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Liver Function Test
What Is a Liver Function Test?
A liver function test is one of a group of tests that check levels of certain enzymes and other proteins in your blood.
Some of the tests look for enzymes that you’d find in your blood only when your liver is damaged or has a disease. Others check that the organ is working the way it should.
Your liver does all kinds of work that’s crucial for your health. It helps break down food, clean your blood, make proteins, and store energy. If something goes wrong with it, you might have a number of symptoms, from yellow skin to slurred speech. That’s when you might need a liver test.
Why Are Liver Function Tests Done?
You might have this test to check for a liver disease such as hepatitis (an illness in which your liver swells and can cause serious issues). General symptoms of liver problems include:
Often, however, you don’t notice any symptoms.
Your doctor may order a liver test if you’re more likely to have liver damage or disease, like if you:
The liver test can also help your doctor learn whether an illness is getting worse or how well treatment is working.
Types of Tests and What They Measure
There are a number of liver tests, with lots of complex names. Some common ones include:
- Alanine transaminase (ALT) test. ALT is an enzyme that helps break down proteins and is found mainly in your liver. High levels in your blood could mean you have liver damage.
- Alkaline phosphatase (ALP) test. ALP is an enzyme in your liver, bile ducts, and bone. You might have high levels if you have liver damage or disease, a blocked bile duct, or bone disease.
- Albumin and total protein test. Your liver makes two main proteins: albumin and globulin. Low levels might mean damage or disease. Keep in mind that your immune system also makes globulin.
- Aspartate transaminase (AST) test. AST is another enzyme in your liver. High blood levels could be a sign of damage or disease.
- Bilirubin test. Your body makes bilirubin when it breaks down red blood cells. Usually, your liver cleans bilirubin out of your body. If you have high levels in your blood, a problem called jaundice, you may have liver damage.
- Gamma-glutamyltransferase (GGT) test. High levels of the GGT enzyme could point to liver or bile duct damage.
- L-lactate dehydrogenase (LD) test. LD is another enzyme that’s high when you have liver damage, but other conditions can also raise its level.
- Prothrombin time (PT) test. This test measures how long it takes your blood to clot. If it takes a long time, that could be a sign of liver damage. Medications that thin your blood, such as warfarin (Coumadin), can also lead to a longer PT. You probably won’t have this test until you have had other liver tests.
How to Prepare for a Liver Function Test
Make sure to tell your doctor about any medicines you’re taking, including over-the-counter medications and herbal supplements. They may tell you to stop eating the night before the test.
What Happens During a Liver Function Test?
Your doctor uses a thin needle to take a small amount of blood, usually from your arm near your elbow. You’ll feel a pinch or stinging when the needle goes in.
You’ll probably have these tests more than once over a few days or weeks. Your doctor can look at how levels change to be sure of your condition.
If you get your test at a clinic that has a lab on site, you can get results in a few hours. If not, it might take a few days.
Liver Function Test Results
The results usually show normal values for the specific test, along with your numbers. Keep in mind that what’s normal can vary with different labs. It also depends on whether you’re male or female.
If your results aren’t normal, you’ll probably get more tests.
By itself, a liver test can’t tell for sure that you have a certain illness. Your doctor can help you understand what your results mean.
Liver Function Test Risks
Liver function tests are generally safe, with few risks. You may have some soreness or a bruise where the blood is taken. Call your doctor if it doesn’t get better after a couple of days.
Liver Function Panel | Michigan Medicine
A liver (hepatic) function panel is a blood test to check how well the liver is working. This test measures the blood levels of total protein, albumin, bilirubin, and liver enzymes. High or low levels may mean that liver damage or disease is present.
The liver serves several important functions in the body, including changing nutrients into energy for the body and breaking down toxic substances.
Your doctor may order a liver function panel if you have symptoms of liver disease. These symptoms include fever, vomiting, abdominal pain, yellowing of your eyes or skin (jaundice), dark yellow urine, and feeling very tired. This blood test also may be done if you have recently been exposed to a hepatitis virus or are taking a medicine that may cause liver damage.
Other Works Consulted
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.
Current as of:
September 23, 2020
Author: Healthwise Staff
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
W. Thomas London MD – Hepatology
Current as of: September 23, 2020
Medical Review:Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & W. Thomas London MD – Hepatology
Liver Panel | Lab Tests Online
Sources Used in Current Review
2020 review performed by Hoda Hagrass MD, PhD Medical Director of Clinical Chemistry and Immunology, UAMS and ACH.
Liver Function Tests. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/lab-tests/liver-function-tests/. Accessed on 4/18/2020.
Liver Function Tests. Cleveland Clinic. Available online at https://my.clevelandclinic.org/health/diagnostics/17662-liver-function-tests. Accessed on 4/18/2020.
Library of Medicine. How does the liver work? Accessed on 4/19/2020.
Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. Burtis Carl and Bruns David. 7th Edition, Elsevier Saunders.
Washington, M. Autoimmune liver disease: overlap and outliers. Mod Pathol 20, S15–S30 (2007). Available online at https://doi.org/10.1038/modpathol.3800684.
Spinella R, Sawhney R, Jalan R. Albumin in chronic liver disease: structure, functions and therapeutic implications. Hepatol Int. 2016;10(1):124–132. doi:10.1007/s12072-015-9665-6.
Inherited Liver Diseases. WebMD. Available online at https://www.webmd.com/digestive-disorders/inherited-liver-diseases#2-6. Accessed on 4/19/2020.
Nomura F, Kanda T, Seimiya M, Satoh M, Kageyama Y, Yamashita T, Yokosuka O, Kato N and Maruyama K. Determination of serum carbohydrate-deficient transferrin by a nephelometric immunoassay for differential diagnosis of alcoholic and non-alcoholic liver diseases. Clin Chim Acta. 2018; 485:181-186. doi: 10.1016/j.cca.2018.06.040.
Guido Viel, Rafael Boscolo-Berto, Giovanni Cecchetto, Paolo Fais, Alessandro Nalesso and Santo Davide Ferrara. Phosphatidylethanol in Blood as a Marker of Chronic Alcohol Use: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2012; 13(11): 14788–14812. doi: 10.3390/ijms131114788.
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Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby; 1998.
(© 2008-2010). Hepatic Function Panel. ARUP’s Laboratory Test Directory [On-line information]. Available online at http://www.aruplab.com/guides/ug/tests/0020416.jsp. Accessed January 2010.
Mayo Clinic staff (2008 July 18). Liver function tests. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/liver-function-tests/MY00093. Accessed January 2010.
Dufour, R. (2007 October 2). CP105 Approaches to Diagnosing and Monitoring Liver Disease Using Laboratory Tests—Something Old, Something New. College of American Pathologists [On-line information]. PDF available for download through http://www.cap.org. Accessed January 2010.
(© 1995-2010) Blood Test: Hepatic [Liver] Function Panel. KidsHealth from Nemours [On-line information]. Available online at http://kidshealth.org/parent/general/sick/labtest6.html. Accessed January 2010.
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby’s Diagnostic and Laboratory Test Reference. 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 28-29, 36-37, 143-145, 157-160, 469-470, 775-779, 783-786.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests. 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 64-67, 69-71, 78-85, 154-157, 172-177, 916-921.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005). Harrison’s Principles of Internal Medicine. 16th Edition, McGraw Hill. Pp 1813-1816.
Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry. AACC Press, Washington, DC. Pp 269-277.
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. Louis: Elsevier Saunders; 2006. Pg 1805.
Vorvick, L. (Updated 2012 October 14). Liver function tests. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003436.htm. Accessed February 2013.
(Updated October 4). Liver Function Tests. American Liver Foundation [On-line information]. Available online at http://www.liverfoundation.org/abouttheliver/info/liverfunctiontests/. Accessed February 2013.
(Updated 2012 October). Liver Disease Evaluation. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/LiverDzEval.html. Accessed February 2013.
Carey, W. (© 2000-2011). Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests. Cleveland Clinic [On-line information]. Available online through http://www.clevelandclinicmeded.com. Accessed February 2013.
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Shaffer, E. (Revised 2009 June) Laboratory Tests of the Liver and Gallbladder. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed February 2013.
2016 review by Preetpal S. Sidhu, PhD, C (ASCP), Director, Progressive Diagnostics.
