What are liver function tests. How are they performed. What do normal levels indicate. When should you get a liver function test. How to interpret test results. What are the risks associated with liver function tests. How to prepare for a liver function test.

What is a Liver Function Test and Why is it Important?

A liver function test is a group of blood tests that provide valuable information about the health and functionality of the liver. These tests measure various enzymes, proteins, and substances in the blood that are produced or processed by the liver. By analyzing these components, healthcare providers can assess liver health, detect potential liver problems, and monitor existing liver conditions.

The importance of liver function tests stems from the critical role the liver plays in our body. Some key functions of the liver include:

• Filtering toxins from the blood
• Producing essential proteins
• Storing vitamins and minerals
• Regulating blood clotting
• Producing bile for digestion
• Balancing hormones
• Fighting infections

Given these vital functions, maintaining liver health is crucial for overall wellbeing. Liver function tests serve as an important tool in detecting and managing liver issues before they become severe.

Components of a Liver Function Test

A typical liver function test panel includes several components that provide different insights into liver health. The main tests in a liver function panel are:

• Alanine transaminase (ALT)
• Aspartate transaminase (AST)
• Alkaline phosphatase (ALP)
• Gamma-glutamyl transferase (GGT)
• Bilirubin
• Albumin
• Prothrombin time (PT)

Each of these tests provides specific information about liver function and potential issues. For instance, elevated levels of ALT and AST may indicate liver cell damage, while high bilirubin levels could suggest problems with bile flow.

Understanding Normal Ranges

Normal ranges for liver function tests can vary slightly depending on the laboratory and the specific test methods used. However, generally accepted normal ranges include:

• ALT: 7-56 units per liter (U/L)
• AST: 10-40 U/L
• ALP: 44-147 U/L
• GGT: 0-51 U/L
• Bilirubin: 0.1-1.2 mg/dL
• Albumin: 3.4-5.4 g/dL
• PT: 9.5-13.8 seconds

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

When Should You Get a Liver Function Test?

Liver function tests are recommended in various situations to assess liver health or monitor existing conditions. Some common reasons for getting a liver function test include:

1. Screening for liver diseases such as hepatitis
2. Monitoring the effects of medications that may impact liver function
3. Evaluating the progression of known liver diseases
4. Investigating symptoms of liver problems
5. As part of a routine health check-up
6. Before starting certain medications
7. During pregnancy planning

If you’re experiencing symptoms that might indicate liver problems, your healthcare provider may recommend a liver function test. These symptoms can include:

• Jaundice (yellowing of skin and eyes)
• Abdominal pain or swelling
• Fatigue
• Nausea or vomiting
• Dark urine or pale stools
• Itchy skin
• Unexplained weight loss

Common Causes of Liver Problems

Liver problems can arise from various factors, ranging from lifestyle choices to genetic predispositions. Understanding these causes can help in prevention and early detection of liver issues. Some common causes include:

• Excessive alcohol consumption
• Viral infections (such as hepatitis B and C)
• Non-alcoholic fatty liver disease (NAFLD)
• Autoimmune disorders
• Certain medications
• Genetic disorders
• Obesity
• Toxin exposure

Identifying and addressing these risk factors can play a crucial role in maintaining liver health and preventing liver damage.

The Impact of Lifestyle on Liver Health

Lifestyle choices significantly influence liver health. A balanced diet, regular exercise, and moderate alcohol consumption can help maintain a healthy liver. Conversely, excessive alcohol intake, a high-fat diet, and sedentary lifestyle can contribute to liver problems. Making positive lifestyle changes can often improve liver function and overall health.

How is a Liver Function Test Performed?

A liver function test is a simple blood test that can be performed at a hospital, clinic, or specialized testing facility. The procedure typically involves the following steps:

1. The skin at the site of blood draw (usually the arm) is cleaned to prevent contamination.
2. A tourniquet or pressure band is applied to make the veins more visible.
3. A needle is inserted into a vein to draw the required amount of blood.
4. The blood sample is collected in one or more vials.
5. The needle is removed, and the puncture site is covered with a bandage.
6. The blood samples are sent to a laboratory for analysis.

The entire process usually takes only a few minutes. Results are typically available within a few days, depending on the laboratory and specific tests ordered.

At-Home Liver Function Tests

With advancements in medical technology, at-home liver function tests are becoming increasingly available. These tests allow individuals to collect blood samples at home and send them to a laboratory for analysis. While convenient, it’s important to note that at-home tests should be used under the guidance of a healthcare provider and should not replace regular medical check-ups.

Interpreting Liver Function Test Results

Interpreting liver function test results requires medical expertise, as the significance of the results can vary based on individual factors. However, understanding some basic principles can help you have an informed discussion with your healthcare provider:

• Elevated ALT and AST levels often indicate liver cell damage.
• High ALP levels may suggest bile duct obstruction or certain bone disorders.
• Increased GGT can be a sign of alcohol abuse or bile duct issues.
• High bilirubin levels may indicate problems with bile flow or red blood cell breakdown.
• Low albumin levels could suggest chronic liver disease or malnutrition.
• Prolonged PT may indicate liver damage affecting clotting factor production.

Remember, a single abnormal result doesn’t necessarily indicate a serious problem. Your healthcare provider will consider your overall health, symptoms, and other factors when interpreting your results.

What Happens if Results are Abnormal?

If your liver function test results are outside the normal range, your healthcare provider may recommend:

1. Repeat testing to confirm the results
2. Additional diagnostic tests, such as imaging studies or liver biopsy
3. Lifestyle modifications
4. Treatment for underlying conditions
5. Referral to a liver specialist (hepatologist)

The specific course of action will depend on the nature and severity of the abnormality, as well as your overall health status.

Risks and Preparation for Liver Function Tests

Liver function tests are generally safe and pose minimal risks. However, as with any blood draw, there are some rare potential complications:

• Slight pain or bruising at the needle site
• Fainting or dizziness during blood draw
• Excessive bleeding (rare)
• Infection at the puncture site (very rare)

Preparation for a liver function test is usually minimal. However, your healthcare provider may give you specific instructions, which may include:

• Fasting for a certain period before the test
• Avoiding certain medications that could affect the results
• Informing your provider about all medications and supplements you’re taking
• Avoiding alcohol for a specified period before the test

Following these instructions carefully can help ensure accurate test results.

The Future of Liver Function Testing

As medical science advances, liver function testing continues to evolve. Some emerging trends and developments in this field include:

• Non-invasive imaging techniques for liver assessment
• Genetic testing to identify liver disease risk factors
• Advanced blood tests that can detect early-stage liver fibrosis
• Artificial intelligence algorithms for interpreting test results
• Personalized medicine approaches based on individual genetic profiles

These advancements promise to enhance our ability to detect, monitor, and treat liver diseases more effectively in the future.

The Role of Preventive Care

While liver function tests are crucial for detecting and monitoring liver problems, preventive care plays an equally important role in maintaining liver health. Some key preventive measures include:

• Maintaining a healthy diet rich in fruits, vegetables, and whole grains
• Exercising regularly to maintain a healthy weight
• Limiting alcohol consumption
• Avoiding risky behaviors that could lead to hepatitis infections
• Getting vaccinated against hepatitis A and B
• Using medications as directed and informing your healthcare provider about all supplements you take

By combining regular health check-ups, including liver function tests when appropriate, with these preventive measures, you can significantly reduce your risk of liver problems and maintain overall health.

