What are liver function tests. How do liver enzymes indicate liver health. What causes elevated liver enzymes. What are the symptoms of liver enzyme abnormalities. How are liver enzyme issues diagnosed and treated.

The Importance of Liver Function Tests

Liver function tests (LFTs) are crucial blood tests used to assess liver health and detect potential liver damage. These tests measure various enzymes, proteins, and substances produced by the liver, providing valuable insights into its overall function and identifying any abnormalities.

LFTs typically include measurements of the following:

• Albumin
• Total protein
• Alkaline phosphatase (ALP)
• Alanine transaminase (ALT)
• Aspartate aminotransferase (AST)
• Gamma-glutamyl transferase (GGT)
• Bilirubin
• Lactate dehydrogenase (LD)
• Prothrombin time (PT)

When one or more of these substances are outside the normal range, it may indicate liver disease or damage. Understanding these tests and their implications is essential for both healthcare professionals and patients.

Aminotransferase Enzymes: ALT and AST Explained

Among the various liver enzymes, aminotransferases play a significant role in assessing liver health. The two primary aminotransferase enzymes are:

1. Alanine aminotransferase (ALT), also known as serum glutamic pyruvic transaminase (SGPT)
2. Aspartate aminotransferase (AST), also known as serum glutamic oxaloacetic transaminase (SGOT)

These enzymes catalyze chemical reactions involving amino acid transfer. While both are indicators of liver health, they have distinct characteristics and distributions within the body.

Alanine Aminotransferase (ALT)

ALT is primarily found in liver cells, making it a more specific indicator of liver health. Elevated ALT levels often precede clinical signs and symptoms of liver disease, particularly in cases of viral hepatitis and other conditions associated with liver cell damage.

Why is ALT considered more liver-specific? ALT elevations are rarely observed in conditions unrelated to liver disease, and its elevated levels tend to persist longer than those of AST. This makes ALT a valuable marker for detecting and monitoring liver issues.

Aspartate Aminotransferase (AST)

AST, while also present in liver cells, is found in various other tissues, including the heart, muscle, kidney, and brain. It catalyzes the conversion of aspartate and alpha-ketoglutarate to oxaloacetate and glutamate.

Due to its presence in multiple tissues, elevated AST levels can result from damage to organs other than the liver. For instance, heart attacks or muscle injuries can cause AST elevations. This wider distribution makes AST a less specific indicator of liver damage compared to ALT.

Normal Ranges and Elevated Levels of Liver Enzymes

Understanding the normal ranges of liver enzymes is crucial for interpreting test results. The typical ranges for ALT and AST are as follows:

• ALT (SGPT): 7 to 56 units per liter of serum
• AST (SGOT): 5 to 40 units per liter of serum

When enzyme levels exceed these ranges, it may indicate liver damage or disease. However, it’s important to note that slight elevations may not always be cause for immediate concern. Factors such as age, gender, body mass index, and certain medications can influence enzyme levels.

Causes of Elevated Liver Enzymes

Elevated liver enzymes can result from various factors, ranging from temporary conditions to chronic liver diseases. Some common causes include:

• Viral hepatitis (A, B, C)
• Alcoholic liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Autoimmune hepatitis
• Certain medications
• Obesity
• Metabolic syndrome
• Celiac disease
• Hemochromatosis
• Wilson’s disease

In some cases, elevated enzymes may be due to non-liver related factors such as muscle damage, heart problems, or thyroid disorders. This underscores the importance of a comprehensive diagnostic approach.

Symptoms Associated with Liver Enzyme Abnormalities

Liver enzyme abnormalities may not always present with noticeable symptoms, especially in the early stages. However, as liver damage progresses, individuals may experience:

• Fatigue
• Weakness
• Loss of appetite
• Nausea and vomiting
• Abdominal pain or discomfort
• Jaundice (yellowing of skin and eyes)
• Dark urine
• Pale stools
• Itching
• Easy bruising or bleeding

It’s crucial to note that these symptoms can be associated with various liver conditions and may not be specific to enzyme abnormalities alone. Prompt medical evaluation is essential if these symptoms occur, especially in conjunction with abnormal liver function test results.

Diagnosis and Further Testing

When liver enzyme levels are found to be elevated, healthcare providers typically recommend additional tests to determine the underlying cause. These may include:

1. Repeat liver function tests to confirm the abnormality
2. Complete blood count (CBC)
3. Tests for viral hepatitis
4. Imaging studies such as ultrasound, CT scan, or MRI
5. Liver biopsy in some cases

The diagnostic process often involves a thorough medical history, physical examination, and consideration of risk factors such as alcohol consumption, medication use, and family history of liver disease.

How do healthcare providers interpret liver enzyme test results? They consider not only the absolute values but also the pattern of elevation. For instance, a higher AST to ALT ratio may suggest alcoholic liver disease, while a predominant ALT elevation might point towards viral hepatitis or non-alcoholic fatty liver disease.

Treatment Approaches for Liver Enzyme Abnormalities

Treatment for elevated liver enzymes depends on the underlying cause. Some general approaches include:

• Lifestyle modifications (e.g., reducing alcohol intake, losing weight)
• Dietary changes
• Discontinuation or adjustment of medications that may be causing liver damage
• Treatment of underlying conditions (e.g., antiviral therapy for hepatitis)
• Management of chronic liver diseases
• Liver transplantation in severe cases of liver failure

In many cases, addressing the root cause can lead to normalization of liver enzyme levels. However, ongoing monitoring and follow-up are often necessary to ensure the effectiveness of treatment and to detect any progression of liver disease.

