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Liver level blood test: Liver function tests – Mayo Clinic


Liver function tests – Mayo Clinic


Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.

Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease.

Abnormal liver function test results don’t always indicate liver disease. Your doctor will explain your results and what they mean.

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Why it’s done

Liver function tests can be used to:

  • Screen for liver infections, such as hepatitis
  • Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working
  • Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
  • Monitor possible side effects of medications

Liver function tests check the levels of certain enzymes and proteins in your blood. Levels that are higher or lower than normal can indicate liver problems. Some common liver function tests include:

  • Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
  • Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
  • Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
  • Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
  • Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
  • Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
  • L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.
  • Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you’re taking certain blood-thinning drugs, such as warfarin.

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The blood sample for liver function tests is usually taken from a vein in your arm. The main risk associated with blood tests is soreness or bruising at the site of the blood draw. Most people don’t have serious reactions to having blood drawn.

How you prepare

Certain foods and medications can affect the results of your liver function tests. Your doctor will probably ask you to avoid eating food and taking some medications before your blood is drawn.

What you can expect

During the test

The blood sample for liver function tests is usually drawn through a small needle inserted into a vein in the bend of your arm. The needle is attached to a small tube, to collect your blood. You may feel a quick pain as the needle is inserted into your arm and experience some short-term discomfort at the site after the needle is removed.

After the test

Your blood will be sent to a laboratory for analysis. If the lab analysis is done on-site, you could have your test results within hours. If your doctor sends your blood to an off-site laboratory, you may receive the results within several days.


Normal blood test results for typical liver function tests include:

  • ALT. 7 to 55 units per liter (U/L)
  • AST. 8 to 48 U/L
  • ALP. 40 to 129 U/L
  • Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
  • Total protein. 6.3 to 7.9 g/dL
  • Bilirubin. 0.1 to 1.2 milligrams per deciliter (mg/dL)
  • GGT. 8 to 61 U/L
  • LD. 122 to 222 U/L
  • PT. 9.4 to 12.5 seconds

These results are typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children.

Your doctor will use these results to help diagnose your condition or determine treatment you might need. If you already have liver disease, liver function tests can help determine how your disease is progressing and if you’re responding to treatment.

Liver function tests – Mayo Clinic


Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.

Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease.

Abnormal liver function test results don’t always indicate liver disease. Your doctor will explain your results and what they mean.

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Why it’s done

Liver function tests can be used to:

  • Screen for liver infections, such as hepatitis
  • Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working
  • Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
  • Monitor possible side effects of medications

Liver function tests check the levels of certain enzymes and proteins in your blood. Levels that are higher or lower than normal can indicate liver problems. Some common liver function tests include:

  • Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
  • Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
  • Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
  • Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
  • Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
  • Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
  • L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.
  • Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you’re taking certain blood-thinning drugs, such as warfarin.

More Information

Show more related information


The blood sample for liver function tests is usually taken from a vein in your arm. The main risk associated with blood tests is soreness or bruising at the site of the blood draw. Most people don’t have serious reactions to having blood drawn.

How you prepare

Certain foods and medications can affect the results of your liver function tests. Your doctor will probably ask you to avoid eating food and taking some medications before your blood is drawn.

What you can expect

During the test

The blood sample for liver function tests is usually drawn through a small needle inserted into a vein in the bend of your arm. The needle is attached to a small tube, to collect your blood. You may feel a quick pain as the needle is inserted into your arm and experience some short-term discomfort at the site after the needle is removed.

After the test

Your blood will be sent to a laboratory for analysis. If the lab analysis is done on-site, you could have your test results within hours. If your doctor sends your blood to an off-site laboratory, you may receive the results within several days.


Normal blood test results for typical liver function tests include:

  • ALT. 7 to 55 units per liter (U/L)
  • AST. 8 to 48 U/L
  • ALP. 40 to 129 U/L
  • Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
  • Total protein. 6.3 to 7.9 g/dL
  • Bilirubin. 0.1 to 1.2 milligrams per deciliter (mg/dL)
  • GGT. 8 to 61 U/L
  • LD. 122 to 222 U/L
  • PT. 9.4 to 12.5 seconds

These results are typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children.

Your doctor will use these results to help diagnose your condition or determine treatment you might need. If you already have liver disease, liver function tests can help determine how your disease is progressing and if you’re responding to treatment.

Liver Test Interpretation – Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests


William D. Carey, MD

Laboratory assessment of the patient with suspected or clinically obvious liver disease is context dependent. For example, the acutely ill jaundiced patient with a history of prolonged alcohol ingestion requires a different laboratory assessment than the well patient in whom one or more standard liver test results are discovered to be abnormal during routine testing. Additionally, the sequence of liver tests depends heavily on the questions being asked. If it is to determine whether this well person whose brother was recently diagnosed with hemochromatosis also has this genetic disease, then a series of tests will be initiated to detect the possibility of iron overload. If it is to determine whether this spouse has been infected with hepatitis B, then blood tests related to hepatitis B will be required. Thus generic algorithms for the evaluation of liver disease need to be considered skeptically.

This chapter is intended to discuss a useful way of thinking about liver tests. It emphasizes limitations of and alternative explanations for isolated abnormalities of common liver test results. It also provides information on the initial screening test to be chosen, their interpretation, and the tests needed to confirm the diagnosis of common liver disorders based on current recommendations. Information in this chapter should be combined with discussions of specific liver diseases. A final caveat relates to terminology. Tests done in clinical laboratories do not measure any functional capacity of the liver. Hence, the commonly used term liver function test is inaccurate, and the term liver tests is used in this chapter. Guidelines on the interpretation and evaluation of abnormal liver test results have been published. Useful algorithms are presented that parallel the recommendations in this chapter.

Isolated Abnormalities in Liver Test Results

A common clinical scenario is the unanticipated discovery of an abnormal liver test result, obtained when a bundle of tests has been done for other reasons. Most clinical laboratories offer bundled blood tests, which often contain all or most of the following:

  • Bilirubin
  • Aspartate transaminase (AST, formerly referred to as serum glutamic-oxaloacetic transaminase, SGOT)
  • Alanine transaminase (ALT, formerly called serum glutamic-pyruvic transaminase, SGPT)
  • Gamma-glutamyl-transpeptidase (GGTP)
  • Alkaline phosphatase
  • Lactate dehydrogenase (LDH)

Of these tests only the GGTP is liver specific. An isolated elevation of just one of the other test values should raise suspicion that a source other than the liver is the cause (Table 1). When several liver test results are simultaneously out of the normal range, consideration of non-hepatic sources becomes less relevant.

Table 1: Nonhepatic Sources of Abnormalities for Select Laboratory Tests

TestNonhepatic Source
BilirubinRed blood cells (e.g., hemolysis, intra-abdominal bleed, hematoma)
ASTSkeletal muscle, cardiac muscle, red blood cells
ALTSkeletal muscle, cardiac muscle, kidneys
LDHHeart, red blood cells (e.g., hemolysis)
Alkaline phosphataseBone, first trimester placenta, kidneys, intestines

ALT, alanine aminotransaminase; AST, aspartate transaminase; LDH, lactate dehydrogenase.

Additional note should be made of the GGTP and LDH as liver tests. The GGTP level is too sensitive, frequently elevated when no liver disease is apparent. A GGTP test is useful in only two instances: (1) It confers liver specificity to an elevated alkaline phosphatase level; (2) In aminotransferase level elevations with AST/ALT ratio greater than 2, elevation of GGTP further supports alcoholic liver disease. In addition, it can be used to monitor abstinence from alcohol. An isolated elevation of the GGTP level does not need to be further evaluated unless there are additional clinical risk factors for liver disease. The LDH assay is insensitive and nonspecific because LDH is present in tissues throughout the body.

Evaluation Based on Enzyme Levels

It is customary and useful to categorize liver diseases into three broad categories: Hepatocellular, in which primary injury is to the hepatocytes; cholestatic, in which primary injury is to the bile ducts; and infiltrative, in which the liver is invaded or replaced by non-hepatic substances, such as neoplasm or amyloid. Although there is a great deal of overlap in liver test result abnormalities seen in these three categories, particularly in cholestatic and infiltrative disorders, an attempt to characterize an otherwise undifferentiated clinical case as hepatocellular, cholestatic, or infiltrative often makes subsequent evaluation faster and more efficient. The AST, ALT, and alkaline phosphatase tests are most useful to make the distinction between hepatocellular and cholestatic disease.

The normal range for aminotransferase levels in most clinical laboratories is much lower than that for the alkaline phosphatase level. Accordingly, when considering levels of elevations, it is necessary to consider them relative to the respective upper limit of normal for each test compared. Consider a patient with an AST level of 120 IU/mL (normal, ≤40 IU/mL) and an alkaline phosphatase of 130 IU/mL (normal, ≤120 IU/mL). This represents a hepatocellular pattern of liver injury because the AST level is three times the upper limit of normal, whereas the alkaline phosphatase level is only marginally higher than its upper limit of normal.

Serum aminotransferase levels—ALT and AST—are two of the most useful measures of liver cell injury, although the AST is less liver specific than is ALT level. Elevations of the AST level may also be seen in acute injury to cardiac or skeletal muscle. Lesser degrees of ALT level elevation may occasionally be seen in skeletal muscle injury or even after vigorous exercise. Thus in clinical practice, it is not uncommon to see elevations of AST, ALT or both in common non-hepatic conditions such as myocardial infarction and rhabdomyolysis. Diseases that primarily affect hepatocytes, such as viral hepatitis, will cause disproportionate elevations of the AST and ALT levels compared with the alkaline phosphatase level. The ratio of AST/ALT is of little benefit in sorting out the cause of liver injury except in acute alcoholic hepatitis, in which the ratio is usually greater than 2.

The current upper limit of serum ALT, though varied among laboratories, is generally around 40 IU/L. However, recent studies have shown that the upper limit threshold of ALT level should be lowered because people who have slightly raised ALT levels that are within the upper limit of normal (35-40 IU/L) are at an increased risk of mortality from liver disease.   In addition, it has been suggested that gender-specific thresholds be applied because women have slightly lower normal ALT levels than men. One such study conducted in the U.S. identified an ALT upper limit of 29 IU/L for men and 22 IU/L for women.  In asymptomatic patients with minimal elevations of aminotransferases, it is reasonable to repeat the test in a few weeks to confirm elevation. Common causes of mild increases in AST and ALT levels include non-alcoholic fatty liver disease (NAFLD), hepatitis C, alcoholic fatty liver disease, and medication effect (e.g., due to statins).

Serum alkaline phosphatase comprises a heterogeneous group of enzymes. Hepatic alkaline phosphatase is most densely represented near the canalicular membrane of the hepatocyte. Accordingly, diseases that predominately affect hepatocyte secretion (e.g., obstructive diseases) will be accompanied by elevations of alkaline phosphatase levels. Bile-duct obstruction, primary sclerosing cholangitis, and primary biliary cirrhosis (PBC) are some examples of diseases in which elevated alkaline phosphatase levels are often predominant over transaminase level elevations (Table 2).

