What are liver function tests. How are they interpreted. What do normal levels indicate. When should you be concerned about liver function test results. How do various factors affect liver enzyme levels. What are the implications of abnormal liver function tests.

The Basics of Liver Function Tests

Liver function tests (LFTs) are a group of blood tests that provide valuable information about the health and functionality of the liver. These tests measure various enzymes, proteins, and other substances produced or processed by the liver. Understanding LFTs is crucial for diagnosing liver diseases, monitoring liver health, and assessing overall well-being.

The most common liver function tests include:

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

Each of these tests provides specific insights into liver function and can help healthcare providers identify potential liver problems or diseases.

Normal Ranges for Liver Function Tests

Understanding the normal ranges for liver function tests is essential for interpreting results accurately. However, it’s important to note that these ranges can vary slightly depending on the laboratory and the specific testing methods used.

Typical normal ranges for common liver function tests include:

• ALT: 7-56 units per liter (U/L) for males, 7-45 U/L for females
• AST: 10-40 U/L
• ALP: 44-147 U/L
• GGT: 9-48 U/L for males, 8-41 U/L for females
• Total bilirubin: 0.1-1.2 milligrams per deciliter (mg/dL)
• Albumin: 3.5-5.0 grams per deciliter (g/dL)
• PT: 11-13.5 seconds

Are these ranges absolute? No, they serve as general guidelines. Individual factors such as age, gender, and overall health can influence what is considered “normal” for a specific person.

Interpreting Elevated Liver Enzymes

Elevated liver enzymes, particularly ALT and AST, are often the first indicators of liver damage or disease. But what do these elevations mean?

Mild elevations (less than 5 times the upper limit of normal) can be caused by:

• Fatty liver disease
• Alcohol consumption
• Certain medications
• Obesity

Moderate elevations (5-15 times the upper limit of normal) may indicate:

• Viral hepatitis
• Autoimmune liver diseases
• Alcohol-related liver disease

Severe elevations (more than 15 times the upper limit of normal) often suggest:

• Acute viral hepatitis
• Drug-induced liver injury
• Ischemic hepatitis

Is the AST/ALT ratio significant? Yes, this ratio can provide additional diagnostic information. An AST/ALT ratio greater than 2 is often associated with alcoholic liver disease, while a ratio less than 1 is more common in viral hepatitis and other liver conditions.

The Role of Bilirubin in Liver Function

Bilirubin is a yellowish pigment produced during the breakdown of red blood cells. The liver plays a crucial role in processing bilirubin, making it an important marker of liver function.

There are two types of bilirubin measured in liver function tests:

• Direct (conjugated) bilirubin
• Indirect (unconjugated) bilirubin

What does elevated bilirubin indicate? Elevated total bilirubin levels can signal various liver or bile duct problems, including:

• Hepatitis
• Cirrhosis
• Gallstones
• Hemolytic anemia

However, it’s important to note that some individuals may have naturally higher bilirubin levels due to a benign condition called Gilbert’s syndrome, which affects about 3-7% of the population.

Alkaline Phosphatase and Gamma-Glutamyl Transferase: Beyond the Liver

While ALP and GGT are commonly included in liver function tests, they are not specific to the liver and can be elevated due to conditions affecting other organs.

Elevated ALP levels may indicate:

• Bile duct obstruction
• Bone diseases (e.g., Paget’s disease)
• Pregnancy
• Certain cancers

GGT elevations are often associated with:

• Alcohol consumption
• Pancreatic disease
• Heart failure
• Certain medications

How can healthcare providers differentiate between liver and non-liver causes of elevated ALP and GGT? By considering other liver function test results, patient history, and additional diagnostic tests when necessary.

Factors Affecting Liver Function Test Results

Several factors can influence liver function test results, potentially leading to abnormal readings even in the absence of liver disease. These factors include:

1. Medications: Some drugs can cause temporary elevations in liver enzymes.
2. Alcohol consumption: Even moderate drinking can affect liver function tests.
3. Obesity: Non-alcoholic fatty liver disease is a common cause of mildly elevated liver enzymes.
4. Exercise: Intense physical activity can temporarily increase ALT and AST levels.
5. Diet: Certain foods and supplements may impact liver function test results.
6. Pregnancy: Normal physiological changes during pregnancy can alter liver function test results.
7. Time of day: Some liver enzymes exhibit diurnal variations.