Liver Function Test – About, Normal Range, Preparation, Test Results & More

what is a liver function test?

It is a group of tests that gives a statement on the health of a patient’s liver. It determines the health of the liver by evaluating the level of liver enzymes, proteins or bilirubin in the blood. The main tests in the liver function tests are prothrombin time, APTT, albumin, bilirubin. 

A liver function test is recommended for the following reasons:  

• To screen for any infections such as hepatitis C in the liver
• If you are consuming any medications that might have a side effect on the liver functions
• To monitor an already existing liver disease and its status during treatment like liver cancer
• If you have any symptoms of any liver problems or liver disease
• Planning for pregnancy 

symptoms of liver problems:

• Jaundice fever – skin and eyes turn yellowish
• Swelling and pain of the abdominal
• Swelling of legs and ankles
• Itching of the skin
• Dark colour Urine
• Stool is either bloody, tar-coloured or pale
• Fatigue 
• Queasiness or vomiting
• Appetite loss
• Easily getting bruised

causes of liver problem:

There may be many liver damage causes. Some of them are: 

• Infection 
• Immune system abnormality 
• Genetics
• Cancer 
• Habits such as excessive alcohol intake

why do i need liver function test?

The liver is a vital organ of the human body and liver functions play a vital role in the overall health of your body.

A liver function test helps in determining the condition and health of your liver in order for it to perform the following liver functions efficiently. 

what is the function of a liver?

• Cleanses your blood by removing contaminants eliminating liver infections
• Helps in converting nutrients from your food intake
• Stores vitamins and minerals in your body 
• Regulates blood clot
• Produces enzymes, proteins and bile
• Produces infection fighting factors
• Removes bacteria from the blood
• Processes harmful substances from the body
• Helps in balancing hormones

With so much liver functions, a problem caused in the liver can cause life-threatening diseases to the person.

what do my test results mean?

The most common blood test taken for liver function test is aminotransferases.

If your liver function test results range between 7-56 units/litre for ALT and 10-40 got AST, your liver function is normal. Anything outside the liver function test normal range means there might be some liver problems or liver infection and needs to be diagnosed and treated.  

how is liver function test done?

The liver function test is like any other blood test. It may be taken at a hospital, clinic or specialised testing facility. You can administer the test by checking if the following steps are done: 

• Your skin will be cleaned by the blood test technician to prevent any substances on your skin to avoid contamination of the test. 
• They will wrap your arm with some sort of pressure device to make the veins more visible. They will then insert the needle into the vein to draw enough blood samples for the test. 
• Once the blood is drawn, they will cover the pierced area to avoid any infection and will send the blood samples for testing to the laboratory.  

does liver function test pose any risk?

Blood tests are a very common routine to check several diseases and diagnosis like the liver disease. The rare cases of risks that might happen while giving a blood sample are: 

• Internal bleeding under the skin
• excessive bleeding
• fainting due to weakness after blood withdrawal
• Infection

how do i prepare for the test?   

You will be guided by the doctor with instructions to follow before taking the tests. You may have to avoid certain foods and medicines before the test as they might affect the levels of enzymes and proteins present in your blood. 

how can we help?

Do you find yourself searching for “Liver function test near me” on google? Worry no more. We now provide services for home liver function test. If you have noticed any symptoms of a liver problem or liver infection and your doctor can recommended you to take this tests, all you have to do is contact us!

We will have a health care expert sent to your house and do the necessary procedures. The samples will be sent for testing and you will receive your liver function test report at your doorstep.

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liver function test (lft) cost 2022 in india

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Understanding results ofLiver Function

SGOT	The normal range for the AST test is 10 to 34 IU/L (international units per liter)
GGT	The normal range for GGT in blood is 0 to 51 international units/liter.
Total Protein	The total protein is between 6 and 8.3 gm/dL (grams per deciliter)
Albumin	The typical value for albumin is 3.4 to 5.4 g/dL of blood
Bilirubin	In an older child or adult, normal values of direct (conjugated) bilirubin are from 0 to 0. 3 milligrams per deciliter (mg/dL). Normal values of total bilirubin (direct and indirect) are from 0.3 to 1.9 mg/dL. In a newborn, higher bilirubin is normal due

‘*A Reference range is a set of values which helps the healthcare professional to interpret a medical test. It may vary with age, gender, and other factors. Reference ranges may also vary between labs, in value & units depending on instruments used and method of establishment of reference ranges’

References

1. https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/diagnosing-liver-disease/
2. https://medlineplus.gov/liverfunctiontests.html
3. https://www.labtestsonline.org.au/learning/test-index/liver-function
4. https://www.drugabuse.gov/news-events/nida-notes/2013/12/medications-treat-opioid-addiction-do-not-impair-liver-health
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609680/

Special Considerations in Interpreting Liver Function Tests

DAVID E. JOHNSTON, M.D.

A number of pitfalls can be encountered in the interpretation of common blood liver function tests. These tests can be normal in patients with chronic hepatitis or cirrhosis. The normal range for aminotransferase levels is slightly higher in males, nonwhites and obese persons. Severe alcoholic hepatitis is sometimes confused with cholecystitis or cholangitis. Conversely, patients who present soon after passing common bile duct stones can be misdiagnosed with acute hepatitis because aminotransferase levels often rise immediately, but alkaline phosphatase and γ-glutamyltransferase levels do not become elevated for several days. Asymptomatic patients with isolated, mild elevation of either the unconjugated bilirubin or the γ-glutamyltransferase value usually do not have liver disease and generally do not require extensive evaluation. Overall hepatic function can be assessed by applying the values for albumin, bilirubin and prothrombin time in the modified Child-Turcotte grading system.

The commonly used liver function tests (LFTs) primarily assess liver injury rather than hepatic function. Indeed, these blood tests may reflect problems arising outside the liver, such as hemolysis (elevated bilirubin level) or bone disease (elevated alkaline phosphatase [AP] level).

Abnormal LFTs often, but not always, indicate that something is wrong with the liver, and they can provide clues to the nature of the problem. However, normal LFTs do not always mean that the liver is normal. Patients with cirrhosis and bleeding esophageal varices can have normal LFTs. Of the routine LFTs, only serum albumin, bilirubin and prothrombin time (PT) provide useful information on how well the liver is functioning.

The general subject of LFTs^1,2 and the differential diagnosis of abnormal LFTs in asymptomatic patients^3–5 have been well reviewed. This article discusses some common pitfalls in the interpretation of LFTs. Hints for interpreting these tests are presented in Table 1.

Situation	Comments
Mildly elevated ALT level (less than 1.5 times normal)	ALT value could be normal for gender, ethnicity or body mass index.
	Consider muscle injury or myopathy.
Alcoholic hepatitis	Laboratory values can appear cholestatic, and symptoms can mimic cholecystitis.
	Minimal elevations of AST and ALT often occur.
AST level greater than 500 U per L	The AST elevation is unlikely to result from alcohol intake alone.
	In a heavy drinker, consider acetaminophen toxicity.
Common bile duct stone	Condition can simulate acute hepatitis
	AST and ALT become elevated immediately, but elevation of AP and GGT is delayed.
Isolated elevation of GGT level	This situation may be induced by alcohol and aromatic medications, usually with no actual liver disease.
Isolated elevation of AP level (asymptomatic patient with normal GGT level)	Consider bone growth or injury, or primary biliary cirrhosis.
	AP level rises in late pregnancy.
Isolated elevation of unconjugated bilirubin level	Consider Gilbert syndrome or hemolysis.
Low albumin level	Low albumin is most often caused by acute or chronic inflammation, urinary loss, severe malnutrition or liver disease; it is sometimes caused by gastrointestinal loss (e.g., colitis or some uncommon small bowel disease).
	Normal values are lower in pregnancy.
Blood ammonia level	Blood ammonia values are not necessarily elevated in patients with hepatic encephalopathy.
	Determination of blood ammonia levels is most useful in patients with altered mental status of new onset or unknown origin.