Table 2: Category of Liver Disease by Predominant Serum Enzyme Abnormality

Liver Disease Category

AST, ALT higher than alkaline phosphatase levelTypical
Alkaline phosphatase higher than AST, ALT levelsTypical
Elevation of alkaline phosphatase with near-normal AST, ALT levelsTypicalTypical

ALT, alanine aminotransaminase; AST, aspartate transaminase.

Infiltrative liver diseases most often result in a pattern of liver test result abnormalities similar to those of cholestatic liver disease. Differentiation often requires liver imaging studies. Liver imaging by ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) most often identify infiltration of the liver by mass lesions such as tumors. Imaging by cholangiography—endoscopic retrograde cholangiography, transhepatic cholangiography, or magnetic resonance cholangiography—identifies many bile duct lesions that cause cholestatic liver disease. Liver biopsy is often needed to confirm certain infiltrative disorders (e.g., amyloidosis) and microscopic biliary disorders such as PBC.

Bilirubin Level Elevations

Bilirubin is produced by the normal breakdown of pigment-containing proteins, especially hemoglobin from senescent red blood cells and myoglobin from muscle breakdown. Bilirubin released from such sources, tightly albumin bound, is delivered to the liver, where it is efficiently extracted and conjugated by hepatic glucuronidation and sulfation. Conjugated bilirubin is rapidly excreted into bile and removed from the body through the gut. Therefore, the amount of conjugated bilirubin present in serum in healthy subjects is trivial (<10% of measured total bilirubin). An elevated level of conjugated serum bilirubin implies liver disease. Also, it is important to note that only conjugated bilirubin appears in urine (unconjugated bilirubin is albumin bound and water insoluble). The presence of bilirubin in urine almost always implies liver disease.

Many laboratories report only the total bilirubin level, the sum of the conjugated and unconjugated portions. It is sometimes useful to determine the fraction of total serum bilirubin that is unconjugated versus that which is conjugated, usually referred to as fractionation of bilirubin. This is most useful when all the standard liver test results are normal, except the total bilirubin. To make matters more confusing, the conjugated bilirubin is sometimes referred to as the direct-reacting bilirubin and the unconjugated as the indirect-reacting bilirubin (Table 3).

Table 3: Bilirubin Fractions Present in Blood and Urine

FractionIn Serum AsMeasured AsPresent in Urine
UnconjugatedAlbumin-boundIndirect-reacting bilirubinNever
ConjugatedUnboundDirect-reacting bilirubinYes, when serum bilirubin level is elevated

Normally, 90% or more of measured serum bilirubin is unconjugated (indirect-reacting). When the total bilirubin level is elevated and fractionation shows that the major portion (≥90%) is unconjugated, liver disease is never the explanation. Instead, the clinician should suspect one of two explanations: Gilbert disease or hemolysis. If the patient is young and healthy, an inherited decrease in the inability to conjugate bilirubin is likely and is referred to as Gilbert syndrome. It is seen in about 5% of the general population and causes only mild hyperbilirubinemia without symptoms. It is not associated with liver disease. Interestingly, fasting and intercurrent illnesses such as influenza often make the level of unconjugated bilirubin even higher in those with Gilbert syndrome. This syndrome is easily diagnosed when all standard liver-test results are normal and 90% or more of the total bilirubin is unconjugated. There is no need for an imaging study or liver biopsy in cases of suspected Gilbert syndrome.

Elevations of the unconjugated bilirubin level when the conjugated bilirubin level remains normal may also indicate an increased load of bilirubin caused by hemolysis. Anemia and an elevated reticulocyte count are usually present in such cases (Table 4).

Table 4: Common Causes of Isolated Bilirubin Elevation

CauseDirect-Reacting BilirubinIndirect-Reacting BilirubinAssociated Features
Liver disease (many types)ElevatedElevated or normalLiver enzyme levels often elevated
HemolysisNormalElevation represents more than 90% of total bilirubinAnemia usual; increased reticulocyte count; normal liver enzyme levels (although LDH may be elevated)
Gilbert’s syndromeNormalElevation represents more than 90% of total bilirubin (common)No abnormal liver tests; no anemia; onset in late adolescence; fasting makes bilirubin rise

LDH, lactate dehydrogenase.

Many clinicians mistakenly interpret elevations of direct-reacting bilirubin to indicate that cholestatic (obstructive) liver disease is present. It is apparent from Table 2 that the serum bilirubin level plays no useful role in categorizing a case as hepatocellular, cholestatic, or infiltrative. The bilirubin level may be normal or elevated in each type of disorder. Viral hepatitis A, a prototypic hepatocellular disease, may frequently be associated with bilirubin levels that are high, whereas PBC, a prototypic cholestatic disorder, is associated with a normal serum bilirubin level except in later stage disease. Serum bilirubin levels should be disregarded when trying to decide whether the liver-test pattern is more suggestive of hepatocellular or cholestatic disease.

Determination of Specific Liver Disorders

Acute Alcoholic Hepatitis

Acute alcoholic hepatitis may be mild or life threatening. The pattern of liver test abnormality is hepatocellular. The AST is typically in the 100 to 200 IU/L range, even in severe disease, and the ALT level may be normal, even in severe cases. The AST level is higher than the ALT level, and the ratio is greater than 2:1 in 70% of patients. A ratio greater than 3 is strongly indicative of alcoholic hepatitis. An important corollary is that an AST greater than 500 IU/L or an ALT greater than 200 IU/L is not likely to be explained by acute alcoholic hepatitis—even in an alcoholic patient—and should suggest another etiology.

The degrees of bilirubin level increase and prothrombin time elevation are better indicators of severity of disease. In alcoholic hepatitis, the Maddrey discriminant function (MDF), a disease-specific prognostic score which indicates the severity of liver injury, has been developed. The formula to calculate the score is as follows:

MDF = 4.6 (patient’s prothrombin time − control prothrombin time) + total bilirubin (mg/dL)

Patients who have a score of 32 or greater have an increased risk of death, with a 1-month mortality rate of 30% to 50%.

Other tools to assess severity of alcoholic hepatitis include the MELD or MELDNA score. Several MELD calculators are available on line (https://optn. transplant.hrsa.gov/resources/allocation-calculators/meld-calculator/ ), and require only four laboratory values: bilirubin, prothrombin time INR, creatinine, and [Na]. A MELD score of > 20 defines patients with severity alcoholic hepatitis and high mortality.

Finally, the Lille score tracks changes in bilirubin over time. Failure of improvement in bilirubin within seven days bodes poorly. Recently, the Lille score using change in bilirubin after only 4 days has been validated. Web-based calculators are available (www.mdcalc.com/lille-model-alcoholic-hepatitis).

Viral Hepatitis

Viral hepatitis most often produces a hepatocellular pattern of injury (AST and ALT level elevations predominate). Patients who have no symptoms and in whom aminotransferase levels are normal may still be infected. In addition, a great deal of confusion is caused by abnormal viral markers, many of which do not indicate active infection but rather immunity. These concepts are more fully developed elsewhere in the Cleveland Clinic Disease Management.

Hepatitis A

Hepatitis A virus (HAV) infection is an acute, self-limited disease in most cases, although it may rarely be fatal. Diagnosis is made through the use of antibody tests (anti-HAV). Positive anti-HAV IgM antibody is diagnostic of acute hepatitis A infection and has a very good sensitivity and specificity.

Three antibody tests are commonly used for diagnosis of hepatitis A:

  • Anti HAV IgG
  • Anti HAV IGM
  • Anti HAV (total)

The IgM antibodies are usually positive at the time of the onset of symptoms and they remain positive for about 3 to 6 months after, and in some cases as long as 1 year. Anti-HAV immunoglobulin G (IgG) antibodies develop later than anti-HAV immunoglobulin M (IgM) but they persist for many years and offer immunity. Anti-HAV IgG antibodies are also seen following vaccination.

The presence of anti-HAV IgM—irrespective of the presence of anti-HAV IgG—suggests acute infection. The presence of anti-HAV IgG in the absence of IgM suggests previous infection or post-vaccination antibodies.

When an acute hepatitis A panel is ordered, the test result that is obtained from the laboratory must be interpreted with caution before making the diagnosis. This is because the standard screening tests performed by most laboratories measure the level of total anti-HAV antibodies. Total anti-HAV antibody tests will be positive in the presence of either anti-HAV IgG or IgM, as the reagents used in this test will react to both anti-HAV IgG and IgM. Therefore, a positive total anti-HAV antibody test alone does not provide the diagnosis of acute hepatitis A. Selective testing of serum IgM anti-HAV is required to establish such a diagnosis (Table 5).

Table 5: Hepatitis A Antibody Testing In Different Clinical States

StateTotal Anti-HAV (IgG, IgM)Anti-HAV IgM
Acute hepatitis APositivePositive
Resolved hepatitis APositiveNegative

HAV, hepatitis A virus; IgG, immunoglobulin G; IgM, immunoglobulin M.

Hepatitis B

Like hepatitis A, hepatitis B in adults produces hepatocellular enzyme level elevations (AST and ALT predominate). In adults who acquire hepatitis B, the infection almost always clears, but antibodies persist. In a few, the disease does not resolve but becomes chronic. These patients retain serum markers of viral infection. Many blood tests are available for hepatitis B antigenic determinants and their antibodies. It is best to separate testing appropriate for the acute hepatitis situation from testing for chronic liver disease caused by hepatitis B. Only a few tests need to be considered by the generalist to determine the status of a patient with possible hepatitis B. A full discussion of hepatitis B can be seen in the Disease Management chapter on Hepatitis B.

Acute Hepatitis B

Hepatitis B surface antigen (HBsAg) emerges within 2 weeks of exposure but can often be delayed for weeks or months. This antigen is present in the blood for a variable period, usually encompassing the time during which the patient is clinically ill and most likely to seek medical attention. In patients with mild symptoms whose testing may be delayed, the HBsAg level may have already declined. In this case, a second chance to make the diagnosis comes from detection of the IgM antibody directed against the hepatitis B core (HBc) antigen, anti HBc-IgM (Table 6). Similar to the testing for acute hepatitis A, selective testing of serum IgM anti-HBc is required to establish a diagnosis of acute hepatitis B in patients whose HBsAg levels have already declined. The total anti-HBc antibody test will be positive in the presence of either anti-HBc IgG or IgM.

Table 6. Common Hepatitis B Testing Results

HBsAgNegativeImmune due to natural infection
HBsAgNegativeImmune due to hepatitis B vaccination
HBsAgPositiveAcutely infected
IgM anti-HBcPositive 
HBsAgPositiveChronically infected
IgM anti-HBcNegative 
HBsAgNegativeInterpretation unclear 4 possibilities:
Anti-HBcPositive1. Resolved infection (most common)
Anti-HBsNegative2. False positive
  3. “Low level” chronic infection
  4. Resolving acute infection

From: Interpretation of hepatitis B serologic test results. Centers for Disease Control and Prevention website. www.cdc.gov. Accessed June 27, 2013.