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(Jan 30, 2016) Taylor, W, Ziegler, O. Liver Panel. University of Rochester Medical Center. Available online at https://www.urmc. rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=liver_panel. Accessed on 1/31/2016.
(August 2014) Yamini Durani, MD. Hepatic (Liver) Function Panel. Nemours Foundation. Available online at http://kidshealth.org/parent/general/sick/labtest6.html#. Accessed on 1/31/2016.
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Common Liver Tests | Johns Hopkins Medicine
A series of special blood tests can often determine whether or not the liver is inflamed, injured, or functioning properly. These tests can also distinguish between acute and chronic liver disorders and between hepatitis (infection or inflammation of the liver) and cholestasis (disruption in the formation of or obstruction in the flow of bile).
Serum alkaline phosphatase test. This test is used to measure the level of alkaline phosphatase (an enzyme) in the blood. Alkaline phosphatase is found in many tissues, with the highest concentrations in the liver, biliary tract, and bone. This test may be performed to assess liver functioning and to find liver lesions that may cause biliary obstruction, such as tumors or abscesses.
Alanine transaminase (ALT) test. This test measures the level of alanine aminotransferase. This is an enzyme found mostly in the liver that is released into the bloodstream after acute liver cell damage. This test may be performed to assess liver function, and/or to evaluate treatment of acute liver disease, such as hepatitis.
Aspartate transaminase (AST) test. This test measures the level of aspartate transaminase. This is an enzyme that is found in the liver, kidneys, pancreas, heart, skeletal muscle, and red blood cells that is released into the bloodstream after liver or heart problems. This enzyme is released into the bloodstream after acute liver cell damage.
Gamma-glutamyl transpeptidase test. This test measures the level of gamma-glutamyl transpeptidase. This is an enzyme that is made in the liver, pancreas, and biliary tract. This test is often performed to assess liver function, to provide information about liver diseases, and to detect alcohol ingestion.
Lactic dehydrogenase test. This test can find tissue damage and may assist in the diagnosis of liver disease. Lactic dehydrogenase is a type of protein (also called an isoenzyme). It is involved in the body’s metabolic process. However, this is a very nonspecific liver test. It is rarely used for liver disease assessment.
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 to avoid further unnecessary testing. This could lead to a delay in the treatment you need.
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.
Lab Tests Online has more information on liver function tests.
If your symptoms or liver function test suggest an advanced form of ARLD (either alcoholic hepatitis or cirrhosis), you may need further tests.
These are described below.
Scans may be needed to produce detailed images of your liver.
This may include:
Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred.
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.
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: 10 August 2018
Next review due: 10 August 2021
Causes, symptoms, tests, and treatment
Elevated liver enzymes may be a sign that a person’s liver is not working properly. Damaged or inflamed liver cells release enzymes into the bloodstream, which a blood test will detect.
Doctors test people for elevated liver enzymes if they have symptoms of conditions that typically cause liver damage.
In this article, learn about the causes of elevated liver enzymes, as well as the symptoms and treatment of each of these conditions.
Share on PinterestIf a person has elevated liver enzymes, a doctor may investigate possible underlying causes.
If a person’s blood test results show elevated liver enzymes, a doctor will investigate possible underlying causes. They may do further tests in addition to asking about a person’s lifestyle and dietary habits.
The most common cause of elevated liver enzymes is fatty liver disease. Research suggests that 25–51% of people with elevated liver enzymes have this condition.
Other health conditions that typically cause elevated liver enzymes include:
- metabolic syndrome
- alcohol or drug use disorder
- cirrhosis, which is liver tissue scarring
Other conditions that less commonly cause elevated liver enzymes include:
Certain medications, including some pain relievers and statins, can also cause elevated liver enzymes.
Elevated liver enzymes are themselves asymptomatic, but the underlying conditions responsible for them may cause symptoms.
Below are the common causes of elevated liver enzymes, as well as their symptoms:
Fatty liver disease
Fatty liver disease occurs when fats build up in the liver. If this buildup is due to alcohol consumption, it is called alcoholic fatty liver disease.
When alcohol is not a causative factor, the buildup of fat in the liver is called nonalcoholic fatty liver disease (NAFLD). People with metabolic syndrome are at a higher risk of NAFLD.
Fatty liver disease may sometimes cause tiredness and pain on the right side of the abdomen, but it often causes no symptoms.
A doctor may test someone with alcohol use disorder or metabolic syndrome for elevated liver enzymes to check for fatty liver disease.
Learn about what to eat to help manage fatty liver disease here.
Metabolic syndrome is a group of symptoms that increase the risk of heart disease. These symptoms include:
The doctor may test people with one or more of these symptoms for elevated liver enzymes.
Hepatitis is a virus that leads to liver inflammation. There are several different strains of hepatitis, which are called A, B, C, D, and E. The symptoms of all of the strains are similar.
Common hepatitis symptoms include:
- muscle soreness
- joint pain
- loss of appetite
- stomach pain
- dark urine
- skin itching
- yellowing of the eyes and skin (jaundice)
The doctor may test a person with symptoms of hepatitis for elevated liver enzymes.
Alcohol or drug use disorder
Drinking too much alcohol or using illicit drugs may lead to liver inflammation or damage.
Liver inflammation due to alcohol consumption is called alcoholic hepatitis. When drugs are the underlying cause, doctors call it toxic hepatitis.
The symptoms of alcoholic and toxic hepatitis are similar to those of other strains of hepatitis.
If a person is experiencing symptoms of alcohol or drug use disorder, the doctor may check their liver enzyme levels and offer various forms of treatment and support.
Cirrhosis is a type of liver damage. A person with cirrhosis has permanent scarring of the liver, which can prevent it from working properly. Cirrhosis may eventually lead to liver failure.
Cirrhosis symptoms include fatigue and skin itching. People are at risk of cirrhosis if they do not receive treatment for hepatitis or fatty liver disease.
If a person has cirrhosis symptoms, the doctor may check their liver enzyme levels.
A blood test can show elevated liver enzymes. The blood test checks for raised levels of AST and ALT, which are enzymes that the liver releases when it becomes inflamed or damaged.
If a doctor finds that a person has raised AST or ALT levels, they are likely to carry out further tests to determine the underlying cause.
Different ratios of AST to ALT may indicate various underlying causes.
The treatment for elevated liver enzymes will focus on managing the underlying condition causing the increased levels.
The treatments for some common causes of raised AST or ALT levels include:
Fatty liver disease
People can work with their doctor to treat NAFLD with weight loss. The doctor may advise a person to make lifestyle changes to lose weight, such as:
- exercising more
- eating a healthful, balanced diet
- trying to burn more calories than they consume
Speaking with a nutritionist or even a personal trainer can help someone stay on track with their weight loss plan.
If a person has fatty liver disease due to alcohol consumption, the doctor will support them in reducing their alcohol intake.
Share on PinterestSomeone with metabolic syndrome may benefit from exercising more, losing weight, and reducing their stress levels.
Treatments for metabolic syndrome include:
- losing weight
- exercising more
- eating a healthful, balanced diet
- managing blood sugar levels
- reducing stress levels
Lifestyle changes that may help a person manage stress include:
- reducing commitments
Treatments for hepatitis depend on whether it is acute or long term. A doctor may recommend the following treatments for acute hepatitis:
- bed rest
- plenty of fluids
- avoiding alcohol
Treatment for long term hepatitis usually includes antiviral medication.
Alcohol or drug misuse disorder
Treatments for alcohol or drug use disorder include:
- behavioral therapies
- support groups
Anyone who feels as though their alcohol or drug use is causing health problems or interfering with their everyday life should speak to their doctor.
Cirrhosis is permanent liver damage, so it is not always treatable. However, the underlying cause of liver damage is usually responsive to treatment. The conditions that we discussed above may all lead to cirrhosis.
Treatments such as a modified diet, weight loss, and reduced alcohol consumption can all reduce the risk of further liver damage. The prompt diagnosis and treatment of conditions that affect the liver can help prevent cirrhosis.
Elevated liver enzymes are a sign that a person has an inflamed or damaged liver. Many conditions may cause liver inflammation or damage.
Doctors use a blood test to check for elevated liver enzymes. They may test anyone with symptoms of one of the conditions that they know to raise liver enzyme levels.
If a person’s blood test results reveal that they have elevated liver enzymes, the doctor will investigate the underlying cause. Once they make a diagnosis, the doctor will recommend suitable treatments.