Markers of Hepatocellular Injury

The most commonly used markers of hepatocyte injury are aspartate aminotransferase (AST, formerly serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT, formerly serum glutamate-pyruvate transaminase [SGPT]). While ALT is cytosolic, AST has both cytosolic and mitochondrial forms.

Hepatocyte necrosis in acute hepatitis, toxic injury or ischemic injury results in the leakage of enzymes into the circulation. However, in chronic liver diseases such as hepatitis C and cirrhosis, the serum ALT level correlates only moderately well with liver inflammation. In hepatitis C, liver cell death occurs by apoptosis (programmed cell death) as well as by necrosis. Hepatocytes dying by apoptosis presumably synthesize less AST and ALT as they wither away. This probably explains why at least one third of patients infected with hepatitis C virus have persistently normal serum ALT levels despite the presence of inflammation on liver biopsy.^6,7 Patients with cirrhosis often have normal or only slightly elevated serum AST and ALT levels. Thus, AST and ALT lack some sensitivity in detecting chronic liver injury. Of course, AST and ALT levels tend to be higher in cirrhotic patients with continuing inflammation or necrosis than in those without continuing liver injury.

As markers of hepatocellular injury, AST and ALT also lack some specificity because they are found in skeletal muscle. Levels of these aminotransferases can rise to several times normal after severe muscular exertion or other muscle injury, as in polymyositis,⁸ or in the presence of hypothyroidism, which can cause mild muscle injury and the release of aminotransferases. In fact, AST and ALT were once used in the diagnosis of myocardial infarction.

Slight AST or ALT elevations (within 1. 5 times the upper limits of normal) do not necessarily indicate liver disease. Part of this ambiguity has to do with the fact that unlike the values in many other biochemical tests, serum AST and ALT levels do not follow a normal bell-shaped distribution in the population.⁹ Instead, AST and ALT values have a skewed distribution characterized by a long “tail” at the high end of the scale (Figure 1).⁵ For example, the mean values for ALT are very similar from one population to another, but the degree to which the distribution is skewed varies by gender and ethnicity. The ALT distributions in males and nonwhites (i.e., blacks and Hispanics) tend to have a larger tail at the high end, so that more values fall above the upper limits of normal set for the average population.^10,11

AST and ALT values are higher in obese patients, probably because these persons commonly have fatty livers.¹² ALT levels have been noted to decline with weight loss. ¹³ Depending on the physician’s point of view, the upper limits of normal for AST and ALT levels could be set higher for more obese persons.

Rare individuals have chronically elevated AST levels because of a defect in clearance of the enzyme from the circulation.¹⁴ For both AST and ALT, the average values and upper limits of normal in patients undergoing renal dialysis are about one half of those found in the general population.¹⁵ Mild elevations of ALT or AST in asymptomatic patients can be evaluated efficiently by considering alcohol abuse, hepatitis B, hepatitis C and several other possible diagnoses (Table 2).⁵

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Various liver diseases are associated with typical ranges of AST and ALT levels (Figure 2). ALT levels often rise to several thousand units per liter in patients with acute viral hepatitis. The highest ALT levels—often more than 10,000 U per L—are usually found in patients with acute toxic injury subsequent to, for example, acetaminophen overdose or acute ischemic insult to the liver. AST and ALT levels usually fall rapidly after an acute insult.

Lactate dehydrogenase (LDH) is less specific than AST and ALT as a marker of hepatocyte injury. However, it is worth noting that LDH is disproportionately elevated after an ischemic liver injury.¹⁶

It is especially important to remember that in patients with acute alcoholic hepatitis, the serum AST level is almost never greater than 500 U per L and the serum ALT value is almost never greater than 300 U per L. The reasons for these limits on AST and ALT elevations are not well understood. In typical viral or toxic liver injury, the serum ALT level rises more than the AST value, reflecting the relative amounts of these enzymes in hepatocytes. However, in alcoholic hepatitis, the ratio of AST to ALT is greater than 1 in 90 percent of patients and is usually greater than 2. ¹⁷ The higher the AST-to-ALT ratio, the greater the likelihood that alcohol is contributing to the abnormal LFTs. In the absence of alcohol intake, an increased AST-to-ALT ratio is often found in patients with cirrhosis.

The elevated AST-to-ALT ratio in alcoholic liver disease results in part from the depletion of vitamin B₆ (pyridoxine) in chronic alcoholics.¹⁸ ALT and AST both use pyridoxine as a coenzyme, but the synthesis of ALT is more strongly inhibited by pyridoxine deficiency than is the synthesis of AST. Alcohol also causes mitochondrial injury, which releases the mitochondrial isoenzyme of AST.

Patients with alcoholic hepatitis can present with jaundice, abdominal pain, fever and a minimally elevated AST value, thereby leading to a misdiagnosis of cholecystitis. This is a potentially fatal mistake given the high surgical mortality rate in patients with alcoholic hepatitis.¹⁹

Markers of Cholestasis

Cholestasis (lack of bile flow) results from the blockage of bile ducts or from a disease that impairs bile formation in the liver itself. AP and γ-glutamyltransferase (GGT) levels typically rise to several times the normal level after several days of bile duct obstruction or intrahepatic cholestasis. The highest liver AP elevations—often greater than 1,000 U per L, or more than six times the normal value—are found in diffuse infiltrative diseases of the liver such as infiltrating tumors and fungal infections.

Diagnostic confusion can occur when a patient presents within a few hours after acute bile duct obstruction from a gallstone. In this situation, AST and ALT levels often reach 500 U per L or more in the first hours and then decline, whereas AP and GGT levels can take several days to rise.

Both AP and GGT levels are elevated in about 90 percent of patients with cholestasis.²⁰ The elevation of GGT alone, with no other LFT abnormalities, often results from enzyme induction by alcohol or aromatic medications in the absence of liver disease. The GGT level is often elevated in persons who take three or more alcoholic drinks (45 g of ethanol or more) per day. ²¹ Thus, GGT is a useful marker for immoderate alcohol intake. Phenobarbital, phenytoin (Dilantin) and other aromatic drugs typically cause GGT elevations of about twice normal. A mildly elevated GGT level is a typical finding in patients taking anticonvulsants and by itself does not necessarily indicate liver disease.^22,23

Serum AP originates mostly from liver and bone, which produce slightly different forms of the enzyme. The serum AP level rises during the third trimester of pregnancy because of a form of the enzyme produced in the placenta. When serum AP originates from bone, clues to bone disease are often present, such as recent fracture, bone pain or Paget’s disease of the bone (often found in the elderly). Like the GGT value, the AP level can become mildly elevated in patients who are taking phenytoin.^22,23

If the origin of an elevated serum AP level is in doubt, the isoenzymes of AP can be separated by electrophoresis. However, this process is expensive and usually unnecessary because an elevated liver AP value is usually accompanied by an elevated GGT level, an elevated 5′-nucleotidase level and other LFT abnormalities.