In acute hepatitis B, medical attention is often not sought early, especially if symptoms are mild. In such cases the HBsAg may have already disappeared by the time testing is done. The anti-HBs will not yet have emerged. Thus the sole viral marker may be anti-HBc. This same serologic pattern may be seen years after infection when the titer of anti-HBs is low. Sorting out the difference between late resolved hepatitis B and the period in acute hepatitis B described above can be achieved by testing for anti-HBc IgM which will be positive during this so-called “window period” of acute hepatitis B.

Chronic Hepatitis B

Chronic hepatitis B is characterized by persistence of HBsAg for a period longer than 6 months with positive anti-HBc (IgG), and negative anti-HBs. An additional antigen-antibody system plays a role in patients with chronic hepatitis B and requires mention: the hepatitis B e antigen (HBeAg) and its antibody (anti-HBe). HBeAg positivity in chronic hepatitis B usually indicates active viral replication and significant liver injury. In time, HBeAg may be lost, replaced by its antibody, anti-HBe. This transformation is often associated with lower level infection (less viral replication) or HBV DNA, lower AST and ALT values, and less (or no) hepatic inflammation.

Reactivation Hepatitis B

Hepatitis B reactivation is a sudden increase in hepatitis B virus (HBV) replication or the reappearance of active inflammatory disease of the liver in a patient with previously documented resolved HBV, or with the inactive HBsAg carrier state. Reactivation is usually triggered by immunosuppression in the host, which can occur following the use of chemotherapeutic agents for malignancy and following therapy for autoimmune diseases or organ transplantation.

Reactivation can also occur spontaneously. The extent of clinical manifestation from reactivation HBV can vary from a transient, clinically silent disease to severe or acute liver failure. A chronic infectious state can also be seen following HBV reactivation. Diagnosis of HBV reactivation depends on the HBV disease state before activation. In a patient with resolved infection (negative HBsAg and positive anti-HBs), reactivation is indicated by the decline in anti-HBs and the reappearance of HBsAg. In patients with quiescent HBV with positive HBsAg, reactivation is diagnosed by a rise in the serum HBV DNA (>1 log10 IU/mL) or a rise in the serum ALT levels (>3 times baseline). Reappearance of HBeAg in a patient with previous negative HBeAg also indicates HBV reactivation.

Role of HBV DNA Assays, HBV Genotypes and Liver Biopsy in Chronic Hepatitis B

HBV DNA level plays several important roles in chronic hepatitis B. It is one factor in predicting the progression to cirrhosis, helps to determine the need for treatment in HBeAg negative patients, and also plays a crucial role in estimating the response to treatment.

Up to 8 HBV genotypes, labeled from A to H, have been identified. HBV genotypes are not currently used in contemporary clinical practice.

Resolved Hepatitis B and Immunization Status

As indicated in Table 6, an individual with resolved hepatitis B infection almost always has anti-HBc and anti-HBs. An individual successfully immunized against hepatitis B expresses only anti-HBs. Confusion may occasionally arise in the interpretation of hepatitis B tests in a patient who has recovered from hepatitis B many years ago and who has a low or absent level of measurable anti-HBc.

Hepatitis C

Because hepatitis C infection usually produces no symptoms, or only mild, nonspecific, flu-like symptoms, it is infrequently diagnosed in the acute phase. The virus clears spontaneously in about 15% of infected patients. Although generally helpful for the diagnosis of chronic infection, antibody tests are often not useful for diagnosis of acute hepatitis C virus (HCV) infection because the emergence of the antibody is delayed for several months after infection.

Three tests are commonly used to define hepatitis C status:

  • Anti HCV
  • HCV Genotype

Most commonly, anti HCV is used for screening. However, for diagnosis of suspected infection HCV RNA is performed.

Table 7: Hepatitis C Testing

Anti-HCV EIAPositive indicates infection, past or present
HCV RNA PCRPositive indicates current infection
HCV genotypeGenotypes 1-6. Often required for insurance pre-authorization for hepatitis C treatment

HCV, hepatitis C virus; EIA, enzyme immunoassay; PCR, polymerase chain reaction.

False-positive anti-HCV antibodies are occasionally encountered. Confirmation of chronic hepatitis C infection is obtained by the direct measurement of viral products in serum (HCV RNA). HCV RNA in serum definitively establishes the presence of HCV infection and is recommended in all patients with a positive anti-HCV test. Some clinicians have questioned whether the initial screening test for HCV should be an HCV RNA test or an antibody test. Currently, however, because of cost considerations, the initial test for HCV remains an anti-HCV antibody test.

False-negative anti-HCV tests can occur in two clinical contexts: in a patient with a recent infection, in an immunocompromised individual, or an individual receiving hemodialysis. HCV RNA testing is recommended in patients with negative anti-HCV antibody tests but who have liver disease of unknown etiology and are also immunocompromised. In addition, all potential organ donors should be tested for HCV RNA.

Once the presence of HCV is established, the genotype should be determined. There are 6 major HCV genotypes (1-6). Genotyping continues to gain importance for treatment determinations. This is discussed more fully elsewhere in the Hepatitis C chapter.

Iron and Copper Overload Diseases

Diseases characterized by iron overload and copper overload are discussed in detail in the Disease Management (Inherited Metabolic Liver Diseases: Hemochromatosis, Wilson Disease). A practice guideline has been published.

Iron Tests

Excess iron may accumulate in the liver and other organs for a variety of reasons. Some individuals have a genetic disorder while others may accumulate too much iron for other reasons. Among the genetic iron-overload conditions, the most common in individuals of Northern European ancestry is related to an autosomal recessive disorder, hereditary hemochromatosis. Before ordering tests it is important to be clear about what question is being asked. Most of the time the question is: Does my patient have iron overload?

This question should be entertained in the following situations:

  • Any adult with liver disease, especially men and post-menopausal women
  • Patients with symptoms suggestive of or having a family history of HH

The initial evaluation for iron overload includes measurement of serum ferritin, iron, iron-binding capacity, and transferrin saturation levels. Transferrin saturation less than 45%, in addition to normal serum ferritin level usually rules out iron overload (negative predictive value of 97%), and no further testing is necessary. Transferrin saturation greater than 45% and/or a serum ferritin above normal level warrants further investigation. However, these thresholds are low, and most patients who exceed these limits will not prove to have iron overload as explained below.

Limitations of Serum-Based Tests of Iron Overload

Because both iron and ferritin are stored in liver cells, any condition that results in hepatocyte injury and release of intracellular contents into the blood will falsely raise iron, transferrin saturation, and ferritin levels. Therefore, in acute hepatic injury these tests will falsely suggest iron overload. Acute inflammation outside the liver may also falsely elevate the results of serum-based iron tests. Tests of serum ferritin levels, iron, iron-binding capacity, and percentage saturation determined in the setting of markedly elevated aminotransferase levels (AST and ALT), such as those seen in acute viral hepatitis or massive hepatic necrosis, will be identical to those seen in hemochromatosis. Iron studies cannot be interpreted in the face of major elevations of transaminase levels.

Normal serum iron studies do not preclude future iron overload in the genetically susceptible individual. In a young patient with this condition who has not yet had enough time to accumulate iron (especially the premenopausal woman), screening tests for iron overload may be normal, even though the individual is at risk for the subsequent development of iron overload.

When iron overload is found or suspected, the question may become:

Does my patient have hereditary hemochromatosis?

This question should be entertained in:

  • Any patient with elevated iron/total iron-binding capacity ferritin values
  • Those with a family history of liver disease or of hemochromatosis

It has been known for years that many cases of hemochromatosis are inherited as an autosomal recessive trait. In many cases, a defective gene called the HFE gene is implicated. The presence of this inherited gene results in the production of a protein in which a tyrosine amino acid rather than a cysteine amino acid is present at position 282 of the HFE protein. A second missense gene that results in an aspartic acid (instead of histidine) at position 63 of the same protein may increase iron absorption in some patients. The abnormalities are called C282Y and H63D mutations respectively. Most individuals of Northern European descent with hereditary hemochromatosis usually have two abnormal genes (homozygosity). Most often, two C282Y genes are present, but occasionally a compound heterozygote (C282Y-H63D) will also have excess iron. Homozygosity for H63D does not usually result in excess iron absorption (Table 8).

Table 8: Guidance for the Likelihood of Iron Accumulation with Various HFE Patterns

HFE FindingLikelihood of Iron Overload
Wild type/wild type (no abnormal genes)Nil
Wild type/C282YNil
C282Y/C282Y (C282Y homozygote)High
Wild type/H63DNil
H63D/H63D (H63D homozygote)Low
C282Y/H63D (compound heterozygote)Moderate

Confirming a Diagnosis of Hemochromatosis and the Role of Liver Biopsy

Homozygosity for C282Y and compound heterozygosity for C282Y/H63D are diagnostic of HH and a liver biopsy with hepatic iron index (HII) estimation, which was previously the criteria for diagnosis, is no longer needed to confirm the diagnosis of HH in these patients. In addition, HFE gene mutation testing is indicated in all first-degree relatives of patients with hemochromatosis. However, it must be remembered that many individuals have iron overload with normal HFE protein. Pre-menopausal women with C282Y homozygosity most often have no iron accumulation. Finally, there is incomplete penetrance of iron overload in many C282Y homozygotes. In other words, expression of disease may not occur despite having the genetic susceptibility.

HFE gene mutation analysis does not establish either the presence or the degree of liver fibrosis or cirrhosis. Studies have shown that patients with serum ferritin less than 1,000 ng/mL are less likely to have cirrhosis in HH. A liver biopsy is thus indicated in patients with elevated ferritin greater than 1,000 ng/mL or having abnormal liver enzymes. This serves two purposes, determining fibrosis and providing an assessment of iron stores. Because there is an age-dependent increase in hepatic iron in normal individuals, it is necessary to create an index that takes this into account. HII is calculated as follows:

HII = hepatic iron concentration(mcmol/g dryweight) ÷ patient age (years)

HII less than 1.9 is normal; values greater than 1.9 are seen in hemochromatosis. A caveat to this would be in cirrhotic livers, which have the tendency to rapidly accumulate iron in liver disease of other etiologies and cause elevation of HII to a level greater than 1.9. Newer techniques, such as the HIC estimation by proton transverse relaxation time determined by MRI, could be an alternative to liver biopsy, and studies have shown good correlation between the tests. It must be remembered that bone marrow iron stores are not adequate to assess total body iron stores. Cases of hemochromatosis with absent stainable bone marrow iron have been reported.

Copper Tests

Although copper may accumulate to moderate excess in the liver in any chronic cholestatic liver condition, it does not appear to be injurious in these conditions. Wilson disease is the main disease in which pathologic copper deposition results in serious liver injury, cirrhosis, and death. In Wilson disease, copper also accumulates in the basal ganglia of the brain, where it produces a wide gamut of neurologic abnormalities. Patients may present with liver disease, brain disease, or both. This disorder is discussed in more detail in the Disease Management (Inherited Metabolic Liver Diseases: Wilson’s Disease).