Fatty liver disease is the most common cause of elevated liver damage. People with fatty liver disease can manage their condition by losing weight, if necessary, or reducing their alcohol consumption. Other causes of liver inflammation are also treatable.
Elevated liver enzymes are usually a temporary sign. Liver enzyme levels may return to normal quickly if a person follows the doctor’s recommended treatment plan for the underlying condition.
Abnormal Liver Function Tests | Patient
What are liver function tests?
Liver function tests measure a series of chemicals which relate to the way the liver works. They include substances that are made in the liver or affected by the health of the liver cells, chemicals which are processed or excreted by the liver, and hormones that the liver makes in order to do its work.
Liver function tests are aimed at giving a picture of the ‘state’ of your liver. They are a sensitive way of looking for liver strain or liver damage, as they often show this well before you get any symptoms or problems with your liver. This means that the cause of liver strain or damage can be diagnosed and, often, reversed.
Liver function tests are also used for monitoring in cases of known liver inflammation, injury or disease.
Where and what is the liver, and what does it do?
The liver is your largest internal organ. It sits in the tummy (abdomen), under your diaphragm on the right-hand side. It is usually tucked under the ribs, which protect it, although in some people the edge of the liver protrudes slightly. If the liver is swollen, through inflammation or disease, it can swell out from under the ribs and make your tummy swollen.
Diagram showing the liver
The liver is a factory for the production and breakdown of carbohydrates, fats, proteins, hormones and other essential body chemicals, and helps dispose of waste products. This work is mainly carried out by liver cells (hepatocytes). Some of the most important functions include:
Production of these substances
- Glycogen (a carbohydrate energy store), which it makes from glucose.
- Glucose, made and released into the blood from glycogen, proteins and fats.
- Many essential proteins and amino acids (building blocks of proteins).
- Many of the clotting factors that help your blood to clot normally.
- Plays a part in red blood cell production.
- Albumin, the main protein in your blood, which bulks out your serum and enables it to carry essential substances around the body.
- Angiotensinogen, which plays a role in blood pressure control.
- Thrombopoietin, which regulates some of the work of your bone marrow.
- Cholesterol, triglycerides, lipoproteins and fats – as part of the management of fat stores in your body.
- Bile, excreted into the intestine for absorbing fats and vitamin K.
- Hormones that help children grow and that build muscle in adults.
Breakdown of these substances
- Excess hormones, including insulin.
- Bilirubin, which is a waste product from worn-out blood cells.
- Many waste products.
- A wide range of toxic substances and medicines, including alcohol.
- Foreign proteins that reach it from the digestive system (trapped and destroyed by specialised immune cells in the liver).
Storage of these (and other) substances
- Glucose (as glycogen).
- Vitamin A (1-2 years’ supply).
- Vitamin D (1-4 months’ supply).
- Vitamin B12 (3-5 years’ supply).
- Vitamin K.
- Iron and copper.
What liver function tests are there?
The usual liver function tests typically include the following:
- Total protein.
- Transferases (AST or SGOT and ALT or SGPT).
- Gamma GT.
- Creatine kinase.
- Calcium and corrected calcium.
- Prothrombin time or International Normalised Ratio (INR).
Each of these is discussed below. The liver performs hundreds of different functions, so there are many other possible tests that look at its health. These would normally be done if an abnormality is found with the basic liver function tests described here, or if a specific problem is suspected. They might include:
- Virus tests – for example, for hepatitis A, B or C – to look for the cause of disease.
- Autoantibody tests (to detect and monitor immune diseases).
- Immunoglobulins (antibodies made in response to various challenges including allergies, infections, some blood disorders and some cancers).
- Serum ferritin and transferrin saturation (measures of iron storage and management by your body).
- Alpha-fetoprotein (maternal levels help look at the health of the baby during pregnancy, and levels are also raised in some cancers).
- Copper/caeruloplasmin (measures of copper management by the body).
- Alpha-1 antitrypsin (a hormone involved in protecting liver and lung cells from injury).
- Clotting factors (particularly if there is a suspicion that your blood is not clotting well or you have severe liver disease).
What can cause your liver function tests to be abnormal?
Your liver tests can be abnormal because:
- Your liver is inflamed (for example, by infection, toxic substances like alcohol and some medicines, or by an immune condition).
- Your liver cells have been damaged (for example, by toxic substances, such as alcohol, paracetamol, poisons).
- Your liver is having to work harder to process medicines or toxic substances (for example, alcohol, paracetamol, poisons).
- The bile drainage from your liver is blocked – for example, by a gallstone.
- There is a swelling inside your liver (for example, an abscess or a tumour).
- You have an underlying condition that affects the liver’s production and storage abilities (for example, Wilson’s disease, haemochromatosis, Gilbert’s syndrome). In these cases the abnormality of your liver tests will be a feature of your condition, and may be normal for you.
- Your liver is physically injured (for example, trauma).
- You fall just outside the normal limits (see below).
What does the ‘normal range’ mean in liver function tests?
The ‘normal range’ is a range of values given by the local laboratory for liver function tests. The range varies slightly between laboratories according to the measurement methods that they use.
The ‘normal’ limits are defined by laboratories as the range of levels inside which 19 of every 20 people with healthy livers will fall. This means that, for any one liver test, around 1 in 20 people with healthy livers will have a result that is slightly abnormal. There will, in the majority of cases, be nothing wrong with their liver; having a test that’s just over the edge usually means nothing, as long as – crucially – there is only one slight abnormality out of the whole range of tests. You should always discuss even a slightly abnormal result with your doctor.
What should I do if my liver function tests are abnormal?
You are likely to find out that your liver tests are abnormal from your healthcare provider, who will tell you what you need to do next. However, if you obtain your test results without explanation, you should contact your healthcare provider to discuss them.
Doctors consider a slightly abnormal liver function test as one that is less than twice the upper limit of the ‘normal’ value. Doctors consider a very abnormal liver function test as one that is more than twice the upper limit of the ‘normal’ value.
- If the tests are very mildly abnormal, only one or two tests are affected and you are perfectly well then this would not normally need an urgent consultation. However, you should speak to a health professional for advice within a few days (in case more tests or monitoring need to be done).
- If you have multiple abnormalities on your tests, if some of the tests are very abnormal or if you are also unwell or in pain then you should seek medical advice more urgently.
- If you have known liver disease and your liver function tests have altered significantly since the last time they were checked, you should seek medical advice the same day unless you have a standing instruction to do something different.
- Sometimes an abnormal liver function test is normal for you. If you already know this is the case then it may be that no action is needed. A common example of this is Gilbert’s syndrome, when you have a naturally raised level of bilirubin but other liver function tests are normal and you are well. Your doctor will tell you if you have Gilbert’s syndrome.
What will my doctor do if I have abnormal liver function tests?
All abnormal liver function tests need explanation, even if that explanation is that you are one of the 5% who fall outside the ‘normal’ range. In many cases, a single, isolated, slightly abnormal liver function test in a well patient will not signify an underlying problem. However, some liver disorders, including early signs of overuse of alcohol, can produce slight changes (especially at first), so it’s important to be sure.
Your doctor will want to do further tests and to see, question and examine you, to determine the reason for the blood test abnormality. If you are otherwise well, this will initially be done in primary care. Options include:
- Repeating the blood test.
- Further blood tests in order to discover or rule out particular causes.
- An ultrasound scan of your liver and gallbladder.
- A liver biopsy, to work out exactly what is going on.
- Depending on the severity and suspected cause, referral to a liver specialist for advice, more specialist tests and liver biopsy.
- If you are very unwell, you may need referral or admission to hospital.
Can my doctor make a diagnosis from my liver function test?
Sometimes. Single abnormalities in the tests do not give diagnoses on their own but the pattern of abnormalities can point to the most likely cause of the problem. When this is combined with speaking to and examining you, your doctor may be able to make a clear diagnosis.
Once the cause of the abnormality has been determined, your doctor will discuss what you need to do next.
What do unusually low levels on my liver function tests mean?
Note that in most cases (except albumin and calcium) it is a raised (rather than a lowered) level in the liver function test which may indicate a problem. In the following descriptions, where low levels can be significant for your health they are also described.
What does an abnormal bilirubin level mean?