How should these factors be considered when interpreting liver function tests? Healthcare providers must take a comprehensive approach, considering the patient’s medical history, lifestyle, and other relevant factors when evaluating liver function test results.

Liver Function Tests in Specific Populations

Interpreting liver function tests can be particularly challenging in certain populations due to physiological differences or underlying health conditions.

Liver Function Tests in Pregnancy

During pregnancy, several liver function test parameters may change:

• ALP levels typically increase due to placental production
• ALT and AST levels may decrease slightly
• Albumin levels may decrease due to plasma volume expansion

What liver conditions should be considered in pregnant women with abnormal liver function tests? Conditions such as intrahepatic cholestasis of pregnancy, HELLP syndrome, and acute fatty liver of pregnancy require prompt evaluation and management.

Liver Function Tests in Children

Interpreting liver function tests in children requires consideration of age-specific reference ranges. For example:

• Newborns may have higher bilirubin levels due to physiological jaundice
• ALP levels are naturally higher in growing children due to bone turnover
• ALT and AST levels may be slightly different from adult reference ranges

How should pediatricians approach abnormal liver function tests in children? A thorough evaluation considering age, growth, and development is crucial for accurate interpretation and appropriate management.

Liver Function Tests in the Elderly

Aging can affect liver function and, consequently, liver function test results:

• Liver blood flow and mass decrease with age
• Drug metabolism may be altered, affecting liver enzyme levels
• Comorbidities and polypharmacy are more common, complicating interpretation

What considerations are important when evaluating liver function tests in older adults? Healthcare providers must consider age-related changes, medication use, and potential underlying conditions when interpreting results in this population.

Advanced Liver Function Tests and Biomarkers

While traditional liver function tests provide valuable information, advanced tests and biomarkers can offer additional insights into liver health and specific liver diseases.

Fibrosis Markers

Liver fibrosis is a critical factor in assessing liver disease progression. Non-invasive markers of fibrosis include:

• FibroTest
• Enhanced Liver Fibrosis (ELF) test
• APRI (AST to Platelet Ratio Index)
• FIB-4 score

How do these markers compare to liver biopsy? While not perfect, these non-invasive tests can provide valuable information about liver fibrosis without the risks associated with biopsy.

Hepatitis Virus Markers

Specific tests for hepatitis viruses are crucial for diagnosing and monitoring viral hepatitis:

• Hepatitis B surface antigen (HBsAg)
• Hepatitis C antibody (anti-HCV)
• Hepatitis A IgM antibody

What role do viral load tests play in managing hepatitis? Viral load tests help monitor treatment response and disease progression in chronic viral hepatitis.

Autoimmune Liver Disease Markers

Autoimmune liver diseases require specific antibody tests for diagnosis:

• Anti-smooth muscle antibodies (ASMA)
• Anti-mitochondrial antibodies (AMA)
• Anti-liver kidney microsomal antibodies (anti-LKM)

How are these autoantibodies used in diagnosing autoimmune liver diseases? The presence and titer of specific autoantibodies, along with other clinical and laboratory findings, help diagnose conditions such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis.

Liver Function Tests in Liver Transplant Patients

Monitoring liver function tests is crucial for liver transplant recipients to assess graft function and detect complications. Post-transplant LFT monitoring involves:

• Frequent testing in the immediate post-operative period
• Regular monitoring during long-term follow-up
• Evaluation of immunosuppression-related liver effects

What patterns of LFT abnormalities should raise concern in transplant patients? Sudden elevations in liver enzymes may indicate rejection, while a gradual increase in bilirubin and alkaline phosphatase might suggest biliary complications.