Wilson disease is rare. Untreated, it is usually fatal before the patient is aged 40 years. Therefore, it is most appropriate to consider this potential cause in a child or young adult with otherwise unexplained liver disease. However, a diagnosis of Wilson disease should not be excluded based on age alone. Laboratory diagnosis is most often based on the finding of a low ceruloplasmin level. Serum ceruloplasmin level of less than 5 mg/dL strongly suggests Wilson disease while any subnormal level warrants further evaluation. Most acute and chronic liver diseases cause the ceruloplasmin level to elevate. There are a few exceptions to this. A patient with acute fulminant liver failure of any sort may no longer have a liver capable of ceruloplasmin synthesis, so that patient may have a low serum level. Similarly, the patient with terminal end-stage liver disease may have a falling ceruloplasmin level. Finally, a few individuals have congenital hypoceruloplasminemia without copper accumulation and are healthy. At the same time, it must also be remembered that a normal serum ceruloplasmin level does not exclude Wilson disease.

In patients in whom Wilson disease is suspected, in addition to serum ceruloplasmin, 24-hour urinary copper levels and slit lamp examination to look for Kayser-Fleischer (KF) rings should be obtained. A serum ceruloplasmin level less than 20 mg/dL, 24-hour urine copper greater than 40 mcg, and the presence of KF rings confirms the diagnosis of Wilson disease. No further testing such as a liver biopsy is needed in this setting.

Copper is present in the serum in two forms: copper that is bound to ceruloplasmin, and free copper or the non-ceruloplasmin bound copper. The total serum copper level is the sum of the levels of these two forms of copper and is usually low in those with Wilson disease. This is partly explained by the decrease in the ceruloplasmin bound copper level that results from a reduction in the ceruloplasmin level in Wilson disease. However, the serum free copper level is typically elevated to ≤25 mcg/dL in patients with Wilson disease and may be approximated as follows:

Serum free copper level = Total serum copper level (ug/dl)l − (3 x serum ceruloplasmin level (mg/dL))

A practical algorithm on the diagnostic tests for Wilson disease in shown in Table 9.

Table 9: Diagnostic Tests for Wilson Disease11

Level 1 TestsLevel 2 TestsLevel 3 Tests
Low serum ceruloplasmin level (<20 mg/dL)Liver histopathology and stainable copperUltrastructural study of hepatocytes
Kayser-Fleischer ringsLiver copper concentration (>250 µg/g dry weight)Mutational gene analysis for Wilson disease
Raised serum-free copper level (non-ceruloplasmin-bound) (>25 µg/dL)Incorporation of radiocopper into ceruloplasmin
24-hr urinary copper (>100 µg/24 hr)

Autoimmune Liver Diseases

The two most common forms of autoimmune liver disease are autoimmune chronic hepatitis and PBC. Ninety percent of those with each disorder are women. Autoimmune hepatitis (AIH) is characterized by very high serum aminotransferase (ALT and AST) levels, whereas PBC is a cholestatic disorder with predominant elevations of the alkaline phosphatase level. Each is associated with autoantibodies in the serum. The treatment for each is different, so accurate diagnosis is essential. Table 10 contrasts the laboratory findings of these two autoimmune liver disorders.

Table 10: Contrasting Features of Two Autoimmune Liver Diseases

FeatureAutoimmune Chronic HepatitisPrimary Biliary Cirrhosis
AST, ALT7-10 times upper limit of normal (ULN)1-3 times ULN
Alkaline phosphatase1-3 times ULN2-10 times ULN
Anti-smooth muscle antibody positive90% (usually high titer)10%-20% (usually low titer)
Anti-mitochondrial antibody positive10%-20% (usually low titer)90%-100% (usually high titer)
Liver-kidney microsomal antibody positivePositive in some cases in which smooth muscle antibody is negative (rare in North America)Negative

ALT, alanine aminotransaminase; AST, aspartate transaminase.

Interpretation of autoimmune markers in a patient with liver disease is highly context-dependent. Autoantibodies are common in low titer in a number of acute and chronic liver conditions, such as viral hepatitis. Therefore, the finding of autoantibodies in low titer is not sufficient evidence with which to make a diagnosis of autoimmune chronic hepatitis or PBC. At the same time, low titers do not exclude the diagnosis.

Autoimmune Hepatitis

AIH should be rapidly recognized by its propensity to occur in women (90%) and to be associated with high transaminase levels (200 IU/mL or higher). In this disease, elevations of the gamma globulins (especially IgG) are pronounced. A myriad of autoimmune markers may be positive in autoimmune chronic hepatitis, but only a few serological markers have to be assessed: anti-smooth muscle antibody, antinuclear antibody, liver-kidney microsomal antibody and anti-liver cytosol type 1 antibody. High titers of antibodies are suggestive of but on their own they do not establish a diagnosis of AIH.

The diagnosis of AIH can be difficult at times and various factors need to be taken into account. Clinical criteria are usually sufficient to make a diagnosis of or to exclude AIH. Scoring systems have been developed to assist in establishing a diagnosis of AIH. Exclusion of other liver diseases should be undertaken as part of the work up. A liver biopsy at presentation is recommended to establish the diagnosis of AIH and to make treatment decisions.

Primary Biliary Cirrhosis

Primary biliary cholangitis (PBC) is an autoimmune liver disease that involves the intrahepatic small bile ducts. In this condition, serum-based liver tests reveal a predominant elevation of the alkaline phosphatase level. It is associated with the elevation of an autoantibody in high titer known as the anti-mitochondrial antibody (AMA). It has a high sensitivity and a very high specificity. It is reported to be seen in less than 1% of normal people. However AMA has been shown to be present in increased frequency in relatives of patients with PBC. One study showed that the frequency of positive AMA among first-degree relatives of patients with PBC was 13% as compared with 1% in controls. Though positive AMA antibodies may suggest susceptibility to development of PBC, they, on their own even in high titers, do not establish a diagnosis of PBC. Ultrasound or other imaging techniques are necessary in all patients to exclude bile duct obstruction as the cause of cholestasis. Presence of predominant alkaline phosphatase elevation and positive AMA antibody establishes the diagnosis of PBC. Liver biopsy is indicated if the AMA is negative or is in low titers and if associated AIH or NAFLD is suspected. Occasionally, a patient may have features of both autoimmune chronic hepatitis and PBC known as AIH/PBC overlap syndrome.

Non-Alcoholic Fatty Liver Disease

NAFLD is the most common cause of mildly elevated liver enzymes. Please see the chapter on Non-Alcoholic Fatty Liver Disease in Disease Management. NAFLD is defined as the accumulation of fat in the liver in the absence of conditions that cause secondary fat accumulation such as alcoholic hepatitis, medications, metabolic disorders or viral hepatitis. Two types of NAFLD have been described, non-alcoholic fatty liver and non-alcoholic steatohepatitis. The latter has evidence of hepatocellular injury in addition to fat accumulation. Patients with NAFLD are non-alcoholic, usually obese, and have a high BMI.

Liver tests are unreliable guides to the presence or absence of fatty liver disease. When elevated, enzymes show hepatocellular pattern, often with an AST/ALT ratio of less than 1. However, they can be normal. Therefore, liver tests are not useful to make a diagnosis of NAFLD. A history of significant alcohol intake can reliably distinguish between alcoholic fatty liver disease and NAFLD. Imaging is performed to demonstrate the presence of fat in the liver. Liver biopsy is indicated if competing etiologies cannot be ruled out, if a co-existing liver disease is suspected, and for patients at risk of developing cirrhosis.

A scoring system has been developed to identify patients with liver fibrosis in NAFLD. This scoring system comprises of six variables namely: age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio. The system has been shown to distinguish patients with NAFLD and with or without advanced fibrosis accurately. Certain biomarkers such as serum CK18 have been shown to predict the presence of hepatocellular injury in NAFLD, but further studies are needed to establish their utility.

Noninvasive Tests for Liver Fibrosis and Cirrhosis

Liver biopsy is the gold standard for determining the stage of liver fibrosis and cirrhosis. However, it is invasive and can cause significant complications and sampling error, the latter due to the non-uniform distribution of fibrosis in the liver. In recent years, a number of noninvasive tests have been developed and are being studied to assess liver fibrosis and cirrhosis. Among these, the most widely studied and promising noninvasive tests are hepatic elastography and the serologic markers of fibrosis. Serologic markers can be further divided into direct markers and indirect markers. Direct serologic markers are those that are associated with the deposition of matrix and include procollagen type III amino-terminal peptide (P3NP), type I and IV collagens and matrix metalloproteinases among others. P3NP is found to be the most promising among these markers. It is elevated in both acute and chronic liver disease. Studies have also shown that the serum levels of P3NP reflect the degree of fibrosis in chronic liver disease. However, the test is currently not readily available in commercial laboratories and has not yet been validated for use.

Hepatic elastography is a noninvasive imaging technique used to determine the degree of fibrosis of the liver. Most frequently, ultrasound-based elastrography is performed. It uses a device called Fibroscan which transmits low-frequency waves into the liver. The waves’ velocities are then recorded and are shown to correlate with the liver stiffness. It can be performed either by an ultrasound or MRI. Studies have shown that ultrasound elastography has excellent diagnostic accuracy to diagnosing cirrhosis but does not perform as well to assess fibrosis. Magnetic resonance elastography has been shown to be the most promising noninvasive test as studies have shown that it can assess both the degree of fibrosis in addition to diagnosing cirrhosis. However, its use may be limited by its high cost. In addition, these tests are not yet FDA-approved to be used in the United States. Therefore, liver biopsy still remains the most important tool in the assessment of liver fibrosis and cirrhosis, though the need for it may be significantly decreased in the future with the further development and validation of noninvasive tests.

Elevated Liver Enzymes in Children: Symptoms, Diagnosis and Treatment

How Are Elevated Liver Enzymes Diagnosed in a Child?

High liver enzymes may show up on a routine blood test during a child’s yearly checkup. A health care provider may also test for elevated liver enzymes when a child is feeling unwell. This is especially true if a child has abdominal pain, vomiting, diarrhea, or jaundice (yellowish color of the eyes or skin).

What Does a Diagnosis of Elevated Liver Enzymes in a Child Mean?

Liver enzyme levels alone are not enough to tell exactly what is wrong with the liver. This is why it is very important to follow up with a child’s health care provider. If high levels of liver enzymes are found, more tests can help determine the cause.

The reason for elevated liver enzymes sometimes appears to be fairly clear. For example, your child’s health care provider may decide that the elevated liver enzymes are probably due to a virus. In these cases, your child’s health care provider may want to wait and see what happens. As the illness clears up, elevated liver enzymes should return to normal levels. 

Seeing a Specialist

It is rare for a primary health care provider to not be able to explain why liver enzymes are elevated. However, occasionally your child’s health care provider may suspect something more serious. If so, a doctor who specializes in liver diseases (hepatologist) can help.