In one study,²⁴ isolated AP elevations were evaluated in an unselected group of patients at a Veterans Affairs hospital. Most mild AP elevations (less than 1.5 times normal) resolved within six months, and almost all greater elevations had an evident cause that was found on routine clinical evaluation.

Persistently elevated liver AP values in asymptomatic patients, especially women, can be caused by primary biliary cirrhosis, which is a chronic inflammatory disorder of the small bile ducts. Serum antimitochondrial antibody is positive in almost all of these patients.

Indicators of How Well the Liver Functions

BILIRUBIN

Bilirubin results from the enzymatic breakdown of heme. Unconjugated bilirubin is conjugated with glucuronic acid in hepatocytes to increase its water solubility and is then rapidly transported into bile. The serum conjugated bilirubin level does not become elevated until the liver has lost at least one half of its excretory capacity. Thus, a patient could have obstruction of either the left or right hepatic duct without a rise in the bilirubin level.

Because the secretion of conjugated bilirubin into bile is very rapid in comparison with the conjugation step, healthy persons have almost no detectable conjugated bilirubin in their blood. Liver disease mainly impairs the secretion of conjugated bilirubin into bile. As a result, conjugated bilirubin is rapidly filtered into the urine, where it can be detected by a dipstick test. The finding of bilirubin in urine is a particularly sensitive indicator of the presence of an increased serum conjugated bilirubin level.

In many healthy persons, the serum unconjugated bilirubin is mildly elevated to a concentration of 2 to 3 mg per dL (34 to 51 μmol per L) or slightly higher, especially after a 24-hour fast. If this is the only LFT abnormality and the conjugated bilirubin level and complete blood count are normal, the diagnosis is usually assumed to be Gilbert syndrome, and no further evaluation is required. Gilbert syndrome was recently shown to be related to a variety of partial defects in uridine diphosphate-glucuronosyl transferase, the enzyme that conjugates bilirubin.²⁵

Mild hemolysis, such as that caused by hereditary spherocytosis and other disorders, can also result in elevated unconjugated bilirubin values, but hemolysis is not usually present if the hematocrit and blood smear are normal. The presence of hemolysis can be confirmed by testing other markers, such as haptoglobin, or by measuring the reticulocyte count.

Severe defects in bilirubin transport and conjugation can lead to markedly elevated unconjugated bilirubin levels, which can cause serious neurologic damage (kernicterus) in infants. However, no serious form of liver disease in adults causes elevation of unconjugated bilirubin levels in the blood without also causing elevation of conjugated bilirubin values.

When a patient has prolonged, severe biliary obstruction followed by the restoration of bile flow, the serum bilirubin level often declines rapidly for several days and then slowly returns to normal over a period of weeks. The slow phase of bilirubin clearance results from the presence of delta-bilirubin, a form of bilirubin chemically attached to serum albumin.²⁶ Because albumin has a half-life of three weeks, delta-bilirubin clears much more slowly than bilirubin-glucuronide. Clinical laboratories can measure delta-bilirubin concentrations, but such measurements are usually unnecessary if the physician is aware of the delta-bilirubin phenomenon.

ALBUMIN

Although the serum albumin level can serve as an index of liver synthetic capacity, several factors make albumin concentrations difficult to interpret.²⁷ The liver can synthesize albumin at twice the healthy basal rate and thus partially compensate for decreased synthetic capacity or increased albumin losses. Albumin has a plasma half-life of three weeks; therefore, serum albumin concentrations change slowly in response to alterations in synthesis. Furthermore, because two thirds of the amount of body albumin is located in the extravascular, extracellular space, changes in distribution can alter the serum concentration.

In practice, patients with low serum albumin concentrations and no other LFT abnormalities are likely to have a nonhepatic cause for low albumin, such as proteinuria or an acute or chronic inflammatory state. Albumin synthesis is immediately and severely depressed in inflammatory states such as burns, trauma and sepsis, and it is commonly depressed in patients with active rheumatic disorders or severe end-stage malnutrition. In addition, normal albumin values are lower in pregnancy.

PROTHROMBIN TIME

The liver synthesizes blood clotting factors II, V, VII, IX and X. The prothrombin time (PT) does not become abnormal until more than 80 percent of liver synthetic capacity is lost. This makes PT a relatively insensitive marker of liver dysfunction. However, abnormal PT prolongation may be a sign of serious liver dysfunction. Because factor VII has a short half-life of only about six hours, it is sensitive to rapid changes in liver synthetic function. Thus, PT is very useful for following liver function in patients with acute liver failure.

An elevated PT can result from a vitamin K deficiency. This deficiency usually occurs in patients with chronic cholestasis or fat malabsorption from disease of the pancreas or small bowel. A trial of vitamin K injections (e.g., 5 mg per day administered subcutaneously for three days) is the most practical way to exclude vitamin K deficiency in such patients. The PT should improve within a few days.

BLOOD AMMONIA

Measurement of the blood ammonia concentration is not always useful in patients with known or suspected hepatic encephalopathy. Ammonia contributes to hepatic encephalopathy; however, ammonia concentrations are much higher in the brain than in the blood and therefore do not correlate well.²⁸ Furthermore, ammonia is not the only waste product responsible for encephalopathy. Thus, blood ammonia concentrations show only a mediocre correlation with the level of mental status in patients with liver disease. It is not unusual for the blood ammonia concentration to be normal in a patient who is in a coma from hepatic encephalopathy.

Blood ammonia levels are best measured in arterial blood because venous concentrations can be elevated as a result of muscle metabolism of amino acids. Blood ammonia concentrations are most useful in evaluating patients with stupor or coma of unknown origin. It is not necessary to evaluate blood ammonia levels routinely in patients with known chronic liver disease who are responding to therapy as expected.

Grading Liver Function by Child-Turcotte Class

In communicating among themselves, many physicians use the Child-Turcotte class as modified by Pugh, often termed the “Child class,” to convey information about overall liver function and prognosis (Table 3).²⁹ This grading system can be used to predict overall life expectancy and surgical mortality in patients with cirrhosis and other liver diseases.³⁰

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For elective general abdominal surgery, perioperative mortality is in the neighborhood of several percent for patients who fall into the Child class A, 10 to 20 percent for those in class B and approximately 50 percent for those in class C.³¹ These percentages must be balanced by prognostic considerations when transplantation becomes an option. The presence of cirrhosis by itself is not an indication for liver transplantation, and transplantation is rarely performed in patients who fall into Child class A. For example, the 10-year survival rate is as high as 80 percent in patients with hepatitis C and cirrhosis who have Child class A liver function and no variceal bleeding.³² However, once patients with any type of liver disease fall into the Child-Turcotte class B or class C category, survival is significantly reduced and transplantation should be considered.