Prevention and Liver Health Maintenance

Maintaining liver health and preventing enzyme abnormalities involves several key strategies:

1. Limiting alcohol consumption
2. Maintaining a healthy weight
3. Following a balanced diet rich in fruits, vegetables, and whole grains
4. Regular exercise
5. Avoiding unnecessary medications and supplements
6. Getting vaccinated against hepatitis A and B
7. Practicing safe sex and avoiding intravenous drug use to prevent hepatitis C
8. Regular check-ups and liver function tests, especially for those at higher risk

By adopting these preventive measures, individuals can significantly reduce their risk of liver damage and maintain optimal liver function.

How often should liver function tests be performed? For healthy individuals, routine screening is not typically necessary. However, those with risk factors or chronic conditions affecting the liver may require more frequent monitoring, as determined by their healthcare provider.

The Role of Liver Enzymes in Overall Health Assessment

While liver enzyme tests are primarily used to evaluate liver health, they can also provide insights into overall health status. Abnormal liver enzyme levels may be indicators of:

• Metabolic disorders
• Cardiovascular health issues
• Systemic inflammatory conditions
• Muscle disorders
• Certain cancers

This broader relevance underscores the importance of liver function tests as part of a comprehensive health assessment. Healthcare providers often use these tests in conjunction with other diagnostic tools to form a complete picture of an individual’s health status.

How do liver enzyme levels correlate with overall health outcomes? Research has shown that persistently elevated liver enzymes, even within the upper range of normal, may be associated with increased risks of cardiovascular disease, type 2 diabetes, and metabolic syndrome. This highlights the potential of liver enzyme tests as early warning signs for a range of health issues beyond liver disease.

Emerging Research and Future Directions

The field of hepatology continues to evolve, with ongoing research into liver function and enzyme dynamics. Some areas of current interest include:

1. Development of more sensitive and specific biomarkers for liver disease
2. Non-invasive alternatives to liver biopsy for disease staging
3. Personalized medicine approaches based on genetic factors influencing liver enzyme levels
4. Novel treatments for chronic liver diseases
5. The role of the gut microbiome in liver health and enzyme regulation

These research directions hold promise for improving our understanding of liver function and developing more effective diagnostic and treatment strategies.

What potential breakthroughs can we expect in liver enzyme research? Advances in molecular biology and imaging techniques may lead to the discovery of new liver-specific markers that offer greater accuracy in diagnosing and monitoring liver diseases. Additionally, the integration of artificial intelligence and machine learning in analyzing liver function test results could enhance early detection and prediction of liver-related complications.

Special Considerations in Liver Enzyme Interpretation

Interpreting liver enzyme tests requires consideration of various factors that can influence results:

• Age and gender differences in normal ranges
• Ethnic variations in liver enzyme levels
• Impact of pregnancy on liver function tests
• Effects of certain medications on enzyme levels
• Influence of body mass index and muscle mass
• Diurnal variations in enzyme levels
• Effects of exercise on transient enzyme elevations

Healthcare providers must take these factors into account when interpreting liver function test results to avoid misdiagnosis or unnecessary interventions.

How do these factors affect liver enzyme interpretation in clinical practice? For instance, athletes or individuals who engage in intense physical activity may show temporary elevations in liver enzymes, particularly AST, due to muscle breakdown. Similarly, certain ethnic groups may have slightly different baseline enzyme levels, necessitating adjusted reference ranges for accurate interpretation.

Patient Education and Empowerment

Educating patients about liver health and the significance of liver function tests is crucial for promoting proactive health management. Key aspects of patient education include:

1. Understanding the role of the liver in overall health
2. Recognizing risk factors for liver disease
3. Interpreting liver function test results
4. Implementing lifestyle changes for liver health
5. Knowing when to seek medical attention
6. Understanding the importance of medication adherence in liver diseases
7. Recognizing the potential impact of complementary and alternative medicines on liver health

Empowering patients with this knowledge can lead to better health outcomes and more effective management of liver conditions.

How can healthcare providers effectively communicate liver enzyme test results to patients? Clear, jargon-free explanations of test results, along with visual aids such as graphs or charts, can help patients better understand their liver health status. Providers should also emphasize the context of the results, explaining what they mean in terms of overall health and any necessary follow-up actions.

Conclusion

Liver enzyme tests play a vital role in assessing liver health and overall well-being. Understanding the significance of these tests, their normal ranges, and the factors that can influence results is crucial for both healthcare providers and patients. By recognizing the importance of liver enzymes in health assessment, implementing preventive strategies, and staying informed about emerging research, individuals can take proactive steps towards maintaining optimal liver function and overall health.

As our understanding of liver biology continues to advance, we can expect more refined diagnostic tools and treatment approaches for liver diseases. The ongoing research in this field holds promise for improving liver health outcomes and quality of life for individuals affected by liver conditions. With continued emphasis on patient education and empowerment, we can work towards a future where liver diseases are detected earlier, managed more effectively, and potentially prevented through informed lifestyle choices and advanced medical interventions.

Liver Function Tests-Ranges-High & Low

Liver Function Tests (LFT)

Liver function tests (LFT) are blood tests, which are commonly performed to assess liver functions or liver injury. LFT is also known by other names such as, liver panel, liver function panel, liver profile hepatic function panel, LFT.

An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes mostly reside within the cells of the liver.

But when the liver is injured for any reason, these enzymes are spilled into the blood stream. Enzymes are proteins that are present throughout the body, each with a unique function.

Enzymes help to speed up (catalyze) routine and vital chemical reactions in the body.