Specialized care starts with taking a careful history, and then a physical exam to check for outward signs of liver disease. Such signs may include jaundice or an enlarged liver or spleen.  

If liver trouble seems likely, additional tests may include:

  • Other liver tests to compare levels of ALT and AST with alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), bilirubin, albumin, prothrombin time etc.
  • Specialized lab tests to look for specific diseases, such as celiac disease, autoimmune hepatitis, alpha-1 antitrypsin deficiency, Wilson disease, and viruses such as hepatitis B, hepatitis C, EBV or cytomegalovirus (CMV)
  • Imaging tests, such as ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI), to examine the liver, blood vessels, and nearby organs – especially the spleen.
  • Liver biopsy (under anesthesia) to remove a tiny piece of the liver that will be examined under a microscope

Once complete, all of these tests help paint a more complete picture of a child’s liver. This can point the way to the correct diagnosis.


Alcohol-related liver disease – Diagnosis

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.

This is because the condition causes few obvious symptoms in the early stages.

If a doctor suspects ARLD, they’ll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption.

It’s important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need.

Blood tests

Blood tests used to assess the liver are known as liver function tests.

But liver function tests can be normal at many stages of liver disease.

Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver.

A low level of serum albumin suggests your liver is not functioning properly.

A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage.

Lab Tests Online has more information on liver function tests.

Further testing

If your symptoms or liver function test suggest an advanced form of ARLD (either alcoholic hepatitis or cirrhosis), you may need further tests.

These are described below.

Imaging tests

Scans may be needed to produce detailed images of your liver.

This may include:

Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred.

Liver biopsy

During a liver biopsy, a fine needle is inserted into your body (usually between your ribs).

A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope.

The biopsy is usually carried out under local anaesthetic, either as a day case or with an overnight stay in hospital.

Your liver tissue will be examined to determine the degree of scarring in the liver and the cause of the damage.


An endoscope is a long, thin, flexible tube with a light and a video camera at one end. 

During an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach.

Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis.

Page last reviewed: 10 August 2018
Next review due: 10 August 2021

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
  • If you have any symptoms of any liver problems or liver disease
  • Planning for pregnancy 

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.

Understanding results ofLiver Function

SGOTThe normal range for the AST test is 10 to 34 IU/L (international units per liter)
GGTThe normal range for GGT in blood is 0 to 51 international units/liter.
Total ProteinThe total protein is between 6 and 8.3 gm/dL (grams per deciliter)
AlbuminThe typical value for albumin is 3.4 to 5.4 g/dL of blood
BilirubinIn 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’

Liver Panel | Labcorp

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2020 review performed by Hoda Hagrass MD, PhD Medical Director of Clinical Chemistry and Immunology, UAMS and ACH.

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90,000 decryption, the norm, which means an increase in the level of AsAT

June 4, 2020 141229 0
A biochemical blood test for AST is widespread in clinical practice and is used to diagnose a variety of diseases. This study is used by a wide variety of specialists, including cardiologists, therapists and gastroenterologists. The reason for this demand is its informativeness and versatility regarding pathological changes in tissues and organs. The AST test is specific for damage to the heart muscle, hepatitis of all types, malignant lesions of the bone tissue, etc.e. As a rule, it is used in conjunction with blood tests for ALAT *. AlAt is a biochemical blood test that accompanies the diagnosis of liver diseases. It is used as an independent study and in combination with AST.


Tests for AST and ALT are two studies, often prescribed by a doctor in combination. Why is the level of these two enzymes so important to determine simultaneously? For the first time, the idea of ​​the informativeness of their ratio was put forward by the scientist Fernando De Ritis from Italy.He used the method for the differential diagnosis of various types of hepatitis. Since then, his name has become a household name. The Ritis coefficient shows the ratio of the activity of AST and ALT. In healthy people, the coefficient is 0.91-1.75. The indicator is informative only if the values ​​of these enzymes exceed the reference values. If in the double test only the AST values ​​are exceeded, this means that the myocardium is damaged. With damage to the heart muscle, the level of AST increases 8-10 times, ALT – only 1.5-2 times.If the patient has a liver problem, on the contrary, the ALT level increases 8-10 times, and the AST values ​​- only 2-4 times.

What is the enzyme

AST or AST – a protein synthesized inside the cells of the human body. Its highest concentrations are found in the tissues of the myocardium, muscles and liver. To a lesser extent, the enzyme is present in the kidneys, pancreas, cells of the central nervous system and the brain. It is encoded by the genes GOT 1 and GOT 2. In a healthy person, the level of the enzyme is quite low.Its active release into the blood begins with a rupture of the heart muscle, as well as the destruction of the liver as a result of hepatitis, cirrhosis or cancer. The enzyme is important because it contains vitamin B 6, which is involved in amino acid metabolism and, accordingly, insulin synthesis. In analyzes, the indicator is measured in units per liter of blood.

Spectrum of application of the analysis for AST

  • In cardiology as a marker of myocardial infarction. In the heart muscle, the enzyme is more than 10,000 times active than in the blood.With a heart attack, an intense release of the enzyme occurs.
  • For liver pathologies. Diseases such as hepatitis and cirrhosis are certainly accompanied by the destruction of liver tissue and a sharp jump in AST values.
  • For chronic alcoholism.
  • In obstetrics and gynecology. During pregnancy, a woman may experience a slight increase in AST values. This is due to the effects of the growing fetus on the mother’s liver. In the first trimester, its values ​​should not exceed 31 U / L, in the second and third – 30 U / L.
  • In endocrinology for diabetes and / or overweight.

Symptoms for which an AST test is recommended

  • Jaundice of the skin
  • Jaundice of the eye sclera
  • Pain in the right and left hypochondrium
  • Dyspeptic disorders (vomiting, nausea, heartburn)
  • General loss of appetite and appetite and
  • Abnormalities in urine and stool results
  • Pruritus

How to Prepare for Analysis

There are some rules and restrictions to follow to increase the confidence in your analysis.So, on the eve of the study, one should refrain from eating fatty and smoked foods, as well as confectionery. It is best if the test is performed on an empty stomach in the morning. When taking medications, you need to consult with your doctor about their possible cancellation. The fact is that with a biochemical blood test, many medicines can affect the results of the study. When treated with antidepressants, antibiotics, diuretics and other drugs, the test readings may be distorted.In addition, it is forbidden to perform ultrasound, X-ray examination and physiotherapy procedures immediately before a visit to the procedural room.

Explanation of the analysis for AST

Norm in women

The values ​​of the analysis for AST differ depending on age and gender. So in women, the norm of the enzyme in the blood is 31 U / l. The older a person is, the lower his activity in the body. This is due to a slowdown in metabolism in general. A natural physiological condition such as pregnancy also affects enzyme levels.During this period, its small jumps can be observed both in one direction and in the other direction.

Norm in men

The concentration of the enzyme in men begins to exceed its amount in women from 12-17 years of age. Its higher concentrations are due to the large volume of muscle tissue. At puberty, the norm of AST in boys is about 29 U / L. This is about four units higher than that of girls of the same age. In an adult male, the enzyme level can reach 37 U / L.

Deviations from the norms

An excess of AST in the blood can occur for the following reasons:

Rupture of the heart muscle (myocardial infarction)

Malignant liver damage Metastases of malignant tumors in the liver Alcohol abuse Autoimmune muscle tissue diseases Poisoning, including alcohol, drugs and poisonous fungi Injuries, fractures Malignant damage to bone tissue Heat or sunstroke

If high AST values ​​persist for several days, this means that the patient is in serious condition.An increase in the growth of values ​​indicates that the tissues in the focus of pathology have become necrotic and additional rehabilitation measures need to be urgently taken.

A decrease in the AST level is observed at:

  • Manipulation with blood (hemodialysis)
  • Vitamin B deficiency
  • Liver necrosis
  • Pregnancy

Do not forget that only the attending physician can interpret the values. The reason for deviations in the readings of the blood test for AST can be not only diseases, but also other factors, for example, the use of dietary supplements and treatment with medications.Results may be unsatisfactory due to heart, liver, or other organ problems. Additional studies, including a test for bilirubin, total protein, and ALT, will help determine the true cause of the excess enzyme level. The specialist will compare all the data with the results, after which he will draw the appropriate conclusions.

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Biochemical blood test. Decoding of the main indicators

2.Total cholesterol. This figure should normally not exceed 5. 2. High cholesterol in the blood, which was not considered a problem several decades ago, now worries many. Heart attacks and strokes claim lives, and half of them are caused by atherosclerosis of the vessels, which, in turn, is a consequence of high blood cholesterol in men and women. The figure of “total” cholesterol itself is not indicative, so if it is elevated, the doctor will prescribe additional tests that will show cholesterol fractions, that is, the ratio of “bad” (low density lipoprotein) and “good” (high density lipoprotein) cholesterol in blood.

Elevated blood cholesterol contributes to the development of atherosclerotic damage to the walls of blood vessels and is one of the risk factors for the development of severe cardiovascular diseases such as angina pectoris (coronary heart disease) and myocardial infarction, cerebral stroke and intermittent claudication.

Helps reduce cholesterol physical activity, not eating foods containing trans fats, eating fiber in foods allowed for a low-carbohydrate diet, including sea fish at least 2 times a week, quitting smoking and alcohol.

It should be noted the importance of regular medical examinations, because most diseases are much easier to cure at the initial stage, when a person is still practically not worried about anything. Remember: complications caused by high cholesterol are irreversible, and treatment does not eliminate existing problems, but only prevents the development of new ones.

3. Total bilirubin . A biochemical blood test for bilirubin is carried out for: liver diseases, destruction of red blood cells, impaired outflow of bile and diseases of the biliary tract, the appearance of jaundice of the eyes and skin.This indicator gives the doctor an understanding of how a person’s liver works.

Bilirubin is a bile pigment, a substance that is formed during the breakdown of certain substances, including waste hemoglobin. The body reuses iron from hemoglobin, but the protein part of the molecule, after complex biochemical processes, turns into bilirubin.

The indicator is normal – from 5 to 21. If bilirubin is elevated, then you need to see a doctor so that he excludes cholelithiasis, hepatitis, liver infection.Often, elevated bilirubin can indicate hepatitis A (Botkin’s disease, jaundice). The rise of this disease usually occurs in the fall.

4. ALT, ALT, alanine aminotransferase and AST, AST, aspartate aminotransferase. All of this together can be called one term – “transaminases”. Alanine aminotransferase (alt, or ALAT) – marker enzymes for the liver. Aspartate aminotransferase (ast, or AsAT) – marker enzymes for the myocardium. The amount of the enzyme alanine aminotransferase in the blood is measured in units per liter.The doctor looks at the ratio of ALT and AST and draws conclusions.

For diagnostic purposes, not only the fact of changes in blood counts AST and ALT is important, but also the degree of their increase or decrease, as well as the ratio of the number of enzymes to each other. For example:

Myocardial infarction is evidenced by an increase in both indicators (AST and ALT) in the analysis by 1. 5-5 times. If the AST / ALT ratio is between 0.55–0.65, viral hepatitis is suspected.