liver tests for liver enzymes

Contents

• 1 Liver tests: alat and asat in the blood – what does it mean and what conclusions can be drawn
  • 1. 1 Liver enzymes: what are they?
  • 1.2 Liver tests
  • 1.3 Alat and Asat: key indicators of liver enzymes
    • 1.3.1 What are Alat and Asat?
  • 1.4 Normal levels of Alat and Asat in the blood
  • 1.5 Causes of increased levels of Alat and Asat in the blood
    • 1.5.1 Pathological processes in the liver
    • 1.5.2 Injuries and toxic effects
    • 1.5.3 Diseases of other organs
    • 1.5.4 Pathology of muscle tissue
    • 1.5.5 Conclusions
  • Alat and Asat
  • 1.7 Symptoms of elevated levels of Alat and Asat
  • 1.8 Analysis for Alat and Asat: Preparation and conducting
    • 1.8.1 Preparation for analysis
    • 1.8.2 Analysis
    • 1.8.3 Decoding of results
  • 1.9Preparation for the analysis for Alat and Asat
  • 1.10 Interpretation of the results of the analysis of ALAT and ASAT in the blood
    • 1.10.1 What are ALAT and ASAT?
    • 1. 10.2 What does elevated blood levels of ALAT and ASAT mean?
    • 1.10.3 What do low blood levels of ALAT and ASAT mean?
    • 1.10.4 How to interpret the test results?
  • 1.11 What to do in case of elevated levels of Alat and Asat?
  • 1.12 How can the level of Alat and Asat in the blood be reduced?
  • 1.13 Prevention of liver diseases
    • 1.13.1 1. Proper nutrition.
    • 1.13.2 2. Refusal of bad habits.
    • 1.13.3 3. Physical activity.
    • 1.13.4 4. Doctor’s instructions.
    • 1.13.5 5. Taking protective measures.
  • 1.14 Related videos:
  • 1.15 Q&A:
    • • 1.15.0.1 What are alat and asat?
      • 1.15.0.2 What values ​​of alat and asat in the blood can be considered normal?
      • 1.15.0.3 What are the reasons for the increase in the level of ALAT and ASAT in the blood?
      • 1.15.0.4 How can I lower my ALAT and ASAT levels?
      • 1.15.0.5 What symptoms are signs of elevated levels of ALAT and ASAT?
      • 1. 15.0.6 Who is at particular risk for elevated ALAT and ASAT?
      • 1.15.0.7 Can ALAT and ASAT levels fall back to normal without treatment?
      • 1.15.0.8 What is the significance of alat and asat in the diagnosis of diseases?
  • 1.16 How to keep the liver healthy?
  • 1.17 Conclusions

Alat and asat are liver enzymes that can be found in the blood when liver function is impaired. Find out how the test is done, what the results mean, and what diseases can be associated with elevated enzyme levels.

The liver is an organ that plays a key role in processing food and removing waste from the body. Under normal conditions, the liver produces enzymes that help break down the fats and proteins in food. If the liver is exposed to toxins, infection, or other type of stress, the concentration of these enzymes in the patient’s blood may increase.

The two most common enzymes measured in the blood for suspected liver disease are Alat and Asat. They are produced in the liver and can become “excessive” when liver cells become damaged or die. Therefore, the measurement of Alat and Asat levels is an important component in the diagnosis of many liver diseases.

In this article, we will look at why measuring the concentration of Alat and Asat in the blood can help in the diagnosis of liver diseases, what indications for such a study exist, and how to properly prepare for analysis and interpret the results.

Liver enzymes: what are they?

Liver enzymes are protein compounds that help carry out metabolic processes in the body. These enzymes are found in various liver cells and act as markers that may indicate the presence of pathologies in the organ or other possible diseases.

Alat and asat are the two main liver enzymes. Alat is an alanine aminotransferase and asat is an aspartate aminotransferase. High levels of these enzymes may indicate liver damage or inflammation. They are used in conjunction with each other to determine how severe the liver damage is and what stage of the disease it is in.

Some other liver enzymes such as lactate dehydrogenase (LDH) and gamma-glutamyltransferase (GGT) can also help determine liver health. LDH is normally found in high concentrations in various body tissues, including the liver. GGT, like ALAT and ASAT, is located in the liver and can be used to detect the presence of diseases in this organ.

• Important to remember: High levels of liver enzymes are not always indicative of disease. There are many factors that can increase the levels of these enzymes, such as the use of alcohol and certain medications. In any case, if you have elevated levels of liver enzymes, you need to consult a doctor for further examination and diagnosis.

Liver tests

The liver is one of the most important organs in our body. It performs many functions responsible for metabolism, blood purification and storage of the necessary substances. One way to monitor liver health is through liver tests.

Liver tests are a generic name for tests that check liver function. They are done by testing the blood for the presence of certain enzymes, such as aminotransferases (including ALT and AST), alkaline phosphatase (AF), and bilirubin. Changes in the levels of these enzymes may indicate liver damage.

Your doctor may order liver tests if you complain of abdominal pain, nausea, loss of appetite, fatigue, or jaundice. Tests can be used to determine the cause of elevated enzyme levels, which may be due to alcoholism, a viral infection, drug poisoning, or other causes. Liver function tests can also monitor the effectiveness of treatment and track changes over time.

Enzyme Normal level Increased level may indicate

Alanine aminotransferase (ALT)	Men: up to 50 units per liter, women: up to 35 units per liter	Hepatitis, liver cirrhosis, liver tumor.
Aspartate aminotransferase (AST)	Men: up to 40 units per liter, women: up to 35 units per liter	Acute myocarditis, myocardial infarction, hepatitis, liver cirrhosis.
Alkaline phosphatase (AP)	Men: up to 260 units per liter, women: up to 230 units per liter	Diseases of the liver and biliary tract, bone tumors.
Bilirubin	Less than 21 µmol per liter	Jaundice, hepatitis, liver cirrhosis, hemolytic anemia.

If the patient is scheduled for a liver test, the patient should follow all of the doctor’s instructions, such as not eating before the blood test and avoiding alcohol. In addition, it is important to understand that elevated levels of these enzymes do not always mean liver disease; sometimes they can be elevated with other diseases or medications.

Yes, I measure with a glucometer

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Yes, I take tests

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Alat and Asat: key indicators of liver enzymes

What are Alat and Asat?

Alat and Asat are important enzymes produced by the liver that can affect the health of the body. Alat (Alanine transaminase) and Asat (Aspartate transaminase) are associated with protein metabolism and are involved in the process of amino acid degradation.

High levels of Alat and Asat in the blood may indicate problems in the functioning of the liver. A key indicator of the level of Alat and Asat in the blood is used to determine the harmful effects of medications taken. It can also help in the diagnosis of various liver diseases such as hepatitis, cirrhosis and others.

1. Alat is mainly produced by the liver and, to a lesser extent, by the muscles and kidneys.
2. Asat is most commonly produced in the heart, liver and muscles.

If the level of Alat and Asat in the blood is increased, it is necessary to consult a doctor for additional studies and determination of the cause. Controlling your liver enzyme levels is an important part of your overall health and can help prevent various diseases.

The norm of the level of Alat and Asat in the blood

Alat and Asat are enzymes that are normally found inside liver cells. If the liver cells are damaged, these enzymes are released into the blood, causing their levels to rise to abnormal levels. However, the level of Alat and Asat can be increased in various diseases and even with regular intake of certain medications.

To assess the level of Alat and Asat in the blood, a biochemical blood test is performed. The norm of the Asat level in the blood is no more than 31 U/l, and the norm of the Alat level is no more than 35 U/l in women and no more than 45 U/l in men.

Normal levels of Alat and Asat may vary slightly depending on age, gender and other factors such as being obese or taking certain medications. In addition, different laboratories may use different methods and reagents, which may lead to some deviations in the measurement of Alat and Asat levels.

If the level of Alat and Asat exceeds the norm, this may indicate the presence of pathological processes in the liver. To determine the exact cause of the increase in the level of Alat and Asat, it is necessary to perform additional tests and examinations, which must be prescribed by a doctor.