Liver function tests (also known as a liver panel) are blood tests that measure different enzymes, proteins, and other substances made by the liver. These tests check the overall health of the liver.

Following are the different substances often tested at the same time on a single blood sample for LFT:

• Albumin a protein made in the liver
• Total protein. This test measures the total amount of protein in the blood.
• ALP ALP(alkaline phosphatase), ALT (alanine transaminase), AST (aspartate aminotransferase), and gamma-glutamyl transferase (GGT). These are different enzymes made by the liver.
• Bilirubin, a waste product made by the liver.
• Lactate dehydrogenase (LD), an enzyme found in most of the body’s cells. LD is released into the blood when cells have been damaged by disease or injury.
• Prothrombin time (PT), a protein involved in blood clotting.

If levels of one or more of these substances are outside of the normal range, it may be a sign of liver disease.

Aminotransferase Enzymes (ALT, AST)

The aminotransferase enzymes catalyze chemical reactions in which an amino group from one amino acid (amino acids are building blocks of proteins) is transferred from a donor molecule to a recipient molecule, hence, the names “aminotransferases.”

Medical terms can sometimes be confusing, as is the case with these enzymes because they have interchangeable names that commonly appear in both medical and non-medical articles. For example:

• Another name for aminotransferase is transaminase.
• The enzyme aspartate aminotransferase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT).
• Alanine aminotransferase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT).

Briefly, AST = SGOT and ALT = SGPT; they are enzymes produced by the liver and other types of cells.

Alanine aminotransferase (ALT)

Alanine aminotransferase (ALT) is present primarily in liver cells. In viral hepatitis and other forms of liver disease associated with hepatic necrosis, serum ALT is elevated even before the clinical signs and symptoms of the disease appear.

Although serum levels of both aspartate aminotransferase (AST) and ALT become elevated whenever disease processes affect liver cell integrity, ALT is a more liver-specific enzyme.

Serum elevations of ALT are rarely observed in conditions other than parenchymal liver disease. Moreover, the elevation of ALT activity persists longer than does AST activity.

Aspartate Aminotransferase (AST)

Aspartate aminotransferase (AST) is a transaminase enzyme that catalyzes the conversion of aspartate and alpha-ketoglutarate to oxaloacetate and glutamate.

The AST enzyme was formerly known as serum glutamate oxalate transaminase (SGOT) and is present in all tissues except bone, with highest levels in liver and skeletal muscle. Concentration of AST is elevated after bruising, trauma, necrosis, infection, or neoplasia of liver or muscle.

The AST enzyme is found in cerebrospinal fluid, exudates, and transudates in proportion to the amount of cellular damage.

Where AST (aspartate aminotransferase) and ALT (aminotransferase enzymes) are Found

AST (SGOT) is normally found in a variety of tissues including the liver, heart, muscle, kidney, and brain. It is released into the serum when any one of these tissues is damaged.

For example, the AST level in serum is elevated in heart attacks or with a muscle injury. It is, therefore, not a highly specific indicator of liver injury as its elevation can occur as a result of other injured tissues.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in the liver, but that is where it is most concentrated.

It is released into the bloodstream as the result of liver injury. Thus, it serves as a fairly specific indicator of liver status.

High (Elevated) Levels of AST and ALT

Following are the normal ranges of AST and ALT:

• The normal range of values for AST (SGOT) is about 5 to 40 units per liter of serum (the liquid part of the blood).
• The normal range of values for ALT (SGPT) is about 7 to 56 units per liter of serum.

The ranges of AST and ALT numbers may differ slightly depending on the technique and protocols used by different laboratories worldwide. However, normal reference ranges are routinely provided by each laboratory and printed with each patient’s individual report.

AST (SGOT) and ALT (SGPT) are reasonably sensitive indicators of liver damage or injury from different types of diseases or conditions, and collectively they are termed liver tests or liver blood tests.

However, it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not.

For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT results depends upon the entire clinical evaluation of an individual, and so it is best done by physicians experienced in evaluating liver disease and muscle disease.

Moreover, the precise levels of these liver enzyme tests do not correlate well with the extent of liver problems or the prognosis (outlook). Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future prognosis for liver function.

For example, patients with acute viral hepatitis-A may develop very high AST and ALT levels (sometimes in the thousands of units/liter range), but most patients with acute viral hepatitis-A recover fully without residual liver disease.

Again, patients with chronic hepatitis-C infection typically have only a little elevation in their AST and ALT levels while having substantial liver injury and even advanced scarring of the liver (cirrhosis) from ongoing minor inflammation of the liver.

Types of Liver Function Tests (LFT)

A liver function test is one of a group of tests that check levels of certain enzymes and other proteins in the blood. Some of the tests look for enzymes that are found in liver disease  and when the liver is damaged. Others check that the liver is working properly, the way it should.