How to “check” the liver? What tests need to be taken to diagnose liver pathologies

The liver is the largest gland in the human body.It is often compared with a real biochemical laboratory, with a plant for the neutralization of toxic substances, a factory for the production of enzymes or with a depot for storing blood, essential vitamins and minerals. A listing of all the functions and tasks of the liver would take more than one page of small text. Therefore, it is obvious that if such an irreplaceable organ of our body fails, the consequences can be the most sad. In time, laboratory tests will help to recognize the cause of the problem, which we will talk about below.

When might a liver test be required?

It is recommended to undergo examinations of the most important organs and systems of the body for preventive purposes on a regular basis. But there are a number of symptoms that signal that a check is required as soon as possible. So, the liver should be examined immediately if signs of organ dysfunction appear. When should you get your liver checked?

  1. Unpleasant sensations in the area of ​​the lower pair of ribs on the right – one of the initial manifestations of liver problems.Unusual sensations and a feeling of constriction or overcrowding in the liver area can be accompanied by subtle pulling pains, tingling sensations. They usually make themselves felt when laughing, talking loudly or screaming, sneezing, bending to the side, lifting heavy weights, as well as after eating fatty, smoked, fried or spicy foods. At first, a new feeling may not cause pain or perceived discomfort – in this case, they also say: “I found out where the liver is.” This is a reason to be wary, since even mild symptoms can indicate the initial stage of a serious liver disease. Severe abdominal pain , which bothers from time to time, can also be a symptom of liver disease.
  2. The liver is enlarged in size . The change in the size of the main gland is unmistakably fixed by ultrasound, but you can notice the changes yourself. For example, the belly may bulge out – without increasing overall fullness and practically without weight gain. The symptom is especially noticeable in people with a lean physique.
  3. Bad taste in the mouth .Patients with chronic liver problems report persistent dry mouth and bitterness on the tongue, sometimes with a characteristic taste that is defined as “metallic.” At the same time, an astringent feeling is noted in the mouth, taste sensations are reduced. Habitual food can cause rejection, up to nausea and urge to vomit.
  4. Weight loss due to asthenic syndrome . This symptom is largely a consequence of the previous one. Food rejection, loss of taste, nausea lead to a decrease in the diet, which leads to weight loss. At the same time, the patient complains of unreasonable irritability, as well as weakness, drowsiness, fatigue, because the body’s energy needs are not satisfied, and the toxic effects from disturbed nitrogen (protein) metabolism greatly increase – with an increased concentration of ammonia in the blood, secondary (hepatic) hyperammonemia occurs. …
  5. Jaundice – a general complex of symptoms, which is expressed in yellowness of the skin of the mucous membranes and whites of the eyes, as well as in a change in the color of urine and feces, itching of the skin, chills.


The characteristic “hepatic” yellowness is caused by the bile pigment bilirubin, which is formed during the breakdown of red blood cells [1]. This process continuously occurs in human tissues at the cellular level. During normal functioning of the body, bilirubin is excreted and “utilized” by the liver. But the accumulation of icteric pigment in the tissues makes it clear that the liver is not coping with its tasks.

People with chronic gastrointestinal diseases (such as gastroduodenitis, pancreatitis, gallbladder dysfunction, chronic constipation) are also advised to periodically check the liver.

Liver tests are also done during pregnancy (ideally at the planning stage), before surgery and before a course of treatment that involves taking potent drugs.

What can be detected by checking (screening) the liver:

  • the very fact of the disease, its degree, the level of liver dysfunction;
  • the presence and degree of histological (cellular) changes in the structure of the liver tissue, such as fibrosis and cirrhosis of the liver;
  • diagnostics of specific liver diseases – viral and autoimmune hepatitis, fatty hepatosis;
  • Diagnostics and control of the effectiveness of treatment of liver cancer and metastatic organ lesions.

How to check liver health? What tests are taken to check the liver? What techniques are used in this case in modern laboratory practice?

Biochemical blood test in order to assess the state of the liver

Blood biochemistry is a laboratory study, the purpose of which is to assess the functioning of organs and systems of the body based on data on the rate, nature and end products of metabolism – information on the metabolism of proteins, fats and carbohydrates, and also about the needs of the body for vitamins and minerals. Pathological conditions of the liver and pancreas are inevitably reflected in the parameters of the biochemical blood test, showing a discrepancy with the norm – with the so-called reference values.

The amount of information required for making, refuting or clarifying the diagnosis differs depending on the clinical picture formed by the doctor, taking into account the ultrasound data, anamnesis and general examination of the patient. A hepatologist or therapist can prescribe a standard biochemical screening of six parameters or an extended examination, including the determination of up to 15 blood parameters.

In order for a biochemical blood test to give reliable results, it is necessary to properly prepare for it. For accurate information, contact the laboratory staff directly. In some cases, for example, when performing a standard survey, there are no special requirements. But when donating blood for “FibroTest” or alpha-fetoprotein, they are available.

Let’s briefly explain some of the main points:

  1. Why is the analysis for biochemistry taken strictly on an empty stomach . Since the liver is involved in the process of digestion, the nature of the food affects the analysis data, significantly distorting them. To avoid this distortion, the last meal should be no later than eight hours before the blood sample is taken. The same goes for any drink other than water.
  2. Alcohol is prohibited! Even a small dose of alcohol causes a significant load on the liver, changes the properties of the blood, in particular its coagulability. Therefore, the minimum period between drinking alcoholic beverages and taking blood for biochemistry is three days.
  3. Negatively affects the reliability of the results and smoking . Ask your doctor when you can smoke a cigarette before donating blood for examination if you are susceptible to this addiction. For example, you cannot smoke 60 minutes before donating blood for alpha-fetoprotein.
  4. Sport will also wait . When passing some tests, it is recommended to exclude physical activity, especially active sports. Psychoemotional stress, stressful situations should be avoided, and sleep should be observed.
  5. Medication is canceled . Even vitamins can distort the results of biochemistry analysis, therefore, it is not recommended to take any medications at least a week before the crucial moment, since some of them can have a long-term effect on blood composition. But if you cannot refuse to take medications due to clinical indications, the doctor should be informed about the medications taken.

In addition, women are advised to have a pregnancy test before taking biochemistry for liver screening.

The procedure does not require any effort from the patient and does not cause pain.

What values ​​does a biochemical test for liver blood tests show and what does the result indicate? (See Table 1.)

Table 1. Reference values ​​and interpretation of indicators of biochemical liver screening [2] .


  • Cardiac surgery, myocardial infarction, acute rheumatic heart disease, severe angina pectoris.
  • Pulmonary artery thrombosis.
  • Extensive muscle injury.
  • Cholestatic syndrome.
  • Hepatitis: toxic (alcoholic, medicinal) or acute viral.
  • Acute pancreatitis.
  • Primary and metastatic liver cancer


Norm for adults

This can be evidenced by deviation

Higher sharp norms


Men ≥2 months. – 24 μmol / L

Women ≥2 months. – <19 μmol / L

Pregnant women – <19 μmol / L


  • hemolytic (suprahepatic),
  • parenchymal (hepatic),
  • cholestatic (subhepatic).

Functional hyperbilirubinemic syndromes

(direct or conjugated, associated)

5 μmol / L

49 0 902 medication).

  • Jaundice: mechanical and in pregnant women.
  • Biliary tract disorders: cholecystitis and cholangitis.
  • Biliary cirrhosis, oncopathology.
  • Functional hyperbilirubinemic syndromes
  • AlAt, or ALT
    (alanine amino transferase)

    Up to 31 U / L (men) women)

    • Heart failure, myocarditis or extensive myocardial infarction.
    • Major trauma.
    • Hepatitis: toxic (alcoholic, medicinal) or acute viral.
    • Jaundice: cholestatic or mechanical.
    • Fatty hepatosis.
    • Acute pancreatitis.
    • Cirrhosis, primary and metastatic liver cancer
    • Vitamin B deficiency 6 .
    • Extensive necrosis, cirrhosis of the liver

    AsAt, or AST
    (aspartate aminotransferase)

    Up to 40 U / L (men), up to 32 U / L (

    • Vitamin B deficiency 6 .
    • Extensive necrosis, liver rupture

    (Gamma glutamyltranspeptidase)

    Up to 60 U / ml (men), up to 40 U / ml (902,669 908)

  • Cholestatic syndrome: intrahepatic and extrahepatic.
  • Acute and chronic hepatitis: toxic (alcoholic, medicinal), viral, as a result of exposure to radiation.
  • Pancreatitis: acute and chronic.
  • Nephritis: glomerulonephritis and pyelonephritis.
  • Oncopathology: pancreas, prostate, hepatomas
  • Alkaline phosphatase


    13-14 years old / 116-468 E

    15–17 years old – 82–331 U / L,

    ≥18 years old – 55–149 U / L.


    13–14 years old – 57–254 U / L,

    15–17 years old – 50–117 U / L,

    ≥18 years old – 35–104 U / L.

    Pregnant women (> 20 weeks)

    – 30–240 U / L

    • An excess of thyroid hormones – hyperparathyroidism.
    • Calcium and phosphorus deficiency.
    • Bone pathologies and fractures.
    • Cholestatic syndrome: intrahepatic and extrahepatic.
    • Toxic hepatitis: alcoholic and medication.
    • Necrosis, cirrhosis, liver cancer
    • Deficiency of zinc, magnesium, vitamins C and B 12 .
    • Anemia of the blood.
    • Metal poisoning.
    • Thyroid hormone deficiency

    An extended biochemical study to assess liver function may also include indicators of total protein and protein fractions, cholinesterase, lipase, lactate dehydrogenase-1 (LDH), glucose, urea, prothrombin, total cholesterol.It rarely takes more than one to two working days to obtain biochemical analysis data. It should be remembered that the interpretation of the screening results and the diagnosis is the exclusive prerogative of the doctor. For example, an excess of the normal value of alkaline phosphatase by three times may indicate alcoholic or viral hepatitis, five times – about fatty degeneration of the liver, and 20 times – about medicinal hepatitis or biliary cirrhosis.

    The hepatologist collects “puzzles” from the data of blood and urine tests, ultrasound results, general examination, patient’s history into a general clinical picture, which can be called cholestatic, mesenchymal-inflammatory, cytolytic syndrome, portal hypertension syndrome or hepatocellular insufficiency.

    Tests for assessing the degree of fibrosis (cirrhosis) of the liver

    Fibrosis is a liver disease in which special liver cells (hepatocytes) are destroyed and their places are taken by fibrocytes – cells of connective tissue. Infectious diseases of the liver – hepatitis – often become the cause of fibrosis. Also, often fibrosis is a consequence of damage to the liver tissue by toxic substances, potent medications and alcohol.

    There are four stages of fibrosis, which in the international METAVIR system are designated by indices from F1 to F4, where F1 is the mildest stage, and F4 is already cirrhosis.The F0 index means that the liver has no signs of fibrotic changes.