The Future of Liver Function Testing

As our understanding of liver physiology and pathology advances, new approaches to liver function testing are emerging:

Metabolomics and Proteomics

These techniques analyze multiple metabolites or proteins in biological samples, potentially offering more comprehensive insights into liver function and disease.

Genetic Testing

Identifying genetic variants associated with liver diseases can help in risk assessment and personalized treatment approaches.

Artificial Intelligence in LFT Interpretation

Machine learning algorithms are being developed to analyze complex patterns in liver function test results, potentially improving diagnostic accuracy and predicting disease progression.

How might these advancements change liver disease management? These new approaches could lead to earlier detection of liver diseases, more personalized treatment strategies, and improved patient outcomes.

In conclusion, liver function tests are invaluable tools for assessing liver health and diagnosing liver diseases. Understanding normal ranges, interpreting results in context, and considering patient-specific factors are crucial for accurate evaluation. As new technologies and biomarkers emerge, the field of liver function testing continues to evolve, promising even more precise and personalized approaches to liver health assessment and disease management.

A review on laboratory liver function tests

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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.

at-home lipid liver function test in top location include:

Bangalore, Delhi-NCR, Chennai, Hyderabad, Kolkata, Pune, Lucknow, Indore.

liver function test (lft) cost 2022 in india

The average cost of at home Liver Function Test in India is Rs.600, Book from Portea to get tested at your home

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/

How to decipher a biochemical blood test: the norm of indicators

Likbez

Health

November 11, 2020

This is a quick way to check your liver, kidneys, blood sugar and metabolic quality.

Why do we need a biochemical blood test

The meaning of a biochemical blood test (BAC) can be explained in a nutshell. If a general blood test (CBC) gives an idea of ​​the state of the body as a whole, then the BAC adds details – it tells whether specific organs and systems are healthy.

A biochemical blood test helps to detect liver, kidney, diabetes and other ailments.

In addition, the LHC allows you to find out if everything is in order with the level of sugar in the blood, metabolism and what important vitamins, micro and macro elements, hormones, enzymes the body lacks for normal operation.

What the biochemical blood test shows

The laboratory assistant will take a few milliliters of blood from your vein. This must be done on an empty stomach – 8-12 hours after the last meal. The sample taken is then examined for several key components. They are divided into groups.

Glucose

Or blood sugar. Glucose is a source of energy for body cells. The body regulates its amount in the blood with various hormones (such as insulin) and enzymes. If there is too much or too little sugar, then something is wrong with the endocrine or excretory system.

Proteins

• Albumin . It is a protein that is produced by the liver. Blood plasma is approximately 60% albumin.
• Total protein . There are several dozen different proteins in the blood. Total protein is the average total of them.
• Specific proteins . These are separate types of blood proteins, a change in the level of which may be associated with serious diseases. Specific ones include, in particular, C‑reactive protein (it signals an acute inflammatory process in the body), ferritin (needed for normal absorption of iron), myoglobin (creates the necessary supply of oxygen in muscles, including the heart), rheumatoid factor (antibodies that are produced only in case of serious diseases: infectious, muscular and connective tissues, autoimmune, oncological and others). Analysis for specific proteins is not always included in the standard LHC. If the doctor wants to find out the content of a particular substance in the blood, he will write about it in the direction for the study.

Lipids

The so-called lipid panel allows you to check the level of various types of cholesterol.

• High density lipoproteins (HDL) . This is the so-called good cholesterol, which removes harmful substances from the blood and helps the liver break them down.
• Low density lipoproteins (LDL) . We are talking about “bad” cholesterol, which causes the formation of plaques in the vessels and increases the risk of cardiovascular disease.
• Total cholesterol . The sum of the values ​​of “good” and “bad”.

Liver tests

This is the name given to the assessment of the level of certain enzymes associated with the state of the liver.