Following are some of the blood tests reflect liver function:

• Coagulation panel (prothrombin time or PT, and international normalized ratio or INR): These tests measure blood’s ability for normal clotting and prevention of bleeding and bruising. This is the function of certain proteins called clotting factors that normally are produced in the liver. Normal values are about 9.5 to 13.8 seconds.
• Albumin level (hypoalbuminemia): Albumin is a very common protein found in the blood with a variety of functions. It also is produced only in the liver, and if its levels are lower than normal it can be suggestive of chronic liver disease or liver cirrhosis. Of note, many conditions other than liver disease also may cause low albumin levels. Normal values are about 3.5 to 5 g/dL.
• Bilirubin: This molecule is a byproduct of the routine destruction of red blood cells occurring in the liver. It is normally released as bile in the feces. Elevation of the bilirubin can suggest liver dysfunction. However, other conditions with increased destruction of red blood cells also can cause elevated bilirubin levels despite normal liver function. Normal values are about 0.1 to 1.0 mg/dL.
• Platelet count: Low platelet count (thrombocytopenia) has many causes, one of which can be advanced liver disease. Normal platelet counts are about 150,000 to 400,000 per (µL).
• Glucose: Glucose level is maintained in the body by a variety of mechanisms. The liver can release glucose in the blood for nourishment of other cells in case of starvation with insufficient oral intake of glucose. This process, called gluconeogenesis, is another major function of the liver. In advanced liver disease, this function of the liver can be compromised leading to unusually low glucose levels in the absence of adequate oral intake. Again, a large number of patients with liver cirrhosis become glucose intolerant and develop diabetes.
• GGT (Gamma-glutamyl transpeptidase): This enzyme is thought to indicate possible liver damage; the higher the abnormal level, the more likely there is liver damage. Normal levels of GGT are about 9 to 48 U/L.
• ALP (alkaline phosphatase): The liver synthesizes the highest amounts of this enzyme so high levels in the blood may suggest liver injury among other causes. Normal levels of ALP are about 45 to 115 U/L.
• LD or LDH (Lactate dehydrogenase): This enzyme may be elevated in many types of diseases, including liver disease. Normal levels are about 122 to 222U/L.

Reasons for Abnormal Liver Tests

Abnormal liver tests may be detected a variety of liver conditions in the blood. Some of those are the following:

• Mild to moderate elevations of the liver enzymes are common. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT readings in such cases are usually between twice the upper limits of normal and several hundred units/liter. One of the most common causes of mild to moderate elevations of these liver tests is a condition referred to as fatty liver disease (steatohepatitis or hepatic steatosis). In the United States, the most frequent cause of fatty liver disease is alcohol abuse.  

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time.

The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

Other causes of fatty liver include diabetes mellitus, and obesity. Fatty liver disease tests are composed of several tests including blood tests, CT and/or MRI scan tests, and in some patients, a liver biopsy.

• Hepatitis-B and Hepatitis-C are other causes of chronic mild to moderate liver enzyme elevation. In these conditions, ALT and AST may be only slightly high and the degree of abnormality in liver function tests can indicate the degree of injury.
• Chronic and acute alcohol use also can commonly cause abnormal liver blood tests. In alcoholic hepatitis, the range of liver tests can vary greatly. In chronic alcohol liver disease or alcoholic cirrhosis, slight elevation of ALT and AST may be observed, whereas, in acute alcoholic hepatitis, high liver enzyme numbers are often seen.
  
• Some medications can be responsible for a mild to moderate increase in the liver enzyme tests.

Medications that can cause increased liver enzyme tests (AST and ALT) levels

Following are examples of some of the common medications with potential liver toxicity:

Pain Relief Medications

• Aspirin
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)
• Diclofenac (Voltaren, Cataflam, Voltaren-XR)
• Phenylbutazone (Butazolidine)

Anti-seizure Medications

• Phenytoin (Dilantin)
• Valproic acid ( Depakote)
• Carbamazepine (Tegretol)
• Phenobarbital

Antibiotics

• Tetracyclines (Achromycin)
• Sulfonamides
• Isoniazid (Nydrazid, Laniazid)
• Sulfamethoxazole (Gantanol)
• Trimethoprim(Trimpex; Proloprim, Primsol)
• Nitrofurantoin (Macrodantin, Furadantin, Macrobid)
• Fluconazole (Dilflucan) and other anti-fungals

Cholesterol Lowering Drugs (Statins)

• Lovastatin (Mevacor, Altocor)
• Pravastatin (Pravachol)
• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)
• Niacin

Cardiovascular Drugs

• Amiodarone (Cordaone)
• Hydralazine (Apresoline)
• Quinidine (Quinaglute, Quinidex)

Other Drugs

• Antidepressant drugs of the tricyclic type

With drug-induced liver enzyme abnormalities, the enzymes usually normalize weeks to months after stopping the medications. Typically, the physician will want to monitor the patient’s liver enzymes over time to confirm that the values are normalizing.

Diseases that can cause very high AST or ALT levels

AST and ALT serum levels in some liver conditions can range anywhere from ten times the upper limits of normal to thousands of units/liter.

The highest levels of AST and ALT are found with disorders that cause rapid death of numerous liver cells (extensive hepatic necrosis). Although this degree of liver enzymes elevation is not common, it can occur in such conditions as:

• Acute viral hepatitis A or B
• Profound liver damage inflicted by toxins as from an overdose of acetaminophen (brand-name Tylenol) or mushroom poisoning
• Prolonged collapse of the circulatory system (shock) when the liver is deprived of fresh blood providing oxygen and nutrients

Also, very high AST and ALT levels can be a result of severe muscle diseases.

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What Level of Liver Enzyme Should I be Concerned With?

Are you having ongoing slight elevations in your liver enzymes?. Maybe you were told it is perfectly normal and you shouldn’t worry about it.   In this article we go into some of the details of why that may or may not be appropriate for you. We look at what the optimal levels of liver enzymes are for males and females, so you can better understand what to do for your own health.

If you want to know what level of liver enzymes you should be concerned with keep reading. 

What level of liver enzyme should I be concerned with? Mainly we are looking at this from the perspective of getting a blood test back that shows you have elevated liver enzymes.   This could be the AST, the ALT or the GGT.  AST is usually written out as as aspirate amino transferase.  ALT is written out as alanine amino transferase.  Most of the time the GGT isn’t done, but sometimes if you are looking specifically at a liver function test, the GGT will be included.  There are a few other liver tests that may be included in a liver specific test.   These are the three that are of most importance for assessing liver function. 