Causes of increased levels of Alat and Asat in the blood

Pathological processes in the liver

Alat and Asat are enzymes that are found in large quantities in liver cells. Therefore, an increase in the level of Alat and Asat in the blood indicates violations of the liver. This can be caused by various pathological processes in the liver, such as cirrhosis, hepatitis, fatty degeneration, and others.

Injuries and toxic effects

Elevated levels of Alat and Asat can be caused by trauma to the liver, such as bruises, falls or car accidents. Also, increased rates can be caused by toxic effects on the liver, for example, when drinking alcohol, drugs, or when using drugs that have hepatotoxic properties.

Diseases of other organs

Sometimes elevated levels of Alat and Asat in the blood can be caused by diseases of organs other than the liver. For example, it may be associated with diseases of the heart, pancreas, or kidneys.

Muscle tissue pathology

Elevated Alat and Asat levels can also be associated with muscle tissue pathology, for example, in the destruction of muscle fibers during myopathies or during intense physical exertion, especially in untrained people.

Conclusions

An increase in the level of Alat and Asat in the blood is an unfavorable signal for health, as it may indicate various diseases. Therefore, with an increase in the level of these enzymes, you should consult a doctor to conduct an examination and find out the reason for the increase in the level of Alat and Asat.

Causes of low levels of Alat and Asat

Alat and Asat are liver enzymes that are present in the blood. Their elevated level indicates a violation of liver function. But what if the levels of these enzymes are low?

Vitamin B6 deficiency may be one of the reasons, since this vitamin is an important catalyst for the processes associated with Alat and Asat. A lack of vitamin B6 can cause a decrease in the level of these enzymes in the blood.

Another reason may be long-term use of drugs such as hepatoprotectors or antibiotics, which may have an inhibitory effect on liver function. Decreased levels of Alat and Asat can also be associated with anemia or certain infections such as viral hepatitis.

Finally, many people who lead a healthy lifestyle may have low levels of Alat and Asat, as these enzymes are associated with alcohol, fat and protein metabolism, which can be reduced with a healthy diet and exercise.

In any case, the decrease in Alat and Asat should be considered along with other tests and clinical findings to determine possible causes and necessary treatment measures.

Symptoms of elevated levels of Alat and Asat

Alat and Asat are enzymes that are produced in the liver and can be used to evaluate liver function. Elevated levels of these enzymes may indicate problems with the liver or other organs.

One of the most common symptoms of an increase in Alat and Asat is jaundice, which manifests itself in the form of yellow eyes and skin. There may also be an increase in the size of the liver and spleen, as well as discomfort or pain in the right upper quadrant of the abdomen.

Other symptoms of an increase in Alat and Asat can be fatigue, a constant feeling of weakness, loss of appetite and involuntary weight loss. In some cases, elevated levels of these enzymes may be asymptomatic and only show up on blood tests.

In any case, elevated levels of Alat and Asat require diagnosis and treatment under medical supervision. It is necessary to conduct regular medical examinations and monitor the condition of your body in order to detect and prevent health problems in a timely manner.

Analysis for Alat and Asat: preparation and conduct

Preparation for analysis

Before undergoing analysis for Alat and Asat, you must follow a number of simple rules. It is not recommended to take food and alcohol 8 hours before donating blood. Also, do not engage in physical activity, no matter how insignificant it may be. Before the analysis, it is necessary to clarify the family and medical history, as well as inform the attending physician about the use of any medications and supplements.

Testing

Testing for Alat and Asat is performed from a vein on an empty stomach. The specialist takes blood from a vein using a special syringe and sends it to the laboratory for analysis. The results of the analysis are usually ready in a day, sometimes in 2-3 days.

Decoding of results

Liver tests for liver enzymes are used to determine the level of Alat and Asat in the blood. The level of these enzymes may indicate possible diseases of the liver or gallbladder. The normal value of Alat is 5-40 IU / l, and Asat – 5-37 IU / l. However, the norms may vary slightly depending on the laboratory, so the results should only be interpreted in conjunction with the attending physician.

It is important to remember that the analysis for Alat and Asat is only an additional tool in the diagnosis of diseases. The results of the analysis should be evaluated in conjunction with other data – medical history, complete blood count, ultrasound and other studies. Only in this case, you can get an accurate diagnosis and start treatment.

Preparation for analysis for Alat and Asat

For correct diagnosis of the liver condition, it is necessary to take a blood test for Alat and Asat. These indicators reflect the work of this body, reveal the presence of violations in its functioning and establish the cause of the disease.

Preparation for analysis is carried out according to simple rules:

• 10-14 days before the analysis, do not take drugs that can affect liver function;
• Avoid alcoholic beverages, low-fat foods, and high-fat foods 3 days before the test;
• do not smoke, drink coffee, tea or chocolate a few hours before the test;
• On the day of the test, bring your passport and doctor’s referral;

Responsibly treat the preparation for the analysis for Alat and Asat, as this helps to more accurately determine the cause of the disease and prescribe the necessary treatment.

Interpretation of ALAT and ASAT blood test results

What are ALAT and ASAT?

ALAT (alanine aminotransferase) and ACAT (aspartate aminotransferase) are enzymes secreted by the liver into the blood. They are actively involved in metabolic processes and the production of proteins in the body.

What do elevated blood levels of ALAT and ASAT mean?

An increase in the levels of ALAT and ASAT in the blood may indicate a violation of liver function. This is usually associated with various pathologies, such as hepatitis, cirrhosis of the liver, fatty liver and other diseases.

However, elevated blood levels of these enzymes can also be caused by certain medications, alcohol, stress, and strenuous exercise.

What do low blood levels of ALAT and ASAT mean?

Decreased blood levels of ALAT and ACAT are not usually diagnostic of liver disease. This may indicate a violation of the functions of these enzymes, but may also be due to insufficient intake of necessary substances in the body and some other reasons.

How to interpret test results?

The interpretation of ALAT and ASAT blood results should only be performed by a qualified physician based on a comprehensive analysis of the patient’s general condition, medical history and other factors.

Elevated levels of ALAT and ACAT in the blood may indicate the presence of liver disease, but require further examination and confirmation of the diagnosis. Constantly monitoring the blood levels of these enzymes can help diagnose liver problems early and take the necessary steps to treat them.

What to do in case of elevated levels of Alat and Asat?

High levels of Alat and Asat may indicate the presence of liver diseases such as hepatitis, cirrhosis, fatty degeneration and others. In this case, it is necessary to consult a gastroenterologist or hepatologist for further examination and treatment.

In addition, there are several recommendations that can help improve performance:

• maintain a healthy lifestyle: stop smoking, moderate alcohol consumption, eat healthy, exercise;
• take only medicines approved by your doctor;
• Monitor your cholesterol and blood sugar levels, as high levels can adversely affect the liver.

In any case, a more accurate diagnosis and prescription of treatment is possible only after examination by a doctor.

How can the level of Alat and Asat in the blood be reduced?

To reduce the level of Alat and Asat in the blood, you need to take a quality approach to your health. It is necessary to stop drinking alcohol and smoking, as this is the main source of increased levels of Alat and Asat.

You also need to pay attention to nutrition. The diet should contain foods rich in vitamins and minerals, such as vegetables, fruits, herbs, nuts, fish and meat.