    The disease is diagnosed by ultrasound examination of the hypochondrium. However, such a study of the liver is not exhaustive: sometimes fibrosis gives an ultrasound picture similar to cancer or hepatosis.


    Fatty hepatosis is the process of replacing the liver tissue with fatty tissue. It is often a consequence of obesity and diabetes.

    To clarify the picture of the disease, biopsy was previously widely used – taking a sample of liver tissue for analysis. But modern laboratory diagnostic methods, in particular “FibroTest”, “FibroMax” and “SteatoScrin”, developed by the French company BioPredictive and received state registration in Russia, allowed back in 2007 to get away from this traumatic method [3].

    Current methods for determining the state of the liver structure consist in deep mathematical processing of various indicators (absolute values ​​and relationships among themselves) of the patient’s blood, including α2-metaglobulin, apolipoprotein, bilirubin, glucose, AST, ALT, triglycerides and others.


    A significant increase in the ratio of AsAt and AlAt (de Ritis coefficient) may mean pronounced fibrotic changes – liver cirrhosis [4]. But by itself, this indicator may indicate cardiovascular diseases, therefore, it is considered only in combination with other factors.

    In addition, the patient’s height and weight, gender and age are taken into account. The FibroTest result is a numerical value from 0 to 1 with a step of 0.01.

    “FibroTest” not only shows whether there are pathological processes in the liver, but also in quantitative terms illustrates the degree of their development. This is a highly sensitive test, so it allows you to diagnose pathological changes in the liver at the earliest stages, while they are still reversible and have not led to the destruction of the organ.

    There are contraindications and restrictions for passing this test:

    1. Acute hemolysis.
    2. Acute hepatitis.
    3. Extrahepatic cholestasis.
    4. Gilbert’s syndrome (hereditary disease characterized by a moderate increase in free bilirubin in the blood).
    5. Liver transplant.

    Blood collection and preparation for FibroTest is the same as for biochemical analyzes. In this sense, FibroTest is an extended biochemistry.

    Another approach to detecting fibrotic changes is elastography . It was found that structural disorders of the hepatic tissue (fibrosis, cirrhosis, oncology) cause an increase in the elasticity index of the organ.With the help of an ultrasonic device (“FibroScan”), an accurate measurement of the elasticity of the liver in Pascals is carried out, after which the total value is displayed, which is used for diagnostics. This method is also an effective test for liver cancer. The decoding of the indicators of both methods is shown in the table.

    Table 2 . Comparative interpretation of the results of the study “FibroTest” and elastography.



    Elastography (cf.kPa)

    F0 F2 4.38
    F1 0.28–0.47 5.84
    F2 0.48–009 7.45
    F3 0.59–0.74 8.7
    F4 0.75–1 27.6

    Further sharp increase in elasticity liver (75 kPa) shows the presence of hepatocellular carcinoma (HCC, liver cancer).

    Laboratory diagnostics of viral and autoimmune liver diseases

    If the liver disease is infectious (viral) or autoimmune in nature, this is manifested by the presence of antibodies in the blood.

    For your information!

    Autoimmune diseases are diseases that develop as a result of antibodies infecting healthy cells of various organs.

    At some point, the immune system begins to accept its own cells as disease-causing agents and begins to fight against them.The causes and nature of the phenomenon have not yet been fully studied.

    But before diagnosing autoimmune hepatitis, you should definitely rule out the infectious nature of the disease. To confirm or exclude the presence of this factor immediately, tests are prescribed for antibodies of the IgG and IgM classes to viral hepatitis A, B, C, D, G, E, as well as the qualitative and quantitative determination of RNA and DNA of viruses by PCR – polymerase chain reaction.

    Markers of autoimmune hepatitis (AIH) are the following specific antibodies [5]:

    1. AMA-M2 .The main marker of autoimmune hepatitis 1 type, primary biliary cirrhosis. The main indicator of the presence of this disease.
    2. LKM-1 . A marker of type 2 autoimmune hepatitis. To make a diagnosis, the presence of LKM-1 in the blood is not enough, since this antibody can be found in viral hepatitis C.
    3. LC-1 . Also a marker of type 2 hepatitis. The presence of both LC-1 and LKM-1 in the blood allows us to make an accurate conclusion that the disease is of an autoimmune nature, a viral origin is excluded.
    4. SLA / LP . Marker of type 3 autoimmune hepatitis. It is sufficient for diagnosis, since it does not occur in other diseases.

    What is special about each type of autoimmune hepatitis?

    1. Type 1 . It can manifest itself at any age, but the peak incidence occurs in adolescence and pre-retirement age. If untreated, it gives complications in the form of cirrhosis in more than 40% of patients [6]. The main method of therapy is taking immunosuppressants (drugs that suppress immunity).
    2. Type 2 . A rarer type of AIH, but more dangerous: it most often affects children under 14 years of age [7], is resistant to immunotherapy. Discontinuation of drugs often causes relapses of the disease. Often combined with other diseases – insulin-dependent diabetes, ulcerative colitis.
    3. Type 3 . It is observed in patients with type I hepatitis. There is still no consensus on whether this form of the disease is a separate type.

    Studies for viral or autoimmune liver damage, as a rule, are carried out according to the results of biochemical screening – an assessment of liver function, if the latter has revealed serious deviations from the norm.

    Analysis for alpha-fetoprotein – a marker of primary liver cancer

    Alpha-fetoprotein (AFP) is a specific protein that is well known to gynecologists. The protein is synthesized during the development of the embryo, therefore, the assessment of the level of AFP in the blood of a pregnant woman is used to monitor the condition of the fetus.

    In adult men and non-pregnant women, normal AFP levels are very low. Its increase may be associated with the development of liver cancer (or testicular cancer in men) and the presence of metastases in the liver – the fact is that with the development of a tumor process, cancer cells begin to synthesize AFP.Therefore, it is a highly informative tumor marker for liver cancer.

    This is important!

    A slight increase in the level of tumor markers in the blood can also occur in benign tumors and inflammatory diseases.

    The sensitivity of this test is very high: a gradual increase in AFP concentration is observed in 95% of patients with primary liver cancer [8]. The method can be used for early diagnosis, since often an increase in the level of AFP in the blood can be one to three months ahead of the onset of clinical symptoms.Also, using this test, it is possible to assess the success of therapy for liver cancer.

    Some preparation is required before the test, which will be communicated by the lab staff. For example, 10 days before the examination, it is necessary to stop taking any medications (in agreement with the attending physician). The intake of biotin and monoclonal antibodies can affect the results, therefore, if they cannot be canceled, you need to warn the attending physician and the medical professional who takes the biomaterial about this fact.

    To get accurate results, blood for ACE is donated on an empty stomach (8-14 hours after the last meal). For dinner on the eve of the examination, you must not eat fatty foods. An hour before the analysis, you should not smoke, drink tea and coffee, it is recommended to exclude physical and emotional stress. Blood sampling is not done after physiotherapy, massage, ultrasound and X-ray examinations.

    So, in no case should you neglect symptoms that indicate possible liver problems.Modern medicine provides all the possibilities for quick and accurate diagnosis of functional disorders of this organ. You should be attentive to your health and consult a doctor at the first sign of illness, or better – for preventive purposes.

    All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.

    ALT (ALAT) blood test for phosphorus to pass for a fee in Voronezh


    Alanine aminotransferase (ALT) is an intracellular enzyme involved in amino acid metabolism.Its highest concentration is present in the liver and kidneys, in a smaller amount it is also found in skeletal muscles and heart muscle, its lowest concentration is in the lungs, spleen and pancreas. Normally, the level of this enzyme in the blood is insignificant, and its intensive production begins with the destruction of the cells of the above organs.

    Indications for tests for ALT

    High ALAT levels can signal a number of serious diseases such as liver necrosis, cancer or cirrhosis.But with severe liver damage, the number of cells that produce ALT decreases, respectively, the analysis may show a decrease in the concentration of this enzyme with the same cirrhosis or necrosis of the liver.

    Abnormalities in ALT levels can be triggered by vitamin B6 deficiency or indicate chronic alcoholism, liver intoxication with drugs, viral hepatitis and pancreatitis. ALT activity also fluctuates in heart failure, myocardial infarction, and myocarditis.A high level of this enzyme is observed in acute lymphoblastic leukemia, infectious monoucleosis, obesity, and muscle injuries.

    The alanine aminotransferase assay is indicated for the diagnosis of a wide range of liver lesions and for evaluating the effectiveness of treatment. An indication for testing is given when symptoms such as increased fatigue and weakness, loss of appetite, nausea and vomiting, pain in the abdominal region are observed. It is also necessary to be tested for yellowing of the skin and eye whites, darkening of urine and light-colored stools, such symptoms most likely indicate hepatitis A.

    Low ALT levels are normal during pregnancy, in other cases it can be a manifestation of an infection of the genitourinary system, tumors, pyridoxal phosphate deficiency due to excessive alcohol consumption and malnutrition.

    A number of medications may affect ALT readings. An increase in the level of alanine aminotransferase is caused by the use of oral contraceptives, nicotinic acid, anabolic steroids, methotrexate, clarithromycin, cyclosporine, etc.Drugs such as aspirin, interferon and phenothiazines reduce the concentration of ALT.

    The doctor should be responsible for decoding the test results. To obtain a complete clinical picture, if liver disease is suspected, along with an ALT test, a blood test for AST (aspartate aminotransferase) is prescribed. These two analyzes are the most important in diagnosing pathologies of this organ and identifying their causes.

    To get reliable results, you need to prepare for blood donation for ALT.First of all, you need to limit food intake 8, and preferably 12 hours before visiting the clinic. For half an hour, you need to avoid physical and emotional stress, as well as exclude smoking. If you are taking any medications, contraceptives or steroids, please consult your doctor first.

    You can get tested for AST, ALT and a wide range of other tests in one of the clinics of the Children’s Doctor network in Voronezh.

    90,000 to take blood tests for examining the liver and gallbladder

    Biochemical parameters to assess the state of the liver, gallbladder and bile ducts

    ALT (alanine aminotransferase) and AST (aspartate aminotransferase)

    These are enzymes found in the liver and other organs and tissues of our body.Normally, both enzymes are present in the blood serum, and their activity does not exceed 40 U / L. An increase in ALT and AST in a blood test occurs with any damage to liver cells, hepatocytes caused by diseases and liver damage.

    Whey proteins

    Albumin, fibrinogen, haptoglobin and beta-depths are synthesized by liver cells, hepatocytes, gamma globulins are produced by lymphocytes and plasma cells of the liver. In most liver diseases, the level of albumin and other liver proteins in the blood serum decreases, while the level of globulins, on the contrary, increases.Albumin levels below normal and globulin levels above normal may indicate chronic and progressive liver disease.