In other articles we mentioned why these levels might be high. Also some other testing you might want to consider when you have elevated levels of these liver enzymes. These enzymes do come from your liver, but they can be found to a lesser extent in some other tissues as well.  With all that being said, at what level should you start to be concerned when your liver enzymes are high? How high is too high?

The reference range for your liver enzymes will be slightly different from one lab to the next.  Typically the level for the AST or aspirate amino transferase will be reported as between 10 and 40 units per liter.  Alanine amino transferase will be between 7 to 56 units per liter. These are the reference ranges.  If you fall within those parameters, you will not get flagged as high or low.  Mild elevations are generally considered to be one or two times the normal limit.  Moderate elevations are two to three times the reference range. Severely high levels are in the thousands.  Then the question is, what do you do when your levels are in the sixties, seventies, or even fifties? Are these really a problem? Should you be concerned if your liver enzymes are on the upper end of normal or slightly above? 

It is actually pretty common where to see the lab not flagging the results, but the level is slightly high.  I see this very commonly in my practice.  There is usually a good reason for it, but that doesn’t mean the level is actually in the optimal range.  Optimal or a true healthy range for ALT is a range between 29 and 33 units per liter for males and slightly lower for females 19 to 25 units per liter.  Levels consistently above this, meaning multiple tests that are higher than this, should be investigated.  We’ are not getting into the causes here because there’s other articles on that topic.  

Why Liver Enzymes Are High

The same approximate ranges can be used for the AST and GGT to make things simple and straightforward. I usually use 25 as a general reference range for both males and females.  If it’s above that, that could be a problem. Of course,  there’s some leeway depending on if you are a male or female and which tests we are actually looking at.  That’s a rule of thumb that I usually go off of.  Now, transient elevations, like one test above 25 is nothing to be concerned about.  It is the consistent elevations, much more than 25, like 50, or even 30 that could be a problem.  The level will really tell you what the next steps should be. 

When it’s slightly above, it’s not really something to be concerned about. However, when the levels start to get into the upper end of the reference range like the fifties, that’s when you should start looking a little deeper.  Especially if they are like that after multiple tests.  So if you want more details on elevated liver enzymes, check out this videos.  There’s also a very detailed paper that goes into a lot more detail on why we are establishing 25 as a normal, healthy, optimal liver enzyme range. The basis is, if you take a sick population and try and create a reference range from that, you get a sick reference range.   The paper goes into a lot more detail. 

That should give you a better understanding of what what level of liver enzymes should I be concerned with.   If you have questions about the content in this article, please ask it in the comment section below.

If you want a customized plan on your elevated liver enzymes, click in the link below to get started. 

Gamma-glutamyltransferase (GGT) – indications, norm, blood test

EN / ENG / UA

The enzyme was first described by Hanes et al. in 1952 GGT – microsomal enzyme involved in amino acid metabolism. Catalyzes the transfer of ?-glutamyl residue from ?-glutamyl peptide to an amino acid or peptide (external transpeptidation), as well as to another substrate molecule (internal transpeptidation). Normally, the specific activity of the enzyme is higher than in blood serum, 7000-7500 times in the kidneys, 600-650 times in the pancreas, 200-500 times in the liver.

Insignificant activity of the enzyme is also recorded in the spleen, intestines, brain, lungs, skeletal muscles, heart, prostate. The enzyme is found in lysosomes, membranes, and cytoplasm of the cell, and membrane localization of GGT is characteristic of cells with high secretory, excretory, or reabsorption capacity. In the blood plasma of newborns, the activity of gamma-glutamyltransferase is 8-10 times higher than in adults, and even more in preterm infants.

During 7-9 months of life, GGT activity in the blood decreases, remaining constant until puberty. The level of the enzyme is also influenced by gender differences. In adolescents from 13 to 17 years old and in adults, the reference values ​​of gamma-glutamyl transpeptidase activity for women are 20-25% lower than for men.

Diagnosis of gamma-glutamyltransferase

Determination of GGT activity in blood serum has become of great importance for the diagnosis of diseases of the liver and hepatobiliary tract, and an increase in serum GGT values ​​is a sensitive indicator in diseases of the hepatobiliary system (marker of cholestasis)

Serum GGT levels increase in all forms of liver disease. The highest activity of the enzyme in cases of obstructive liver damage (5-30 times higher than normal values). This is a more sensitive indicator of liver pathology than ALT and AST in the diagnosis of obstructive jaundice, cholangitis and cholecystitis. The increase in GGT in these cases is observed earlier and lasts longer than other liver enzymes. The activity of gamma-glutamyl tranpeptidases in infectious hepatitis is 2–5 times higher than normal (in these cases, the determination of GGT is less useful than ALT and AST). In almost 100% of cases in cancer patients with liver metastases (without jaundice and with jaundice), a very significant increase in enzyme activity (12 or more times higher than normal) was found. Moreover, changes in activity gamma-glutamyltransferases are observed earlier and are more pronounced than the activities of other enzymes. A slight increase in GGT (2-5 times) is observed in patients with fatty degeneration of the liver.

An increase in enzyme activity is caused by many substances, especially drugs that can induce microsomal oxidizing capacity, as well as any oxidative stress (including diabetic ketoacidosis). After stopping the administration of drugs, GGT activity gradually returns to normal. In patients suffering from acute or chronic pancreatitis, malignant diseases of the pancreas, GGT activity, as a rule, exceeds the norm by 5–15 times.