It is important not to forget about an active lifestyle, as exercise will help improve blood circulation and reduce the level of Alat and Asat in the blood.

In addition, elevated levels of these enzymes should see a doctor. Treatment may include taking special medications and following a diet.

• Quitting alcohol and smoking
• Proper nutrition
• Active lifestyle
• Medical consultation and treatment

Prevention of liver diseases

1. Proper nutrition.

One of the most important factors in the prevention of liver disease is proper nutrition. Red meat, heavy consumption of fatty and fried foods, alcohol, strong coffee and tea – all this adversely affects the functioning of the liver. The diet should contain a lot of fruits, vegetables, fish, dairy products and greens.

2. Refusal of bad habits.

Alcoholism and smoking are the main bad habits that damage the liver. It is necessary to completely abandon them in order to preserve the health of the liver.

3. Physical activity.

Regular exercise and exercise help strengthen the body and improve overall health, including the liver.

4. Doctor’s instructions.

Follow your doctor’s advice to prevent liver disease. In case of liver disease, it is necessary to strictly follow the prescribed treatment and undergo regular examinations.

5. Taking protective measures.

To avoid infection with viral hepatitis, you must follow the rules of personal hygiene, do not use other people’s personal belongings. Hepatitis A and B vaccinations are also recommended.

Alanine aminotransferase (ALAT) and Aspartate aminotransferase (ASAT) are enzymes made in the liver and used to break down amino acids in the body.

What values ​​of alat and asat in the blood can be considered normal?

Normal values ​​for ALAT can range from 0 to 45 units/l, and for ASAT from 0 to 35 units/l.

What are the reasons for the increase in the level of ALAT and ASAT in the blood?

Elevated levels of ALAT and ACAT may indicate the presence of liver disease, such as hepatitis, cirrhosis, or fatty degeneration. They can also indicate the presence of heart disease, alcohol dependence or other metabolic disorders in the body.

How can I lower my ALAT and ASAT levels?

To lower the levels of ALAT and ASAT, you first need to find out the reason for their increase. Typically, this may be due to lifestyle changes, including avoiding alcohol and changing diet. In some cases, medication may be required.

What symptoms are signs of elevated levels of ALAT and ASAT?

Elevated levels of ALAT and ASAT may not present with obvious symptoms. However, if they are caused by liver disease, symptoms such as jaundice, liver enlargement, fatigue, anemia, etc. are possible.

Who is at particular risk for elevated ALAT and ASAT?

People who have alcoholic or fatty liver disease, or who take medications that can damage the liver, are at increased risk of elevated blood levels of ALT and ACAT.

Can ALAT and ASAT levels fall back to normal without treatment?

If elevated levels of ALAT and ASAT are caused by lifestyle changes, they may return to normal without treatment. But if they are caused by a disease, then treatment is needed to return the levels of ALAT and ASAT to normal levels.

What is the significance of alat and asat in the diagnosis of diseases?

Measurement of ALAT and ASAT levels is a simple and inexpensive method for diagnosing possible liver-related diseases. However, for specific diagnosis and treatment, additional testing is usually required.

How to keep the liver healthy?

The liver is a large and complex organ that performs many functions in our body. It is involved in metabolism, normalization of blood glucose levels, cleaning of toxins and much more. It is important to take care of the health of the liver in order to avoid various diseases and problems.

Some of the following tips can help you keep your liver healthy:

• Give up bad habits. Smoking, alcohol and certain drugs can cause serious damage to the health of the liver. It is necessary to abandon such habits in order to avoid problems with the liver.
• Proper nutrition. Avoid fatty, spicy, fried and high-calorie foods. It is useful to eat vegetables, fruits, herbs, bread made from whole grain flour.
• Physical activity. Sports and exercise can help keep your liver healthy. They help facilitate the release of toxins and other harmful substances.
• Avoidance of harmful substances. Maintain a healthy lifestyle and avoid exposure to hazardous substances that can harm your liver.
• Treat diseases in time. You may develop a disease that can seriously damage the health of your liver. Treat diseases in time to avoid such problems.

By following these simple tips, you can keep your liver healthy, avoid problems and enjoy life to the fullest.

Conclusions

Alat and asat are liver enzymes that can be detected in the blood when the level of liver damage is high enough. The levels of these enzymes can give an indication of the level of damage, but do not always allow for an accurate diagnosis. Therefore, it is important to conduct additional research to determine the cause of the increase in the levels of these enzymes.

Elevated levels of alat may indicate liver damage, but may also be associated with other problems, such as increased physical activity or medication. Elevated levels of asat can also be associated with liver damage, as well as heart and muscle problems.

Therefore, additional investigations such as ultrasound, MRI or liver biopsy are necessary for an accurate diagnosis.

If an increase in the levels of alat and asat is detected, it is necessary to consult a doctor for additional studies and determine the cause of this phenomenon. Prompt treatment can help prevent further liver damage and preserve liver function.

Interpretation of liver tests and their disorders

04.10.2018

PDF article

It is not uncommon for a clinician to examine the liver to assess its functional state. The most commonly used indicators for this are alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and bilirubin. The measurement of these indicators is traditionally called “liver tests”. Some recommendations of the American College of Gastroenterology (2016) regarding the appointment and interpretation of liver tests are presented in the table.

Hepatocyte damage is usually characterized by a disproportionate increase in AST and ALT against a background of normal or slightly altered ALP; cholestasis, on the contrary, a sharp increase in alkaline phosphatase compared with ALT and AST. As for bilirubin, most of it circulates in the blood in an unconjugated form, and increased conjugated bilirubin may indicate both hepatocyte damage and cholestasis.

Diagnostic search for detected laboratory lesions of hepatocytes should include tests for viral hepatitis A, B and C, detection of NAFLD and ALD, screening for hereditary hemochromatosis, autoimmune hepatitis (AIH), Wilson’s disease, α-1-antitrypsin deficiency. The medical history should also be taken into account. With an increase in alkaline phosphatase, it is necessary to diagnose PBC and primary sclerosing cholangitis.

It is important that normal laboratory values ​​are usually defined as the average value in a healthy population ± 2 standard deviations. This definition of the norm covers 95% of people, i.e., in 2.5% of the world’s population, these indicators, by definition, will exceed the norm. The normal levels of ALP and bilirubin differ less in different laboratories, while there is significant variability for ALT.

For example, in one study, 67 laboratories analyzed used an upper limit of normal (ULN) ALT of 31 to 72 U/L. It depends on the equipment of the laboratory, different methods for determining the quantitative indicator of the norm, the characteristics of the population used as healthy.

ALT is a more specific marker of liver damage than AST, but a normal ALT level does not rule out significant liver disease. An increase in AST without a concomitant increase in ALT may indicate damage to the heart or muscles. A borderline increase in AST and/or ALT is considered to be <2×ULN, slight - 2-5×ULN, moderate -5-15 ULN, severe - >15×ULN, and massive – >10,000 IU/L. The diagnostic algorithm at various levels of increase is shown in Figures 1-5.
AP is a member of the zinc metalloproteinase family that catalyzes the hydrolysis of phosphate esters at alkaline pH.

Interestingly, in people with blood type 1 or 2, serum ALP may increase after eating fatty foods, although this metabolic feature is rarely used in practice. The main reasons for the increase in the level of alkaline phosphatase are obstruction of the biliary tract (most often; possibly even in the absence of elevated bilirubin), pregnancy; Also, the level of alkaline phosphatase is increased in children and the elderly, especially in women. With a parallel increase in GGT, it can be concluded that the hepatic cause of the increase in alkaline phosphatase.