Bilirubin comes from the breakdown of red blood cells in the body. The liver processes (conjugates) bilirubin so that it can be excreted via the kidneys. A high bilirubin level can make you appear jaundiced (with a yellow tinge to the skin and to the whites of the eyes).
The most likely cause of raised bilirubin depends on whether the rise is in bilirubin that the liver has already processed (conjugated bilirubin), in the bilirubin that the liver has not yet processed (unconjugated bilirubin), or in both.
A rise in both types of bilirubin
Conjugated bilirubin tends to rise if the flow of bile in the tiny tubes within the liver is blocked, and unconjugated bilirubin tends to rise if the liver calls cannot do their work (or there is too much work for them to do). If the liver is both damaged (not working properly) and swollen or scarred (blocking the drainage system) then both types of bilirubin will tend to rise.
An isolated rise in unconjugated bilirubin
Unconjugated bilirubin may increase because the liver can’t process the bilirubin, or because the body is making an excess of bilirubin by breaking down too many blood cells, and the liver is normal but can’t keep up.
An isolated rise in conjugated bilirubin
Increased conjugated bilirubin suggests that the liver is conjugating the bilirubin properly (the job of liver cells) but not excreting it properly via the bile ducts. Causes include:
- Reactions to some medicines, including common ones such as blood pressure tablets, hormones (for example, oestrogen), antibiotics (particularly erythromycin and flucloxacillin), tricyclic antidepressants and anabolic steroids.
- Some autoimmune diseases that affect bile excretion.
- Blockage of the bile ducts – for example, by a gallstone.
- Dubin-Johnson syndrome and Rotor’s syndrome.
- In babies a rise in conjugated bilirubin can signify rare but serious problems with the development of the bile drainage system in the liver, such as biliary atresia.
What does an abnormal albumin level mean?
Albumin is the main protein in your serum, and its level is a good guide to long-term liver health. Albumin levels that are abnormally low have the greatest significance for the liver.
Low levels of albumin
This can be due to:
- Severe liver disease.
- Poor nutrition.
- Malabsorption of protein (for example, in Crohn’s disease or in coeliac disease).
- Protein-losing enteropathies (for example, severe bowel inflammation or infection such as cholera).
- Protein loss through kidney problems (for example, nephrotic syndrome).
- Failure of protein manufacture through severe liver inflammation.
- Albumin levels also fall if you lose protein through your skin (for example, in extensive skin inflammation and widespread burns).
- Albumin levels decrease during pregnancy, when your blood is more dilute.
High levels of albumin
This is usually due to having the tourniquet on for too long before your blood sample is taken. Sometimes it can be due to a very high-protein diet, as in bodybuilders, or to lack of fluid in the body (dehydration), when the blood is more concentrated.
What does an abnormal total protein level
Total protein measures the total of albumin and globulins. It is usually normal in liver disease even if albumin levels are low, as globulin levels tend to increase as albumin levels fall.
- High values of total protein are seen in chronic active hepatitis and alcoholic hepatitis.
- High values of total protein are also seen in conditions outside the liver which increase globulins (such as myeloma) and conditions involving overactivity of the immune system (such as severe infection and chronic inflammatory disease).
- Low levels of total protein can sometimes be seen in severe liver disease, in conditions of severe protein loss (such as widespread burns) and in severe malnutrition.
What does an abnormal ALT (SGPT), AST (SGOT) or creatine kinase level mean?
These substances are also called transferases. They are liver hormones (proteins which help do the work of the liver) which are normally found inside liver cells rather than in the blood.
- ALT stands for alanine transaminase and is also called SGPT (serum glutamic-pyruvic transaminase).
- AST stands for aspartate transaminase and is also called SGOT (serum glutamic oxaloacetic transaminase).
- Creatine kinase is sometimes checked along with AST and ALT.
If blood levels of transaminases go up this suggests leakage from damaged liver cells due to inflammation or cell death. AST and ALT tend to be high in liver disease and very high in liver inflammation.
- ALT is mainly found in the liver. AST is also found in muscle and red blood cells.
- ALT rises more than AST in acute liver damage.
- In chronic liver disease (for example, alcoholic cirrhosis) ALT is higher than AST; in cirrhosis AST is higher than ALT.
- Lower-than-normal levels of transaminases do not signify disease.
Creatine kinase comes mainly from muscle, so if it is raised alongside AST and ALT it suggests that the liver may not be the main source of the problem.
Causes of mild rises in transferases
Causes of marked increases in transferases
Marked increases are usually caused by acute injury to the liver by viruses, shortage of oxygen (ischaemia) or toxic substances. Causes include:
What does an abnormal gamma-glutamyl transferase level mean?
Gamma-glutamyltransferase (GGT) levels increase in most liver diseases. This test is very sensitive, although it also goes up in some heart, lung and kidney conditions.
- The most common reason for GGT increasing as a single abnormality is drinking more alcohol than your liver can easily cope with. GGT levels can be 10 times normal. The rise is a sign your liver is under strain and is at risk of being damaged by alcohol.
- GGT rises to 2-3 times the upper limit of normal in non-alcoholic fatty liver disease (NAFLD). This condition is increasingly common and can progress to scarring or inflammation of the liver. Transaminase levels also tend to rise in NAFLD.
- Some prescribed and over-the-counter medicines can increase GGT levels.
- GGT rises in some patients with chronic hepatitis C infection.
- In chronic liver disease, a rise in GGT suggests bile duct damage and scarring.
What does an abnormal alkaline phosphatase level mean?
Alkaline phosphatase (ALP) comes mainly from the cells lining bile ducts and from bones – particularly growing bones. It rises if there is slow or blocked flow in the bile ducts, if the bile ducts are damaged and in bone disorders. If the cause is in the liver, the GGT is also abnormal, whereas if it’s the bone, the GGT is usually normal. ALP is also raised during the third trimester of pregnancy.
Common causes of raised ALP with other abnormalities on your tests include:
Isolated raised ALP can occur in:
What do abnormal calcium and corrected calcium levels mean?
99% of the body’s calcium is stored in the bones, with the remaining 1% stored in other tissues, including the blood plasma. The calcium test measures the total calcium in the blood plasma. About half of this is tightly attached to the protein, albumin, which forms the bulk of the protein in your plasma. The calcium level that really counts is the ‘free’, or unbound, calcium that floats unattached in the plasma.
If you have low albumin levels, the total calcium in your blood will be less; however, because the amount attached to the albumin is reduced (because there is less albumin), the actual free levels of calcium may be fine (or even raised). Corrected calcium corrects the figure to give the actual, free amount of calcium.
Causes of low (corrected) calcium levels
Calcium levels are regulated by the kidney, thyroid and parathyroid glands, using the hormones parathyroid hormone, calcitonin and vitamin D. Low levels are uncommon. Causes include:
- Hypoparathyroidism (your parathyroid glands do not make enough of their hormone).
- Just after parathyroid surgery.
- Severe chronic kidney disease.
- Severe liver disease.
- Severe vitamin D deficiency.
- High phosphate ingestion (we can take in phosphate from enemas, from baby milks and from some flours – for example, chapati flour).
- Magnesium deficiency (often due to dietary deficiency and to prescribed medicines, including some antibiotics, diuretics and painkillers).
Causes of raised (corrected) calcium levels
- Primary hyperparathyroidism (overactive parathyroid glands) cause 8 out of 10 cases.
- Cancer of many different kinds can increase calcium levels, and accounts for about 2 out of 10 cases.
Rarer causes of hypercalcaemia include:
- Overconsumption of antacids.
- Pulmonary tuberculosis.
- Addison’s disease.
- Prolonged bed rest – especially in teenagers whose bones are growing fast.
- Vitamin A and/or D overdose.
- A number of medicines, including lithium, tamoxifen and diuretics.
- Kidney dialysis.
What do abnormal prothrombin time and INR mean?
Prothrombin time (PT) or International Normalised Ratio (INR) are sometimes measured as a part of standard liver function tests.
PT and INR are ways of measuring the ability of your blood to clot. Conditions which impair this clotting (prolonging the PT and increasing the INR) include:
- Acute and severe liver disease (including liver failure and severe paracetamol overdose).
- Use of anticoagulant medicines (in this case, lengthening the prothrombin time and increasing the INR is the intention).
How do I keep my liver function healthy?