High GGT activity was noted in the blood of alcoholics. There are certain differences between the activity of GGT in the blood of alcoholics and people who have taken a significant dose of alcohol (in the latter, even after severe intoxication, an increase in activity is observed only for 12 hours and does not exceed 15% of the norm). Therefore, gamma-glutamyltransferase is used to monitor the effectiveness of the treatment of patients with alcoholism. The high specific activity of GGT in the prostate gland, so it can be used as a marker of malignant diseases of the prostate gland. The study of GGT activity in brain lesions has acquired great clinical and diagnostic significance.

Parallel determination of the activity of GGT and alkaline phosphatase (in cases of its increased activity) helps when it is necessary to decide whether their source is an altered bone metabolism or the presence of hepatobiliary disorders, because. in conditions in which alkaline phosphatase is elevated (in healthy pregnant women, in children older than 1 year, in cases of bone diseases), GGT is within normal limits.

Indications for Gamma-glutamyltransferase test

1. Diagnosis and differential diagnosis of liver lesions
2. Monitoring of the course of pancreatic, prostate, hepatoma cancer
3. Screening for alcoholism, monitoring the treatment of people with chronic alcoholism
4. Evaluation of hepatotoxicity of drugs

Examination

Examination preparation: fasting blood sampling

Examination material: blood serum, avoid hemolysis

Method of determination : kinetic (IFCC)

Units of measure : U/l

Reference values ​​(normal gamma-glutamyltransferase in blood)

Increased gamma-glutamyl transpeptidase values ​​

If you have high GGT, possible reasons for this may be:

1. Intra- and extrahepatic cholestasis
2. Acute viral hepatitis, toxic, radiation damage to the liver
3. Chronic hepatitis
4. Acute and chronic pancreatitis
5. Alcohol-induced liver injury
6. Infectious mononucleosis
7. Hyperthyroidism
8. Myotonic dystrophy
9. Diabetes mellitus
10. Kidney pathology (exacerbations of chronic glomerulo- and pyelonephritis)
11. Cancer of the pancreas, prostate, hepatoma
12. Taking medications (barbiturates, phenytoin, rifampicin, cephalosporins, estrogens, oral contraceptives, acetaminophen)

The cost of a blood test for the content of gamma-glutamyl transferase

A blood test for the content of gamma-glutamyl transferase costs 35 UAH. It is carried out within 1-2 days. The cost of taking material for research is paid separately (15 – 25 UAH).

You can get full information about the service from our laboratory assistant.

Medical equipment of our laboratory.

Consultation of a laboratory doctor

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what you need to know about your liver condition

Contents

• 1 Liver criteria
  • 1. 1 Liver criteria: important information about the health of a vital organ
  • 1.2 What are hepatic criteria and why are they important for health
  • 1.3 Liver function and its effects on the body
  • 1.4 Key indicators of the state of the liver
  • 1.5 Determining liver criteria through tests and examinations
  • 1.6 Normal values ​​​​of liver criteria and their interpretation
  • 1.7 Influence of liver criteria on health and disease prevention
  • 1.8 Dangerous deviations of liver criteria and their possible consequences
  • 1.9 Factors affecting liver criteria and how to normalize them
  • 1.10 Recommendations for monitoring liver criteria and preventing liver disease
  • 1.11 The importance of regular medical examination to control liver criteria
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What symptoms may indicate liver problems?
      • 1.13.0.2 What tests will help to find out about the condition of the liver?

Liver criteria (or liver chemistry) are used to evaluate liver function and identify possible abnormalities. Learn what indicators are included in the liver criteria and how to interpret them for liver diagnosis and monitoring.

The liver is one of the most important organs in our body, responsible for many vital functions. It plays an important role in digestion, the processing and disposal of harmful substances, and the production of important proteins and hormones.

However, the liver is also a very vulnerable organ and can be damaged by various factors such as viruses, alcohol, improper diet and drugs. Therefore, it is important to know about the condition of your liver and the features of its work.

There are various methods and criteria for this, which allow you to determine how healthy your liver is. One of these criteria is the level of alanine aminotransferase (ALT) in the blood. High ALT levels can be a sign of inflammation or damage to the liver.

It is important to pay attention to your liver and monitor its condition in order to prevent serious consequences. Knowing about liver criteria will help you see your doctor in a timely manner and take the necessary steps to keep your liver healthy.

Liver Criteria: Important information about the condition of a vital organ

The liver is one of the most important organs in our body, with many functions. It plays the role of a filter, cleansing the blood of toxins, is involved in metabolism, synthesizes bile and helps in the digestion of food. The liver also processes drugs and stores vitamins and minerals. It is important to know about the current state of the liver in order to take timely measures to maintain it and prevent the development of diseases.

The most reliable and accurate method for diagnosing liver diseases is a biopsy – taking a small sample of tissue for examination under a microscope. However, this method is not always possible or desirable due to its invasiveness and risks. Therefore, liver criteria based on blood tests and other biochemical parameters can be used to initially assess the state of the liver.

It is important to understand that liver criteria are only indicators and may not fully reflect the condition of the liver. They can be increased not only in liver diseases, but also in other pathologies of the body. Therefore, in case of detection of abnormalities in the liver criteria, you should always consult a doctor for further examination and accurate diagnosis.

What are liver criteria and why are they important for health

Liver criteria are a set of parameters that assess the state of the liver and determine the presence or extent of liver disease. These criteria include parameters such as liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total and direct bilirubin levels, and albumin and globulin levels.

