liver function test results. What conditions can liver function tests diagnose. How often should liver function tests be done.

What Are Liver Function Tests and Why Are They Important?

Liver function tests, also known as a liver panel, are a crucial set of blood tests that provide valuable insights into the health and functionality of your liver. These tests measure various components in your blood that reflect liver activity, helping healthcare professionals assess liver health, diagnose potential issues, and monitor ongoing conditions or treatments.

The importance of liver function tests cannot be overstated. Your liver plays a vital role in numerous bodily functions, including:

• Filtering toxins from the blood
• Producing essential proteins
• Storing vitamins and minerals
• Regulating blood clotting
• Aiding in digestion

By providing a comprehensive picture of liver health, these tests enable early detection and management of liver diseases, which can be crucial for preventing long-term complications.

The Components of a Liver Function Test: What’s Being Measured?

A typical liver function test panel includes several key measurements, each offering unique insights into liver health and function. The most common components are:

1. Aspartate Aminotransferase (AST)

AST is an enzyme found in various tissues, including the liver, heart, and muscles. Elevated levels can indicate liver damage, but it’s not specific to liver issues alone.

2. Alanine Aminotransferase (ALT)

ALT is an enzyme primarily found in the liver. Increased levels are more specific to liver damage than AST.

3. Alkaline Phosphatase (ALP)

ALP is an enzyme present in the liver, bones, and other tissues. Elevated levels can suggest liver or bone disorders.

4. Bilirubin

Bilirubin is a yellow pigment produced during the breakdown of red blood cells. High levels can indicate liver dysfunction or other conditions affecting bile flow.

5. Albumin

Albumin is a protein produced by the liver. Low levels can suggest chronic liver disease or malnutrition.

Depending on the specific circumstances, additional tests may be included in the panel:

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

When Should You Consider Getting a Liver Function Test?

Liver function tests are versatile diagnostic tools used in various medical scenarios. You might need a liver function test in the following situations:

1. During routine health check-ups
2. If you’re experiencing symptoms of liver problems
3. To monitor known liver conditions
4. When taking medications that may affect liver function
5. To evaluate overall health before surgery

Symptoms that might prompt your healthcare provider to order a liver function test include:

• Jaundice (yellowing of skin and eyes)
• Abdominal pain or swelling
• Chronic fatigue
• Nausea or loss of appetite
• Dark urine or pale stools

If you’re experiencing any of these symptoms, it’s crucial to consult with your healthcare provider promptly.

The Liver Function Test Process: What to Expect

Understanding the liver function test process can help alleviate any concerns you might have about the procedure. Here’s what you can expect:

Preparation

In most cases, no special preparation is required for a liver function test. However, your healthcare provider may ask you to fast for 10-12 hours before the test, especially if other blood tests are being performed simultaneously.

The Blood Draw

The test involves a simple blood draw, typically from a vein in your arm. The procedure is quick and usually causes only minor discomfort.

Analysis

Your blood sample will be sent to a laboratory for analysis. Results are usually available within a few days.

Follow-up

Your healthcare provider will review the results with you and discuss any necessary next steps or further testing.

Interpreting Liver Function Test Results: What Do They Mean?

Interpreting liver function test results can be complex, as various factors can influence the outcomes. Generally, results are compared to reference ranges, which may vary slightly between laboratories.

Here’s a basic guide to understanding your results:

• AST and ALT: Elevated levels may indicate liver damage from various causes, including hepatitis, alcohol use, or medications.
• ALP: High levels can suggest bile duct obstruction or certain bone disorders.
• Bilirubin: Increased levels may indicate liver dysfunction, bile duct obstruction, or certain types of anemia.
• Albumin: Low levels can suggest chronic liver disease or malnutrition.

It’s important to note that abnormal results don’t always indicate a serious problem. Factors such as medications, recent illnesses, or even intense exercise can affect test results. Your healthcare provider will consider your overall health and other factors when interpreting your results.

Common Conditions Diagnosed by Liver Function Tests

Liver function tests can help diagnose or monitor a wide range of conditions affecting liver health. Some of the most common conditions include:

1. Hepatitis

Hepatitis is inflammation of the liver, often caused by viral infections (such as hepatitis A, B, or C) or excessive alcohol consumption. Liver function tests can detect elevated liver enzymes indicative of hepatitis.

2. Cirrhosis

Cirrhosis is scarring of the liver tissue, often resulting from long-term liver damage. Liver function tests may show decreased albumin levels and elevated bilirubin in advanced cases.

3. Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is characterized by fat accumulation in the liver. Mild elevations in liver enzymes may be observed in liver function tests.

4. Alcohol-Related Liver Disease

Excessive alcohol consumption can lead to various liver problems. Liver function tests often show elevated AST and ALT levels, with AST typically higher than ALT in alcohol-related liver disease.

5. Medication-Induced Liver Injury

Certain medications can cause liver damage as a side effect. Liver function tests are often used to monitor liver health in patients taking potentially hepatotoxic drugs.