Bilirubin, bound to albumin, is formed from the breakdown of old red blood cells and predominantly circulates in unconjugated form. Unconjugated (indirect) bilirubin is not excreted in the urine. In turn, conjugated bilirubin becomes water-soluble and excreted into bile, then converted by intestinal bacteria into urobilinogen, excreted in urine and feces. It is the absence of urobilinogen that gives the feces a discolored appearance in violation of the outflow of bile. Unconjugated bilirubin makes up about 70% of total serum bilirubin.

Determination of bilirubin fractions is especially important when ALT, AST and ALP are in the normal range or slightly changed. If total bilirubin is elevated, mainly due to unconjugated bilirubin, hepatocellular damage is unlikely. An increase in direct bilirubin indicates such lesions or cholestasis.

Liver tests (ALT, AST, ALP, bilirubin) are markers of liver damage, not liver function. Albumin and PTT are indicators of hepatocyte function. Decreased albumin levels (normally ≥3.5 g/dL) usually indicate liver disease lasting ≥3 weeks, although any significant disease can decrease albumin levels due to cytokine exposure. PTT is a more sensitive measure of liver function as it may be elevated in patients with severe liver disease lasting <24 hours.

Of note, albumin, bilirubin, and PTT may be affected by extrahepatic factors. For example, in the presence of vitamin K deficiency and steatorrhea (in the absence of liver disease), cholestasis, or significant hepatocellular dysfunction, PTP lengthens. Treatment with warfarin, heparin bolus administration, disseminated intravascular coagulation syndrome, and hypothermia can also lead to an increase in PTT.

Selected liver diseases

Viral hepatitis B and C

The screening test for chronic hepatitis C is an antibody to the virus with a sensitivity of 92-97%. False positive results are observed in 5% of all cases and in 30% of patients without risk factors. Confirmation of chronic infection is provided by highly sensitive polymerase chain reaction (PCR) with the determination of viral RNA. Individuals with identified RNA should be referred to a specialist for further evaluation of infection and liver fibrosis, and a decision on antiviral therapy.

Acute hepatitis C, accompanied by higher levels of transaminases than chronic, usually occurs without jaundice and other clinical symptoms. The diagnosis of acute hepatitis C can be suspected in the presence of risk factors and confirmed using antibodies to the virus (positive 6-8 weeks after infection) and then by determining the virus RNA by PCR.

Hepatitis B testing should be done in all patients with persistently elevated AST/ALT. Determining the status of infection can be done using three serological tests: HBsAg, indicating the presence of infection; total antibodies to HBcAg, reporting previous exposure to infection or the presence of chronic HBV infection; antibodies to HBsAg, signaling the presence of immunity to this hepatitis that arose as a result of vaccination or a disease transferred in the past.

Chronic infection is confirmed by the presence of HBsAg, antibodies to the core antigen of the virus and / or the determination of viremia using a highly sensitive analysis for the detection of viral DNA. Individuals with chronic hepatitis B should be referred to a hepatologist for further evaluation and a decision on antiviral therapy. The diagnosis of acute hepatitis B is made with a positive test for IgM to HBcAg and the presence of HBsAg. Acute hepatitis B is more often than acute hepatitis C accompanied by clinical symptoms.

NAFLD

NAFLD is a very common metabolic syndrome-associated disease. Unlike ALD, there is no unique pattern of changes in ALT and AST for NAFLD, although ALT levels are usually more elevated than AST levels, and levels of both aminotransferases rarely exceed 300 IU/L. Although many individuals with NAFLD suspected of having steatosis on imaging studies may have normal liver tests, the presence of abnormal liver tests indicates a greater likelihood of non-alcoholic steatohepatitis. An accurate diagnosis of this diagnosis requires a liver biopsy, although the role of a non-invasive method for determining the degree of fibrosis and steatosis, elastography, is also increasing.

ABP

Alcohol use is a common cause of elevated liver tests, either alone or in association with chronic liver disease. Specific patterns of changes in liver tests are associated with ALD, in particular the AST:ALT ratio of at least 2:1, and transaminase values ​​rarely exceed 300 IU / L. A further increase in this ratio (3:1, 4:1, etc.) increases the likelihood of ABP. An additional test is the measurement of GGT. All patients with elevated liver tests should be directly asked about alcohol use, recommending that it should be completely discontinued.

Autoimmune liver diseases

Chronic AIH, in which persistently elevated transaminases are noted, can develop in parallel with other autoimmune disorders (hypothyroidism, ulcerative colitis, Sjögren’s syndrome, rheumatoid arthritis, psoriasis). AIH is more common in women than in men (4:1). The characteristic laboratory signs of AIH are the presence of antinuclear antibodies, antismooth muscle antibodies, and less commonly, antirenal and antihepatic microsomal antibodies. The diagnosis of AIH requires histological confirmation with analysis taken from a liver biopsy of a tissue sample.

Drug injuries of the liver

Almost all drugs are associated with at least a minimal risk of elevated liver tests with or without concomitant hepatotoxicity. Among such drugs are antibiotics, antiepileptics, non-steroidal anti-inflammatory drugs, statins, anti-tuberculosis, chemotherapeutic and antiretroviral drugs. It should be noted that although statins are associated with increases in ALT and AST, cases of hepatotoxicity of these agents are rare, even in patients with chronic liver disease. Natural supplements associated with hepatotoxicity include ephedra preparations, green tea extract, and shark cartilage. An online source for information on drug hepatotoxicity is the livertox.nih.gov website. To determine drug damage, treatment should be stopped empirically until ALT/AST normalizes.

PBH

PBC, formerly known as primary biliary cirrhosis, is a rare chronic liver disease that predominantly affects the intralobular bile ducts at a microscopic level. PBC is more common in women than men and is associated with increased fatigue and itching. Laboratory examination reveals elevated alkaline phosphatase with or without elevated bilirubin, as well as the main criterion for diagnosis – a positive analysis for antimitochondrial antibodies (in > 95% of patients).

Other

In patients with jaundice and abdominal pain, a history of previous hepatobiliary disease, including cholelithiasis and inflammatory bowel disease, should be taken. Other extrahepatic causes of abnormal liver function tests include heart failure (congestive hepatopathy), early stages of emphysema, celiac disease, and thyroid disease.

Physical examination findings in patients with abnormal liver tests are usually normal, but some symptoms (jaundice, ascites, splenomegaly, palmar erythema, hepatic encephalopathy) may help confirm the presence of liver disease. In addition, the etiology of the disease can be suspected by specific symptoms. For example, contractures

Dupuytren in combination with an increase in the parotid salivary glands and testicular atrophy may accompany ALD; bronze skin color – hereditary hemochromatosis; severe hepatomegaly – acute viral or alcoholic hepatitis; enlarged nodular liver – a malignant process; right hypochondrium tenderness and a positive Murphy’s sign are hepatobiliary diseases (primarily cholecystitis).

From:
Paul Y. Kwo, Stanley M. Cohen, Joseph K. Lim. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol advance online publication, 20 December 2016; doi:10.1038/ajg.2016.517

Prepared by Larisa Strilchuk

Medical newspaper “Health of Ukraine 21 stories” No. 17 (438), spring 2018

• Number:
• Medical newspaper “Health of Ukraine 21 stories” No. 17 (438), spring 2018

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