Liver criteria identify the presence of liver disease in the early stages, when symptoms are not yet apparent. They can also be used to monitor the effectiveness of treatment and estimate disease prevalence. Regular testing for liver criteria allows you to identify possible problems and take steps to prevent or treat them.

Prevention of liver disease includes a healthy lifestyle, including proper nutrition, moderate alcohol consumption, smoking cessation, regular exercise, and avoidance of exposure to toxic substances. It is also important to undergo regular medical examinations and tests, including checking liver criteria, which will allow timely detection and prevention of liver diseases.

Functions of the liver and its effect on the body

The liver is one of the key organs in our body, performing a large number of important functions. Its influence on the work of the whole organism is very great.

One of the main functions of the liver is the processing of food. After digestion, food enters the liver, where it is decomposed into simpler components. Enzymes are produced here that are involved in the breakdown of fats, proteins and carbohydrates, as well as in the synthesis of glucose and glycogen.

The liver is also involved in the regulation of glucose levels in the body. It maintains a normal concentration of sugar in the blood, storing it in the form of glycogen and, conversely, releasing it when its level decreases. This is especially important for maintaining the energy balance in the body.

In addition, the liver is involved in cleansing the body of toxins and slag substances . It filters the blood, removes from it harmful metabolic products, medicines, alcohol and other substances that are incompatible with the vital activity of the body.

The liver is also involved in the formation of bile, which plays an important role in digestion. Bile not only breaks down fats, but also helps to absorb fat-soluble vitamins. It is secreted from the liver into the intestines and is involved in the process of digestion.

By removing toxins and waste products from the liver, synthesizing substances necessary for metabolism and absorption of nutrients, the liver plays a key role in the overall health of the body. Proper nutrition, regular fluid intake, and the absence of organ overload are of great importance so that the liver continues to perform its functions at the proper level.

Liver health indicators

Alanine aminotransferase (ALT) is an enzyme found in the liver that helps it process proteins in the body. A high ALT level may indicate liver problems such as hepatitis or cirrhosis.

Aspartate aminotransferase (AST) is another enzyme found in the liver. Elevated AST levels can also be a sign of liver damage, such as hepatitis or cirrhosis.

Gamma-glutamyltransferase (GGT) is an enzyme found in the liver, gallbladder and other organs. Elevated GGT levels may indicate problems with the liver or gallbladder, such as gallstones or alcoholic liver disease.

Albumin is a protein produced in the liver. Low albumin levels can be a sign of liver failure or other liver problems.

Total bilirubin is a pigment produced when red blood cells are broken down and the liver plays a role in its processing. High levels of bilirubin may indicate liver problems such as jaundice or blocked bile ducts.

In addition, there are other indicators such as alkaline phosphatase , alpha-fetoprotein and prothrombin time , which can be used to assess liver function and identify problematic situations. Often these indicators, together with general criteria, help in determining the condition of the liver and identifying any abnormalities in its work.

It is important to note that liver health scores can vary depending on many factors, including age, sex, family history, presence of other diseases, and use of certain medications. Therefore, if you have found abnormalities in your liver parameters, it is recommended to consult a doctor for additional analysis and consultation.

Determination of liver criteria through tests and examinations

Various tests and examinations are carried out to determine the condition of the liver and identify liver criteria. They allow you to evaluate the functionality of the body, identify the presence of possible diseases and determine the degree of their development.

Specialists may also refer to ultrasonography (ultrasound) of the liver to determine hepatic criteria. With the help of ultrasound, you can assess the size and shape of the liver, identify changes in the structure and the presence of tumors, as well as assess the condition of the biliary tract.

For a more accurate picture, sometimes more complex tests such as magnetic resonance imaging (MRI) or computed tomography (CT) are required. These methods provide detailed images of the liver and surrounding tissues, as well as detect the presence of tumors, cysts, or other formations.

It is important to note that the determination of hepatic criteria through tests and examinations should be carried out under the guidance of qualified specialists such as gastroenterologists or hepatologists. They will be able to evaluate the results and make the correct diagnosis, as well as prescribe the appropriate treatment, if necessary.

Normal values ​​of liver criteria and their interpretation

Many complex biochemical processes take place in the liver, and its state can be recognized by various indicators, which are called liver criteria. Normal values ​​of these criteria are an important indicator of liver health.

Another important hepatic criterion is Aspartate aminotransferase (AST). Normal AST values ​​also depend on gender and age. In men, they are up to 40 units / l, in women – up to 35 units / l. An increase in the level of AST can be associated with various pathologies, including liver diseases.

Creatinine is another indicator that helps assess liver function. The normal value of this indicator lies in the range from 44 to 97 micromol / l for men and from 44 to 80 micromol / l for women. An increase in creatinine levels may indicate a malfunction of the kidneys, which are closely related to the liver.

The concentration of bilirubin in the blood can also serve as an indicator of the state of the liver. Total bilirubin has a normal value of up to 20.5 µmol/L. In the case of an increase in the level of bilirubin, icteric changes occur, which indicate a malfunction of the liver and a violation of the metabolism of bile pigments.

Other important hepatic criteria include total protein, albumin, ammonia and some other enzymes. The results of the analyzes of these indicators help to diagnose liver diseases and assess its functional state.

Influence of liver criteria on health and disease prevention

The liver plays an important role in the body with many functions, including blood purification, bile production and metabolism. The health of the liver directly affects the general condition of the body, so it is important to monitor the liver criteria and take measures to normalize them.