There is a difference between what you need to do to keep your liver healthy most of the time and what you need to do if your liver is inflamed or damaged.
- If you are well, the way to look after your liver is with a balanced diet with a good fibre content, exercise, maintenance of a healthy weight, avoiding ‘fad’ diets (which can challenge the kidneys and liver hard), avoiding unnecessary medicines and supplements including paracetamol, stopping smoking, and staying within the recommended limits for alcohol (both daily and weekly). The liver does not need a detox diet, which will not help it and will often (if it is very low-calorie, for instance) make it work harder. The liver is a digesting, storage and detoxing organ.
- If your liver is inflamed and injured (for example, you have hepatitis and are jaundiced) or you have advanced liver disease (for example, cirrhosis) then, depending on the severity, you may be advised to have a special diet. This involves using carbohydrates as your major source of calories, eating fat moderately and cutting down on protein. You may be advised to take vitamin supplements, and if you are retaining fluid you should reduce your salt consumption to less than 1500 milligrams per day.
A few things to remember about abnormal liver function tests
- Liver function tests are not a diagnosis; they are a set of clues which help doctors make a diagnosis.
- Liver function tests are a sensitive early warning system for problems in the liver and, in some cases, elsewhere.
- Because ‘normal ranges’ used by laboratories are the levels between which about 19 out of 20 of people’s tests will fall, about 1 person in 20 will have an abnormal test without cause. About half of these people will have slightly high tests and about half will have slightly low tests, but their levels either way should not be extreme.
- The most likely cause of any particular pattern of abnormal liver function tests varies between patients (because of difference in age and gender) and between populations (because of variations in genetics and because different things are more common in different parts of the world).
- Almost any pattern of liver function test abnormality can be caused by medicines (including over-the-counter medications), by herbal remedies and traditional medicines from other cultures, and by poisonous substances.
- Many liver conditions cause no symptoms, at least at first; so, if you have several abnormal tests (or one test is markedly abnormal), it is very important to follow this up.
- Although single, mildly abnormal tests are not usually significant, any unexplained abnormality generally needs a check that you are well and may need a repeat test.
- Abnormal liver function tests in a person who is also sick are more worrying than those in a person who is well.
90,000 The liver is at risk. How to Watch Out for Liver Disease? What tests should be taken regularly?
It is believed that there are safe doses of alcohol and on the Internet you can find norms that seem to be recommended by the world health organization. In fact, WHO warns that there is no safe dose of alcohol .
We know that there is a level of alcohol consumption at which the risk of various ailments is low, but the WHO does not establish clear values for such doses, medical evidence suggests that it is safer for health not to drink.The more a person drinks, the higher the risk of getting sick. Alcoholic liver disease, which leads to cirrhosis, can become one of the serious, but imperceptibly developing diseases of the liver.
Often a person simply does not know about problems with the liver, since this organ is very patient – and until it suffers thoroughly, it tries not to betray the existing problems in any way. Therefore, it is better to periodically check the condition of the liver.
Will the liver hurt if you exceed the safe alcohol intake?
Since there are no nerve endings in the liver, it is “silent” for a long time.Unpleasant sensations of heaviness in the right hypochondrium, pain and discomfort may appear due to stretching of the liver capsule when its size increases. As for jaundice, pruritus, dark urine and light stool, these symptoms can be signs of hepatitis – damage and inflammation of liver cells of infectious or toxic origin. A more frequent symptom of liver disease is a lack of energy and increased fatigue, but since such a symptom can be found in many other diseases. If painful symptoms bother, then you need to be examined.It is especially important to do this for those who do not adhere to the principles of a healthy lifestyle or have to take medications for a long time.
How to avoid liver disease? What tests should be taken regularly?
The best thing we can do for our liver is, without expecting symptoms, regularly once a year to take a biochemical blood test from a vein, checking the level of bilirubin (direct and total) and 4 liver enzymes (AST, ALT, thyroid thyroid hormone and GGT ). This test – Examination of the liver, basic – will assess the toxic effect of harmful substances on the cells of the organ.This examination is necessary if you suspect a current liver disease or in conditions associated with damage to the liver cells themselves, and with impaired outflow of bile.
Advanced complex Liver examination is most appropriate for patients with pre-existing liver diseases both to assess the current state and to assess the effectiveness of the treatment. In addition to the above-mentioned analyzes, this complex includes a test for prothrombin, the level of total protein and protein fractions is determined, and the ability of the liver to synthesize the substances necessary for the body – cholinesterase and cholesterol is assessed.
There are many different tests for liver disease. What is the most accurate analysis?
Blood tests for total, direct and indirect bilirubin are an important marker for assessing liver function. They are usually prescribed when jaundice occurs or if liver disease (such as hepatitis) is suspected.
Alanine aminotransferase (ALT) is an enzyme of the liver cells. When liver cells are damaged, the level of ALT in the blood rises. Moreover, this happens long before the onset of jaundice.A significant (more than 10-fold) increase in ALT levels is usually associated with either acute viral hepatitis or acute toxic liver damage. A moderate increase in ALT (several times) is characteristic of chronic viral hepatitis, impaired outflow of bile and chronic diseases of the hepato-biliary zone, as well as alcohol abuse and liver damage in infectious diseases.
The second enzyme, aspartate aminotransferase (AST), is less indicative, but important in the complex diagnosis of liver function.It is usually given along with an ALT test.
An increase in alkaline phosphatase (ALP) can be observed in violation of the outflow of bile and other liver diseases, as well as in any form of cholestasis (difficulty in bile secretion).
GGT (gamma glutamyl transferase) is an enzyme involved in the metabolism of amino acids. Its increased concentration in blood serum is most often a marker of difficulty in the outflow of bile, as well as intoxication caused by alcohol or drugs.A blood test for GGT is important for the diagnosis of many liver diseases.
Why is there no one test, to assess the liver function is always offered to pass a set of tests?
In fact, it is very important to pass all tests in combination, because it is important to change each of the indicators in combination with each other. For example, high AST levels may indicate not only liver problems, but also damage to the heart muscle. Or, say, a simultaneous increase in GGT and ALP suggests cholestasis, but if GGT rises in isolation from ALP, then one can suspect that the whole point is in the long-term use of alcohol.An increase in alkaline phosphatase at normal GGT values rather speaks not of liver disease, but of the presence of bone tissue diseases.
How to check the liver and what tests need to be taken?
The liver is the largest gland in the human body. It is often compared with a real biochemical laboratory, with a plant for the neutralization of toxic substances, a factory for the production of enzymes, or with a depot for storing blood, essential vitamins and microelements. A listing of all the functions and tasks of the liver would take more than one page of small text.Therefore, it is obvious that if such an irreplaceable organ of our body fails, the consequences can be the most sad. In time, laboratory tests will help to recognize the cause of the problem, which we will talk about below.
When might a liver test be required?
It is recommended to undergo examinations of the most important organs and systems of the body for preventive purposes on a regular basis. But there are a number of symptoms that signal that a check is required as soon as possible.So, the liver should be examined immediately if you notice the following signs of organ dysfunction:
- Unpleasant sensations in the area of the lower pair of ribs on the right – one of the first manifestations of liver problems. Unusual sensations and a feeling of tightness or overcrowding in the liver area can be accompanied by subtle pulling pains, tingling sensations. They usually make themselves felt when laughing, talking loudly or screaming, sneezing, bending to the side, lifting heavy weights, as well as after eating fatty, smoked, fried or spicy foods.At first, a new feeling may not cause pain or perceptible discomfort – in this case, they also say: “I found out where the liver is.” This is a reason to be wary, since even mild symptoms can indicate the initial stage of serious liver disease.
- The liver is enlarged . The change in the dimensions of the main gland is accurately recorded during ultrasound examination, but you can notice the changes yourself. This will be indicated by a bulging belly without an increase in overall fullness and practically without weight gain.The symptom is especially noticeable in people with a lean physique.
- Bad taste in the mouth . Patients with chronic liver problems report persistent dry mouth and bitterness on the tongue, sometimes with a characteristic taste that is defined as “copper”. At the same time, an astringent feeling is noted in the mouth, taste sensations decrease. Habitual food can cause rejection, up to nausea and urge to vomit.