While liver function tests can provide valuable insights, they are usually just one part of the diagnostic process. Additional tests, such as imaging studies or liver biopsies, may be necessary for a definitive diagnosis.

Maintaining Liver Health: Lifestyle Factors and Prevention

While regular liver function tests are important for monitoring liver health, there are several lifestyle factors you can control to maintain a healthy liver:

1. Limit Alcohol Consumption

Excessive alcohol intake is a leading cause of liver disease. If you choose to drink, do so in moderation.

2. Maintain a Healthy Weight

Obesity is a risk factor for non-alcoholic fatty liver disease. Maintaining a healthy weight through diet and exercise can help protect your liver.

3. Exercise Regularly

Regular physical activity can help prevent fatty liver disease and improve overall liver function.

4. Eat a Balanced Diet

A diet rich in fruits, vegetables, whole grains, and lean proteins can support liver health. Avoid excessive consumption of processed foods and saturated fats.

5. Practice Safe Sex and Hygiene

Hepatitis B and C can be transmitted through bodily fluids. Practice safe sex and avoid sharing personal items like razors or toothbrushes.

6. Limit Exposure to Toxins

Be cautious when using household chemicals, pesticides, and other potentially toxic substances. Follow safety guidelines and use protective equipment when necessary.

7. Get Vaccinated

Vaccines are available for hepatitis A and B. Consult with your healthcare provider about whether these vaccinations are recommended for you.

By incorporating these healthy habits into your lifestyle, you can significantly reduce your risk of liver disease and maintain optimal liver function.

The Future of Liver Function Testing: Advancements and Innovations

As medical science advances, so does our ability to assess and monitor liver health. Several exciting developments are on the horizon for liver function testing:

Non-Invasive Imaging Techniques

Advanced imaging technologies, such as elastography, are becoming more widely used to assess liver health without the need for invasive procedures. These techniques can provide detailed information about liver structure and function.

Biomarker Discovery

Researchers are continually identifying new biomarkers that can provide more specific and sensitive indicators of liver health. These may lead to more accurate and comprehensive liver function tests in the future.

Genetic Testing

As our understanding of the genetic factors influencing liver disease grows, genetic testing may become a more integral part of liver health assessment, allowing for earlier detection and more personalized treatment approaches.

Point-of-Care Testing

The development of rapid, point-of-care liver function tests could make regular liver health monitoring more accessible and convenient, especially in resource-limited settings.

Artificial Intelligence in Test Interpretation

AI algorithms are being developed to assist in the interpretation of liver function test results, potentially improving accuracy and consistency in diagnosis and treatment planning.

These advancements promise to enhance our ability to detect, diagnose, and manage liver diseases, ultimately leading to better outcomes for patients with liver health concerns.

In conclusion, liver function tests play a crucial role in maintaining overall health by providing valuable insights into the state of one of our body’s most vital organs. By understanding what these tests measure, when they’re needed, and how to interpret the results, you can take a more active role in managing your liver health. Remember, regular check-ups and a healthy lifestyle are key to maintaining a healthy liver and, by extension, a healthy body.

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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Evaluation of Liver Function | Choose the Right Test

Indications for Testing

Testing may be ordered as part of a routine evaluation or to screen for and monitor liver disease (eg, viral or alcoholic hepatitis). Test selection should be informed by patient history and clinical evaluation. Elevated liver chemistry or function tests should generally be repeated to confirm results before the initiation of exhaustive follow-up testing.  

Laboratory Testing

The table below briefly describes the tests most often included in the evaluation of liver function. Commonly, hepatic function tests are offered in panels that include the recommended first-tier tests for liver disease evaluation. The pattern of abnormal test results should be evaluated to help identify additional testing strategies and determine the underlying cause. Some suggestive patterns are included in the Patterns of Liver Test Results section.

Patterns of Liver Test Results

Hepatocellular Pattern

Elevated ALT and AST concentrations indicate a hepatocellular liver injury.    The differential diagnosis may include viral or autoimmune hepatitis, hemochromatosis, alpha 1-antitrypsin deficiency, or Wilson disease.  If AST elevation is predominant, consider alcohol-related liver damage or cirrhosis.  Although the pattern of AST and ALT may help guide differential diagnosis, additional testing is required for diagnosis. Other liver tests such as bilirubin may also yield elevated results in patients who exhibit a pattern consistent with hepatocellular injury.  

Cholestatic Pattern

Increased ALP and GGT concentrations are indicative of cholestasis.   To determine if ALP elevation is of hepatic origin, GGT should be evaluated.   Cholestatic patterns may be due to hepatobiliary causes such as primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), biliary obstruction, or cholestasis.   

Mixed Pattern

If the pattern of elevation includes features of hepatocellular damage and cholestatic injury, the result is said to be “mixed. ”  A mixed pattern of liver test results accompanied by jaundice is often due to drug-induced liver disease. However, this pattern may also be observed in patients with late-stage acute viral hepatitis or early-stage acute biliary obstruction. 

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.