• Total bilirubin . It is an orange-yellow pigment that is formed when hemoglobin is broken down. Bilirubin is toxic, so normally the liver quickly removes it from the body. But if hemoglobin is destroyed too actively or the liver cannot cope with normal volumes of bilirubin, the level of pigment in the blood rises sharply. This is often manifested externally – yellowing of the skin and whites of the eyes (jaundice).
• Alanine aminotransferase (AlAt, ALT) . Liver enzyme necessary for amino acid metabolism. Its level rises with liver damage.
• Aspartate aminotransferase (AsAt, AST) . Another enzyme that is released into the blood during serious disorders in the liver.
• Alkaline Phosphatase . This is an enzyme involved in phosphorus metabolism. Its increase is also a marker of liver problems.

Kidney tests

• Creatinine . This is a waste product that is formed in the muscles. It is excreted from the blood by the kidneys, so the level of creatinine is a good indicator of the work of this paired organ.
• Uric acid . Formed in the liver and again excreted from the blood by the kidneys. If they fail (or, on the contrary, are unhealthy active), the level of uric acid in the blood rises (or falls).
• Urea . It is also formed in the liver, where proteins are broken down, and excreted from the blood by the kidneys.

Inorganic substances (minerals, electrolytes) and vitamins

• Calcium . One of the most important minerals in the body. Without it, the normal functioning of muscles, nerves, and heart is impossible. In addition, it is critical for bone development and repair.
• Sodium . Responsible for the transmission of nerve impulses and helps to absorb calcium.
• Magnesium . Like sodium, it is actively involved in the transmission of nerve impulses.
• Chlorine . Helps to regulate the amount of fluid in the body and maintain acid-base balance.
• Potassium . Critical to the normal functioning of the heart.
• Iron . Necessary for the delivery of oxygen to organs and tissues.
• Phosphorus . The nervous, muscular and skeletal systems are in great need of it.
• Folic acid . Participates in a huge number of processes in the body – from the absorption of amino acids and glucose to the production of blood.
• Vitamin B12 . It is essential for the production of red blood cells – erythrocytes.

What are the norms of blood parameters in LHC

The form with the results of a biochemical blood test, as a rule, is a table of three columns. The first contains the name of the indicator, the second contains the range of its normal values, and the third contains your result.

To check the norm, first of all, be guided by the numbers indicated on the form issued to you. The fact is that laboratories conduct tests on different reagents and under different conditions. Therefore, the optimal value ranges may vary slightly depending on the organization that processed your analysis. Only one thing is important for you: to check whether the result falls within the limits of the norms established by a particular laboratory.

The figures below are indicative for the most common indicators.

901 47

Indicator	Norm for an adult
Glucose	3, 9-5.6 mmol/l
Albumin	34-54 g/l
Total protein	60–83 g/l
HDL cholesterol	40 mg/dl and above for men; 50 mg/dl and above for women
LDL cholesterol	Less than 100 mg/dL
Total cholesterol	125–200 mg/dL
Total bilirubin	1.71–20.5 µmol/l
Alat , ALT	4–36 U/L
AsAt, AST	8–33 U/L
Alkaline Phosphatase	20-140 U/L
Creatinine	74 –107 µmol/L
Uric acid	3. 5-7.2 mg/dl
Urea	2.5-7.1 mmol/l
Calcium 90 151	2.2-2.7 mmol/l

How to decode a biochemical blood test

This can and should be done only by the doctor who issued you the referral for the analysis. For the reason that many different factors affect blood biochemistry.

Thus, an elevated blood glucose level can be both a symptom of prediabetes or diabetes, and a sign that you were irresponsible about the analysis and, let’s say, drank sweet coffee before it.

There are other examples. Elevated liver function tests are a marker of hepatitis and sometimes cirrhosis. But at the same time, ALT and AST can rise if you are being treated for a bacterial infection by taking antibiotics and other medications. A low urea level is a sign of serious liver damage. Or banal malnutrition if you are on a strict diet.

In general, let’s repeat it again. Only the doctor observing you should decipher the LHC. It is unacceptable to analyze the results of the tests on your own, and even more so to start self-treatment based on them.

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• What is genetic analysis and who needs it
• Why people have different blood types and what it affects
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Interpretation of liver tests and their disorders

04.10.2018

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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.

Certain 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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