- Weight loss due to asthenic syndrome .This symptom is largely a consequence of the previous one. Food rejection, loss of taste, nausea lead to a decrease in the diet, which leads to weight loss. At the same time, the patient complains of unreasonable irritability, as well as weakness, drowsiness, fatigue, because the body’s energy needs are not satisfied, and the toxic effects from disturbed nitrogen (protein) metabolism greatly increase – with an increased concentration of ammonia in the blood, secondary (hepatic) hyperammonemia occurs. …
- Jaundice – a general complex of symptoms, which is expressed in yellowness of the skin, mucous membranes and whites of the eyes, as well as in the dark color of urine, itching and peeling of the skin, chills, bone and joint pain, and is caused by liver problems.
The last symptom complex indicates serious violations in the liver – a neglected disease.
The characteristic “hepatic” yellowness is caused by the bile pigment bilirubin, which is formed during the breakdown of red blood cells. This process continuously occurs in human tissues at the cellular level. During normal functioning of the body, bilirubin is excreted and “utilized” by the liver. But the accumulation of icteric pigment in the tissues makes it clear that the liver is not coping with its tasks.
Liver tests are also done during pregnancy (ideally at the planning stage), before surgery and before a course of treatment that involves taking potent drugs.
What allows you to identify the check (screening) of the liver:
- the very fact of the disease, its degree, the level of liver dysfunction;
- the presence and degree of histological (cellular) changes in the structure of the liver tissue, such as fibrosis and cirrhosis of the liver;
- Diagnosis of specific liver diseases – viral and autoimmune hepatitis, fatty hepatosis.
How to check the health of the liver, what tests must be taken for this and what methods are used in modern laboratory practice?
Biochemical blood test in order to assess the state of the liver
Blood biochemistry is a laboratory study, the purpose of which is to assess the functioning of organs and body systems based on data on the rate, nature and end products of metabolism – information on the metabolism of proteins, fats and carbohydrates, and also about the needs of the body for vitamins and minerals.Pathological conditions of the liver are inevitably reflected in the parameters of the biochemical blood test, showing a discrepancy with the norm – with the so-called reference values.
The amount of information required for making, refuting or clarifying the diagnosis differs depending on the clinical picture formed by the doctor, taking into account the ultrasound data, anamnesis and general examination of the patient. A hepatologist or therapist can prescribe a standard biochemical screening of 6 parameters or an extended examination, including the determination of up to 15 blood parameters.
In order for a biochemical blood test to give reliable results, it is necessary to properly prepare for it:
- Biochemistry analysis is taken strictly on an empty stomach . Since the liver is involved in the process of digestion, the nature of the food affects the analysis data, significantly distorting them. To avoid this distortion, the last meal should be no later than 8 hours before the blood sample is drawn. The same goes for any drink other than water. In addition, before taking the analysis, it is recommended to refrain from spicy and fatty foods for up to three days.
- Alcohol is prohibited! Even a small dose of alcohol causes a significant load on the liver, changes the properties of the blood, in particular its coagulability. Therefore, the minimum period between the use of strong drinks and blood sampling for biochemistry is three days.
- Negatively affects the reliability of the results and smoking . Doctors strongly recommend that you smoke a cigarette no later than 12 hours before taking the test if you are susceptible to this addiction.
- Sport will also wait . Three days before the test, it is recommended to exclude physical activity, especially sports. Psychoemotional stress, stressful situations should be avoided, and sleep should be observed.
- Medication is canceled . Even vitamins can distort the results of biochemistry analysis, therefore, it is not recommended to take any medications at least a week before the crucial moment, since some of them can have a long-term effect on blood composition.But if you cannot refuse to take medications due to clinical indications, the doctor should be informed about the medications taken.
In addition, women are advised to have a pregnancy test before passing biochemistry for “liver screening”.
Sampling of blood for analysis is performed by the doctor intravenously, does not require any effort from the patient and does not cause pain.
What values are shown by biochemical analysis for liver blood samples and what the result indicates, see table 1.
Table 1 . Deciphering the indicators of biochemical liver screening
|Indicator||Norm for adults||What a deviation may indicate|
|Above the norm||Below the norm (sharp drops in the indicator)||rubin||3.4–20 μmol / L || Jaundice:
Functional hyperbilirubinemic syndromes
|Bilirubin (direct or conjugated, bound)||Up to 8.6 μmol / L ||
|AlAT (men), up to 31 U / L (women) ||
|AsAT (Aspartate aminotransfera) ), up to 31 U / L (women) ||
|GGT 9153||Up to 49 U / ml (men), up to 3 2 U / ml (women) ||
|Alkaline phosphatase|| 40-150 U / l 
An extended biochemical study to assess liver function also includes indicators of total protein and protein fractions, cholinesterase, lipase, lactate dehydrogenase-1 (LDH), glucose, urea, prothrombine cholesterol … It rarely takes more than one or two working days to obtain biochemical analysis data.It should be remembered that the interpretation of the screening results and the diagnosis is the exclusive prerogative of the doctor. For example, an excess of the normal value of alkaline phosphatase by 3 times may indicate alcoholic or viral hepatitis, 5 times – about fatty degeneration of the liver, and 20 times – about medicinal hepatitis or biliary cirrhosis.
The hepatologist collects puzzles from the data of blood and urine tests, ultrasound results, general examination, patient’s history into a general clinical picture, which can be called cholestatic, mesenchymal-inflammatory, cytolytic syndrome, portal hypertension syndrome or hepatocellular insufficiency.
Analyzes to assess the degree of fibrosis (cirrhosis) of the liver
Fibrosis is a liver disease in which special liver cells (hepatocytes) are destroyed, and their places are taken by fibrocytes – cells of connective tissue. Infectious diseases of the liver – hepatitis – often become the cause of fibrosis. Also, often fibrosis is a consequence of damage to the liver tissue by toxic substances, potent medications and alcohol.
There are four stages of fibrosis, which in the international METAVIR system are designated by indices from F1 to F4, where F1 is the mildest stage, and F4 is already cirrhosis.The F0 index means that the liver has no signs of fibrotic changes.
The disease is diagnosed by ultrasound examination of the hypochondrium. However, such a study of the liver is not exhaustive: sometimes fibrosis gives an ultrasound picture similar to cancer or hepatosis.
Fatty hepatosis is the process of replacing the liver tissue with fatty tissue. It is often a consequence of obesity and diabetes.
To clarify the picture of the disease, biopsy was previously widely used – taking a sample of liver tissue for analysis. But modern laboratory diagnostic methods, in particular “FibroTest”, “FibroMax” and “SteatoScreen”, developed by the French company BioPredictive and received state registration in Russia, allowed back in 2007 to get away from this traumatic method .
Actual methods for determining the state of the liver structure consist in deep mathematical processing of various indicators (absolute values and ratios among themselves) of the patient’s blood, including α2-metaglobulin, apolipoprotein, bilirubin, glucose, AST, ALT, triglycerides and others.
The ratio of AST to ALT values more than 1 with a high degree of probability means pronounced fibrotic changes – liver cirrhosis. But by themselves, these indicators may indicate cardiovascular diseases, therefore, they are considered only in combination with other factors.
In addition, the patient’s height and weight, gender and age are taken into account. The FibroTest result is a numerical value from 0 to 1 with a step of 0.01.
Blood sampling and preparation for “FibroTest” is the same as for biochemical analyzes. In this sense, FibroTest is an extended biochemistry.
Another approach to the detection of fibrotic changes – elastography . It was found that structural disorders of the hepatic tissue (fibrosis, cirrhosis, oncology) cause an increase in the elasticity index of the organ. With the help of an ultrasonic device (“FibroScan”), an accurate measurement of the elasticity of the liver in Pascals is carried out, after which the total value is displayed, which is used for diagnosis.This method is also an effective test for liver cancer. The decoding of the indicators of both methods is shown in the table.
Table 2 . Comparative interpretation of the results of the study “FibroTest” and elastography
|METAVIR||“FibroTest”||Elastography (avg. KPa)|
A further sharp increase in liver elasticity (75 kPa) indicates the presence of hepatocellular carcinoma (HCC, liver cancer).
Laboratory diagnostics of viral and autoimmune liver diseases
If the liver disease is infectious (viral) or autoimmune in nature, this is manifested by the presence of antibodies in the blood.
For your information!
Autoimmune diseases are diseases that develop as a result of antibodies affecting healthy cells of various organs.