    This is a comprehensive study of homeostasis, which allows you to assess the state of coagulation and other blood systems. Almost all blood clotting factors are synthesized in the liver, in addition, it removes these factors from the bloodstream and participates in the dissolution of blood clots. If the parameters included in the coagulogram deviate from the norm, it can be assumed that the synthesis of coagulation factors in the liver is impaired due to damage and death of hepatocytes in infectious liver diseases, cirrhosis, chronic hepatitis, acute liver failure and other diseases.

    GGT (gamma glutamyltransferase)

    This is an enzyme found in the liver, pancreas and kidneys. It increases with diseases of the liver and pancreas, significantly increases with alcoholic liver damage;

    ALP (alkaline phosphatase)

    It is an enzyme produced in the liver and biliary tract, bone and intestines. An increase in this enzyme is possible in case of impaired patency of the intra- and extrahepatic biliary tract and infiltrative liver diseases, in which substances, for example fats, or foreign cells, for example, metastases, penetrate the liver cells.


    This is a bile pigment, which is one of the most important constituents of bile and is formed as a result of the breakdown of hemoglobin and other blood components; the resulting bilirubin is removed from the bloodstream by the liver and excreted in the bile. An increase in the level of bilirubin in the blood signals a decrease in the ability of the liver to remove bilirubin from the body and a violation of the outflow of bile, occurs in acute and chronic liver diseases, chronic cholecystitis, blockage of the bile ducts and other diseases.


    This is an organic compound that is found in the cell membranes of all animal organisms and is used for the synthesis of bile acids, hormones and vitamin D. Approximately 50% of cholesterol is produced by the liver, some comes from food, the rest is produced by other cells in our body. A decrease in blood cholesterol levels can signal a decrease in the liver’s ability to produce it, and is found in cirrhosis of the liver, malignant liver diseases and other diseases.An increase in cholesterol levels can accompany a violation of the outflow of bile through the intra- and extrahepatic biliary tract.

    These indicators play an important role in the diagnosis of diseases of the liver and gallbladder, in determining the causes and severity of liver dysfunction. In addition to them, others may be needed to diagnose diseases of the liver, gallbladder and bile ducts, so it is better to take biochemical parameters after consulting a gastroenterologist.

    Biochemical blood test – to take in Ryazan at a bargain price – ELAMED Medical Center

    Biochemical blood test is a laboratory diagnostic method that allows you to evaluate the work of internal organs (liver, kidneys, pancreas, gallbladder, etc.), get information about metabolism (metabolism of lipids, proteins, carbohydrates), find out the need for trace elements.

    The Elamed Medical Center in Ryazan has its own expert laboratory. High-class foreign equipment from Germany and the USA allows making detailed analyzes with high accuracy.

    What are the indications for the appointment of a biochemical blood test?

    A biochemical general blood test is important for the diagnosis of almost all diseases, therefore, it is prescribed in the first place.

    What indicators are included in the standard complete blood count?

    We note right away that in this article we will not indicate the limits of the analysis norm due to the fact that different automatic analyzers perform research in different units of measurement

    Glucose (in blood)

    The main test in the diagnosis of diabetes mellitus. This analysis is very important in the selection of therapy and in assessing the effectiveness of diabetes treatment. A decrease in glucose levels is observed in some endocrine diseases and liver dysfunctions.

    Total bilirubin

    Yellow blood pigment, which is formed as a result of the breakdown of hemoglobin, myoglobin and cytochromes. The main reasons for an increase in the amount of total bilirubin in the blood: damage to liver cells (hepatitis, cirrhosis), increased breakdown of erythrocytes (hemolytic anemia), impaired outflow of bile (for example, cholelithiasis).

    Direct bilirubin (conjugated bilirubin, bound)

    Fraction of total blood bilirubin.Direct bilirubin increases with jaundice, which develops due to a violation of the outflow of bile from the liver.

    Indirect bilirubin (unconjugated bilirubin, free)

    Difference between indicators of total and direct bilirubin. This indicator rises with an increase in the breakdown of erythrocytes – with hemolytic anemia, malaria, massive hemorrhages in the tissue, etc.

    AsAT (AST, aspartate aminotransferase)

    One of the main enzymes synthesized in the liver.Normally, the content of this enzyme in blood serum is low, since most of it is found in hepatocytes (liver cells). An increase is observed in diseases of the liver and heart, as well as with prolonged use of aspirin and hormonal contraceptives.

    ALAT (ALT, alanine aminotransferase)

    An enzyme synthesized in the liver. Most of it is found and works in liver cells, so the normal concentration of ALT in the blood is low. An increase is observed with mass death of liver cells (for example, with hepatitis, cirrhosis), severe heart failure and blood diseases.

    Gamma-GT (gamma glutamyl transferase)

    An enzyme found primarily in the cells of the liver and pancreas. An increase in its amount in the blood is observed with diseases of these organs, as well as with prolonged intake of alcohol.

    Phosphatase alkaline

    An enzyme widely distributed in human tissues. The hepatic and bone forms of alkaline phosphatase, the activity of which is determined in the blood serum, are of the greatest clinical importance.

    Cholesterol (total cholesterol)

    The main blood lipid that enters the body with food, and is also synthesized by liver cells.

    Low density lipoprotein (LDL)

    One of the most atherogenic, “harmful” lipid fractions. LDL is very rich in cholesterol and, transporting it to vascular cells, are retained in them, forming atherosclerotic plaques.


    Neutral fats in blood plasma are an important indicator of lipid metabolism.

    Total protein

    An indicator that reflects the total amount of proteins in the blood. Its decrease is observed in some diseases of the liver and kidneys, accompanied by increased excretion of protein in the urine. Increase – with blood diseases and infectious and inflammatory processes.


    The most important protein in the blood, accounting for about half of all serum proteins. A decrease in the content of albumin can also be a manifestation of some diseases of the kidneys, liver, intestines.An increase in albumin is usually associated with dehydration.

    Potassium (K +)

    Electrolyte mainly contained within cells. An increase in the level of potassium in the blood is most often observed in acute and chronic renal failure, a sharp decrease in the amount of urine excreted or its complete absence, most often associated with severe kidney disease.

    Sodium (Na +)

    Electrolyte contained mainly in the extracellular fluid, and to a lesser extent – inside the cells.He is responsible for the work of nervous and muscle tissue, digestive enzymes, blood pressure, water metabolism.

    Chlorine (Cl-)

    One of the main electrolytes found in the blood in an ionized state and plays an important role in maintaining water-electrolyte and acid-base balance in the body.


    A substance that plays an important role in the energy metabolism of muscle and other tissues. Creatinine is completely excreted by the kidneys, therefore, the determination of its concentration in the blood is of the greatest clinical importance for the diagnosis of kidney disease.


    Substance that is the end product of protein metabolism in the body. Urea is excreted by the kidneys, therefore, the determination of its concentration in the blood gives an idea of ​​the functional abilities of the kidneys and is most widely used for the diagnosis of renal pathology.

    Uric acid

    One of the end products of protein metabolism in the body. Uric acid is completely eliminated by the kidneys. An increase in the concentration of uric acid occurs in kidney stones, other kidney diseases that occur with renal failure.

    C-reactive protein (CRP)

    A sensitive blood element that reacts faster than others to tissue damage. The presence of reactive protein in blood serum is a sign of an inflammatory process, trauma, penetration of foreign microorganisms into the body – bacteria, parasites, fungi. The more acute the inflammatory process, the more active the disease, the higher the C-reactive protein in the blood serum.

    Iron (serum iron)

    A vital trace element that is part of hemoglobin, is involved in the transport and storage of oxygen and plays an important role in the processes of hematopoiesis.

    Exam Preparation:

    One day before taking blood for biochemistry, it is necessary to exclude the intake of alcohol, for 1 hour – smoking. It is advisable to take blood on an empty stomach in the morning. At least 12 hours should elapse between the last meal and blood collection. Juice, tea, coffee, chewing gum are not allowed. You can drink water. It is necessary to exclude increased psycho-emotional and physical stress.

    Liver test with up to 50% discount

    Analysis Information

    Comprehensive analysis for the liver, which includes tests that assess the general functional state of the liver: ALT, AST; protein metabolism function: total protein, albumin, urea; synthesis of bilirubin and bile production: bilirubin and its fractions; secretion of bile: GGTP, alkaline phosphatase.

    The complex is recommended at any age with suspicion of liver damage and inflammation, before and against the background of taking hepatotoxic drugs, to control the treatment of liver diseases, cholelithiasis. Also, the complex is suitable for the initial assessment of the state of the liver against the background of diseases of other organs, for example, kidneys, stomach, intestines, diabetes mellitus, rheumatological diseases, parasitic infections.

    Material for research
    – Blood serum

    Composition and Results


    Analysis will be ready in
    within 2 days, excluding the day of collection.The term can be extended by 1 day if necessary.
    You will receive the results by email. mail immediately when ready.

    Deadline: 2 days, excluding Saturday and Sunday (except for the day of taking biomaterial)

    Preparation for analysis

    In advance

    Do not take a blood test immediately after radiography, fluorography, ultrasound, physiotherapy.

    The day before

    24 hours before blood collection:

    • Limit fatty and fried foods, do not drink alcohol.
    • Avoid strenuous physical activity.

    From 8 to 14 hours before donating blood, do not eat, drink only clean non-carbonated water.

    On the day of donation

    Before taking blood

    • No smoking for 60 minutes,
    • Be quiet for 15-30 minutes.

    Liver function, complex of analyzes (liver function tests)

    Comprehensive analysis for the liver, which includes tests that assess the general functional state of the liver: ALT, AST; protein metabolism function: total protein, albumin, urea; synthesis of bilirubin and bile production: bilirubin and its fractions; secretion of bile: GGTP, alkaline phosphatase.

    Many types of metabolism take place in liver cells.Protein metabolism involves enzymes of liver cells (hepatocytes) called transaminases (ALT and AST). An increase in transaminases in the blood can be observed during cytolysis (destruction) of hepatocytes. An increase in ALT more often indicates liver damage, while an increase in AST can also be observed with muscle damage, myocardial infarction, and erythrocyte hemolysis. In acute viral hepatitis, the levels of enzymes exceed the upper limit of the norm by 5-10 times, and in chronic hepatitis by 1.5-2 times, increasing about the same.With alcoholic hepatitis, cirrhosis, liver metastases, there is a predominant increase in AST.

    The enzymes alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGTP) help evaluate the biliary function of the liver and biliary tract. In the case of their simultaneous increase, first of all, obstruction (blockage) of the biliary tract is excluded, for example, with gallstone disease. High levels of GGTP are characteristic of cirrhosis and liver metastases. A moderate increase in GGTP (2-5 times) is observed in viral hepatitis.Unlike GGTP, ALP is also increased in diseases of the bones and intestines.

    For hepatic jaundice and obstruction of the biliary tract, an increase in total bilirubin is also typical, more due to the direct fraction. Violation of bilirubin synthesis occurs in hereditary Gilbert’s syndrome, when there is not enough enzyme that neutralizes indirect bilirubin.

    Many drugs are hepatotoxic, causing temporary damage to liver cells.