One of the main indicators of liver function is the level of alanine and aspartate transaminase (ALT and AST) in the blood. An increase in these enzymes may indicate liver damage, which can be caused by various causes, such as viral infections, alcohol or drug damage, fatty liver, and others. Regular monitoring of ALT and AST levels will help identify possible problems and start treatment in a timely manner.

Another important indicator of the state of the liver is the level of total protein and its fractions (albumin and globulin). With a reduced level of total protein, albumin, or an increased level of globulins, the synthetic function of the liver can be impaired. This may be due to nutritional deficiencies, liver disease, or other factors. Regular analysis of total protein and its fractions will help monitor liver function and take corrective measures if necessary.

Prevention of liver diseases includes the following measures: maintaining a healthy lifestyle, avoiding alcohol and smoking, proper nutrition, physical activity, regular preventive examinations by a doctor and adherence to vaccination recommendations. It is also important to avoid contact with toxic substances, take medicines only when prescribed by a doctor, and avoid self-medication. Regular monitoring of liver criteria and timely visits to a doctor will help identify problems in the liver in the early stages and prevent the development of serious diseases.

Dangerous deviations of liver criteria and their possible consequences

The health of the liver plays an important role in the overall health of the body. It performs many functions, including blood filtration, bile production, and metabolism. However, various factors can cause abnormal liver function, which can lead to serious consequences.

One of the main indicators of liver health is the level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood. Elevated levels of these enzymes may indicate inflammation or damage to the liver. If such deviations are not detected and eliminated in a timely manner, this can lead to the development of cirrhosis of the liver or even cancer.

In addition, elevated levels of bilirubin may also indicate problems with the liver. Bilirubin is a pigment that results from the breakdown of red blood cells in the liver. Elevated levels of this substance may be associated with impaired liver function or obstruction of the biliary tract. In such cases, the person may experience icteric discoloration of the skin and eyes, as well as other symptoms of liver failure.

In addition to these indicators, elevated levels of uric acid in the blood can also indicate problems with the liver. This may be due to metabolic disorders or hepatitis. High levels of uric acid can lead to the development of diseases such as gout.

Thus, regular monitoring of hepatic criteria is an important measure for assessing the state of the liver and identifying possible abnormalities. If suspicious indicators are found, it is necessary to consult a doctor for further examination and treatment in order to prevent serious health consequences.

Factors affecting hepatic criteria and ways to normalize them

The liver is one of the most important organs of the human body, performing many functions. However, various factors can affect its performance and lead to a violation of hepatic criteria. One of the most common factors is malnutrition. Overeating fatty and fried foods, too much alcohol and sweets can cause liver dysfunction and increase liver criteria.

Diseases such as hepatitis, cirrhosis, and fatty degeneration can also affect liver performance. Inflammation of the liver caused by infection or other factors can lead to impaired organ function and increased hepatic criteria.

One way to normalize liver criteria is proper nutrition. Limiting fatty, fried, and sugary foods can help the liver recover and lower liver criteria.

It should be noted that physical activity and moderate exercise can also have a positive effect on the liver and contribute to its normalization. Regular exercise, walking and other forms of physical activity help strengthen the immune system and improve the general condition of the body, including liver function.

Guidelines for monitoring liver criteria and preventing liver disease

Liver health plays an important role in the overall health of the body, so monitoring its functions and preventing diseases is an integral part of a healthy lifestyle. There are several recommendations to help you keep your liver healthy.

It is important to keep an eye on your diet and stick to a healthy diet. Eating a large amount of fatty, fried and spicy foods can adversely affect the functioning of the liver and lead to the development of diseases. At the same time, it is necessary to increase the consumption of fruits, vegetables, greens, cereals and dairy products, which are rich in vitamins and minerals that positively affect the liver.

It is also important to consume alcohol in moderation to maintain a healthy liver. The systematic use of alcohol can adversely affect liver function, lead to cirrhosis and other serious diseases. It is better to stop drinking alcohol or reduce its level to a minimum.

The third recommendation relates to physical activity. Regular physical activity will help maintain a normal metabolism, strengthen the immune system and improve liver function. It is recommended to play sports or simply increase physical activity by doing morning exercises or walking in the fresh air.

Equally important is the correct use of medicines. Medicines can have a negative effect on the liver, especially when taken for a long time or in excess of doses. You should always strictly follow the instructions for use and consult your doctor if in doubt or side effects.

In conclusion, the control of liver criteria and the prevention of liver disease are important components of a healthy lifestyle. Proper nutrition, moderate alcohol consumption, and regular exercise will help maintain a healthy liver and overall well-being.

The importance of regular medical check-ups to control liver criteria

The liver is one of the most important organs in our body, responsible for purifying the blood, disposing of harmful substances and synthesizing substances necessary for the body to function. In this regard, monitoring the condition of the liver is an integral part of the medical examination.

Liver criteria reflect the functioning of the liver and allow detection of its disorders at the earliest stages. This requires regular medical examinations, including blood tests for enzyme levels and other indicators related to liver function.

One of the important indicators is the level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). An increase in these enzymes may indicate the presence of inflammation or damage to the liver. In addition, examinations allow you to assess the level of bilirubin, which is associated with the formation and excretion of bile, and may indicate abnormalities in the liver.

Regular medical examination allows not only to identify problems with the liver, but also to take timely measures to correct them. If abnormalities are found, the doctor may prescribe the necessary treatment, recommend diet and lifestyle changes to maintain the functionality and health of the liver. In addition, regular monitoring of indicators allows you to track the effectiveness of the treatment and adjust it if necessary.

Thus, regular medical examination and monitoring of liver criteria are an important part of a healthy lifestyle.