At some point, the immune system begins to accept its own cells as disease-causing agents and begins to fight them.The causes and nature of the phenomenon have not yet been fully studied.
But before diagnosing autoimmune hepatitis, you should definitely exclude the infectious nature of the disease. To confirm or exclude the presence of this factor immediately, tests for antibodies of the IgG and IgM classes to viral hepatitis A, B, C, D, G, E are prescribed, as well as the qualitative and quantitative determination of RNA and DNA of viruses by PCR – polymerase chain reaction.
Markers of autoimmune hepatitis (AIH) are the following specific antibodies :
- AMA-M2 .The main marker of autoimmune hepatitis 1 type, primary biliary cirrhosis. The main indicator of the presence of this disease.
- LKM-1 . A marker of type 2 autoimmune hepatitis. To make a diagnosis, the presence of LKM-1 in the blood is not enough, since this antibody can be found in viral hepatitis C.
- LC-1 . Also a marker of type 2 hepatitis. The presence of both LC-1 and LKM-1 in the blood allows us to make an accurate conclusion that the disease is of an autoimmune nature, a viral origin is excluded.
- SLA / LP . Marker of type 3 autoimmune hepatitis. It is sufficient for diagnosis, since it does not occur in other diseases.
What is special about each type of autoimmune hepatitis?
- Type 1 . It can manifest itself at any age, but the peak incidence occurs in adolescence and pre-retirement age. If untreated, it gives complications in the form of cirrhosis in more than 40% of patients. The main method of therapy is taking immunosuppressants (drugs that suppress immunity).
- Type 2 . A rarer type of AIH, but more dangerous: it most often affects children under 14 years old, is resistant to immunotherapy. Discontinuation of medication often causes relapses of the disease. Often combined with other diseases – insulin-dependent diabetes, ulcerative colitis.
- Type 3 . It is observed in patients with type 1 hepatitis (every tenth type 1 AIH carrier is simultaneously susceptible to type 3), so there is still no consensus on whether this form of the disease is a separate type.
Studies for viral or autoimmune liver damage, as a rule, are carried out according to the results of biochemical screening – an assessment of liver function, if the latter has revealed serious deviations from the norm.
So, in no case should you neglect symptoms indicating possible liver problems. Modern medicine provides all the possibilities for quick and accurate diagnosis of functional disorders of this organ. You should be attentive to your health and consult a doctor at the first sign of illness, or better – for preventive purposes.
Detailed laboratory examination of the liver
Comprehensive laboratory examination of the liver, including indicators of protein, fat and pigment metabolism, markers of viral hepatitis and a tumor marker alpha-fetoprotein (AFP).
Complete laboratory examination of the liver, screening for liver diseases.
Laboratory liver panel, Tests to diagnose liver diseases, Liver check-up.
What kind of biomaterial can be used for research?
How to properly prepare for the study?
- Do not eat for 12 hours before the test, you can drink clean still water.
- Eliminate physical and emotional stress for 30 minutes before the study.
- Do not smoke within 30 minutes prior to examination.
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, synthesis of cholesterol and glucose, storage of vitamins and iron, and many others. It is not surprising, therefore, that the liver is so susceptible 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 play 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 liver function, 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 ensures the maintenance of oncotic pressure.When the synthetic function of the liver is impaired, the concentration of this protein, as a rule, decreases. It should be noted that this decrease is observed in severe liver disease, 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, a change in the concentration of albumin can be observed in many other diseases and conditions, for example, fasting, malabsorption, nephrotic syndrome, infectious diseases, and others.
- Prothrombin according to Quick (also called prothrombin time) and the international normalized ratio (INR, INR) are the main indicators used to assess the external pathway of blood clotting (fibrinogen, prothrombin, factor V, VII and X). The liver is the main source of the 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 violations of blood coagulation are observed in the late stages of liver disease.
- Cholesterol can be synthesized in almost any cell of the body, however, 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 is of less clinical significance. Different fractions of cholesterol are associated with different effects on human health. Thus, cholesterol in low-density lipoprotein (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, for the diagnosis of cytolysis, the liver enzymes ALT and AST are examined.
- 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 muscles, kidneys, brain, erythrocytes), changes in their concentration in the blood are more often associated with liver diseases, which explains 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 ALT and AST levels is observed. In alcoholic hepatitis, liver metastases and cirrhosis, a more pronounced increase in AST is observed than ALT.
3. To exclude obstruction of the biliary tract with gallstones or a tumor (liver, pancreas, Vater’s papilla), 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 is toxic to the nervous system and must be eliminated from the body in the bile or urine. The 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, bound bilirubin is formed in the liver.Since this type of bilirubin can be determined directly using a direct laboratory test, it is also called direct bilirubin. Bilirubin that has not been conjugated with glucuronic acid is called unbound. Under laboratory conditions, it is not possible to study 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 (suprahepatic) 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 ALP (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 ALP can also be observed in other diseases, for example, in diseases of bone tissue, myocardial infarction, and sarcoidosis. Therefore, to confirm that the reason for the increase in the level of total alkaline phosphatase is precisely the liver disease, it is advisable to conduct an additional study – an analysis for gamma-HT.
- Gamma-glutamyl transpeptidase, gamma-HT, is also a membrane-bound liver enzyme that catalyzes the transfer of the gamma-glutamyl group of glutathione to other molecules. Currently, gamma-HT is 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 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 us 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 metastatic liver disease 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 alkaline phosphatase and gamma-HT is also observed in obstruction of the biliary tract caused by diseases of the pancreas (cancer of the head of the pancreas).
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 remember about hemochromatosis. To exclude it as a cause of liver damage, the level of iron in the blood is examined. With hemochromatosis, it is increased.
5. Viral hepatitis (B and C) is very common in the 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, an analysis for hepatitis is necessary for all patients, especially those who are 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 sex, hemodialysis, HIV -infection, change of sexual partners and others). This comprehensive analysis included the main markers of hepatitis: antibodies to hepatitis C virus (anti-HCV) and hepatitis B virus 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 AFP level is usually above 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 the research used for?
- For the assessment of function and early diagnosis of liver diseases.
When is the study scheduled?
- During routine examination;
- in the presence of symptoms of a disease of the liver, gallbladder and bile ducts: pain or discomfort in the right hypochondrium, nausea, stool disorders, darkening of urine, the appearance of jaundice, edema, increased bleeding, rapid fatigue;
- when observing a patient receiving hepatotoxic drugs for any disease (methotrexate, tetracyclines, amiodarone, valproic acid, salicylates).
What do the results mean?
For each indicator included in the complex:
In the meantime, there is no need to worry about it. ”
Download an example of the result
- To get an accurate result, you must follow the recommendations for preparing for the test;
- research results are evaluated taking into account additional anamnestic, instrumental and laboratory data.
[40-085] Viral hepatitis B.Control of virus activity before starting treatment
[40-091] Viral hepatitis C. Analyzes before starting treatment
[42-028] The effectiveness of treatment with PEG-interferon and Ribavirin
[13-022] Antibodies to liver and kidney microsomal fraction (anti-LKM)
[13-021] Anti-mitochondrial antibodies (AMA)
[13-068] Antibodies to antigens of autoimmune liver diseases (antibodies to liver-kidney microsomes 1 type (LKM-1), pyruvate decarboxylase complex of mitochondria (PDC / M2), cytosolic antigen (LC-1) and soluble liver antigen ( SLA / LP))
[13-069] Detailed serology of autoimmune liver diseases
[12-005] Cytological examination of material obtained during surgery
Who orders the study?
Therapist, general practitioner, infectious disease specialist, gastroenterologist, hepatologist.
- McPhee S. J., Papadakis M. CURRENT Medical Diagnosis and Treatment / S. J. McPhee, M. Papadakis; 49 ed. – McGraw-Hill Medical, 2009.
- Chernecky C. C. Laboratory Tests and Diagnostic Procedures / С. С. Chernecky, B.J. Berger; 5th ed. – Saunder Elsevier, 2008.
- 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.
Liver test with up to 50% discount
Comprehensive analysis for the liver, which includes tests that assess the general functional state of the liver: ALT, AST; protein metabolism function: total protein, albumin, urea; synthesis of bilirubin and bile production: bilirubin and its fractions; bile secretion: GGTP, alkaline phosphatase.
The complex is recommended at any age with suspicion of liver damage and inflammation, before and against the background of taking hepatotoxic drugs, for monitoring the treatment of liver diseases, cholelithiasis. Also, the complex is suitable for the initial assessment of the state of the liver against the background of diseases of other organs, for example, kidneys, stomach, intestines, diabetes mellitus, rheumatological diseases, parasitic infections.
Material for research
– Blood serum
Composition and Results
Analysis will be ready in
within 2 days, excluding the day of collection.The term can be extended by 1 day if necessary.
You will receive the results by email. mail immediately when ready.
Deadline: 2 days, excluding Saturday and Sunday (except for the day of taking biomaterial)
Preparation for analysis
Do not take a blood test immediately after radiography, fluorography, ultrasound, physiotherapy.
The day before
24 hours before blood collection:
- Limit fatty and fried foods, do not drink alcohol.
- Avoid strenuous physical activity.
From 8 to 14 hours before donating blood, do not eat, drink only clean non-carbonated water.
On the day of donation
Before taking blood
- No smoking for 60 minutes,
- Be quiet for 15-30 minutes.
Liver function, complex of analyzes (liver function tests)
Comprehensive analysis for the liver, which includes tests that assess the general functional state of the liver: ALT, AST; protein metabolism function: total protein, albumin, urea; synthesis of bilirubin and bile production: bilirubin and its fractions; bile secretion: GGTP, alkaline phosphatase.
Many types of metabolism take place in liver cells.Protein metabolism involves enzymes of liver cells (hepatocytes) called transaminases (ALT and AST). An increase in transaminases in the blood can be observed during cytolysis (destruction) of hepatocytes. An increase in ALT more often indicates liver damage, while an increase in AST can also be observed with muscle damage, myocardial infarction, and erythrocyte hemolysis. In acute viral hepatitis, the levels of enzymes exceed the upper limit of the norm by 5-10 times, and in chronic hepatitis by 1.5-2 times, increasing about the same.With alcoholic hepatitis, cirrhosis, liver metastases, there is a predominant increase in AST.
The enzymes alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGTP) help evaluate the biliary function of the liver and biliary tract. In the case of their simultaneous increase, first of all, obstruction (blockage) of the biliary tract is excluded, for example, with gallstone disease. High levels of GGTP are characteristic of cirrhosis and liver metastases. A moderate increase in GGTP (2-5 times) is observed in viral hepatitis.Unlike GGTP, ALP is also increased in diseases of the bones and intestines.
For hepatic jaundice and obstruction of the biliary tract, an increase in total bilirubin is also typical, more due to the direct fraction. Violation of bilirubin synthesis occurs with hereditary Gilbert’s syndrome, when there is not enough enzyme that neutralizes indirect bilirubin.
Many drugs are hepatotoxic, causing temporary damage to liver cells.To exclude the development of toxic hepatitis while treating certain diseases, it is necessary to regularly assess liver function.
The general assessment of the research results, the establishment of the diagnosis and the appointment of therapy are carried out by the attending physician.
Biochemical blood test for liver cirrhosis
A biochemical blood test for liver cirrhosis is prescribed by the doctor first. This disease is the replacement of normal fibrous tissue of the organ.The process is accompanied by a change in the size of the liver to a smaller or larger side, an increase in density and the appearance of tuberosity. These signs are detected during examination by a doctor and on an ultrasound examination. Laboratory diagnostics indicate functional changes. For accuracy, analyzes must be combined with other examination methods.
A blood biochemistry test in patients with compensated disease may give results within the normal range, but a slight increase in serum transaminase or gamma-glutamyl transpeptidase activity is also possible.The decompensated form is accompanied by symptoms:
- portal hypertension – an increase in pressure in the portal vein system due to blockage of intra-, extrahepatic vessels,
- liver failure is a syndrome involving a violation of several functions of the liver.
In case of liver cirrhosis, a biochemical blood test shows:
- increase in bilirubin, gamma globulins,
- reduction of albumin, protobin, cholesterol.
Test values are significantly related to process activity.
So, if the patient undergoes complex analyzes, for example, biochemical and clinical, then the second with active cirrhosis of the liver shows:
In the results of a biochemical test in 90 percent of patients, the activity of aminotransferases is increased by 2-5 times. Bilirubin also exceeds the norm by at least two times.
In patients with alcoholic liver damage, the activity of gamma-glutamyltransferase is increased to a greater extent. If, if you suspect viral cirrhosis, you are tested for markers of hepatitis, then the tests will be positive. The indicator of the hepatitis D virus is found in the most pronounced viral cirrhosis.
A biochemical blood test for low-level cirrhosis shows abnormalities in 30-50 percent of cases. The concentration of total bilirubin is 1.5-2 times higher, the activity is 1.5-4 times higher.Decreased prothrombin index.
Cirrhosis is a multifactorial disease that, as it develops, leads to an immune-inflammatory process. Therefore, in addition to a biochemical test for cirrhosis of the liver, the doctor may prescribe an immunological study. It shows a decrease in the activity of T-lymphocytes, the formation of antibodies to the parenchyma, an increase in the concentration of immunoglobulins.
Complex examinations are carried out at Litekh. Here you can do all the necessary analyzes and get expert opinion.
How to tell if your liver is unhealthy? | Healthy life | Health
The most common sign of liver disease is pain or heaviness in the right hypochondrium. Unpleasant sensations and a feeling of constriction or overcrowding in the liver area may accompany subtle pulling pains and tingling sensations. Other symptoms may include increased fatigue, weakness, and enlargement of the gland. More alarming symptoms that should prompt you to see a doctor and get tested are bitterness in the mouth, heartburn, nausea and vomiting.
Since most liver pathologies at first do not have obvious symptoms, doctors recommend not to wait for a deterioration in health, but to determine the disease in time by passing a biochemical blood test. “The first thing to do is go to the clinic once a year and have a biochemical blood test. It will have six indicators: ALT, AST, GGT, ALP and two bilirubins. You can do an ultrasound scan, but most likely you will not see an existing disease, or if you have delayed the process, you will already see cirrhosis.Therefore, in the early stages of the disease, it makes no sense to do ultrasound, ”says gastroenterologist-hepatologist Sergei Vyalov .
A biochemistry test should be taken on an empty stomach, and the last meal should be eight hours before blood sampling for analysis.
What will a biochemical blood test show?
An increase in ALT will indicate the development of such serious diseases as viral hepatitis, toxic liver damage, cirrhosis of the liver, and liver cancer.Decrease in ALT levels – for necrosis or cirrhosis.
An increase in AST in the blood indicates the development of viral, toxic or alcoholic hepatitis, liver cancer, and a decrease in AST levels indicates a ruptured liver and vitamin B6 deficiency.
An increase in GGT can occur in acute viral or chronic hepatitis and toxic liver damage.
An increase in alkaline phosphatase (ALP) will indicate toxic hepatitis, necrosis, cirrhosis or liver cancer.
Elevated total bilirubin is a symptom of jaundice or hepatitis.An increase in the bound bilirubin will also indicate jaundice, which has developed due to a violation of the outflow of bile from the liver.
90,000 Liver examination package | SYNLAB
Liver examination package
The tests available in the package allow you to detect the presence of liver diseases and assess the severity of its damage.
Possible symptoms indicating liver disease: loss of appetite, nausea, vomiting, general malaise and weakness, pruritus, yellowish skin and mucous membranes. Dark urine and light stool may be due to problems with the liver, gallbladder, and / or biliary tract.
Liver function is affected by certain medications, excessive alcohol consumption, as well as overweight, diabetes and hypertension. Liver dysfunction can also be caused, for example, by hepatitis B or C.
The package consists of 7 blood tests :
- Alanine aminotransferase (ALT) (Alaniini aminotransferaas (ALAT))
- Gamma glutamyl transpeptidase (GGT) (Gammaglutamüüli transferaas (GGT))
- Alkaline phosphatase (ALP) (Aluseline fosfataas (ALP))
- Bilirubin (total) (Bilirubiin)
- Prothrombin activity (INR) (Protrombiini aktiivsus, indeks (INR))
- Total antibodies to the core antigen of the hepatitis B virus (B-hepatiidi viiruse tuuma antigeeni vastased antikehad (HBc Ab))
- Antibodies to hepatitis C virus (C-hepatiidi viiruse vastane antikeha (sõeluuring) (HCV Ab))
Results will be available within 3 working days.