Types of liver function tests

Types of liver function tests

Types of liver function
tests

Liver function tests, also referred to as
“LFTs” are blood tests that assess the state of the
liver and the biliary system. Liver function tests are among the
most commonly used tests in medicine. LFTs are divided into true
tests of liver function, such as serum albumin, bilirubin, and
prothrombin time, and tests that are indicators of liver injury
or biliary tract disease.

The liver is a storehouse for many enzymes and
injury or disease affecting the liver causes release of these
enzymes into the bloodstream. Enzyme tests that may indicate
liver damage include the aspartate aminotransferase (AST),
and alanine aminotransferase (ALT). Other
frequently tested liver enzymes that indicate biliary tract
obstruction, whether in the liver or in bile channels outside the
liver, are alkaline phosphatase (ALP) and
gamma-glutamyltranspeptidase (GGT). These
enzymes are also produced in other organs; therefore, enzyme
measurements are not specific for liver disease alone. In
addition to LFTs obtained on routine chemistry tests, the
physician may order more specific tests such as viral serologic
tests or autoimmune tests, that can determine the specific
etiology of a liver disease.

Instant Feedback:

Liver enzyme tests are true tests of liver function.

Normal values for liver function tests are:

• AST (Aspartate aminotransferase): 5 – 40
  IU/L
• ALT (Alanine aminotransferase): 5 – 35
  IU/L
• ALP (Alkaline phosphatase): 30 – 85 ImU/ml
• GGT (Gamma-glutamyltranspeptidase): 5 – 27
  U/L
• Total serum protein: 6 – 8 g/dl *
• Albumin: 3. 2 – 4.5.g/dl
• Total serum bilirubin: 0.1 – 1.0 mg/dl
• Indirect bilirubin: 0.2 – 0.8mg/dl
• Direct bilirubin: 0.1 – 0.3mg/dl
• Urine bilirubin: negative
• Total bilirubin in newborns: 1 – 12 mg/dl

(Note: These values may vary with the
laboratory performing them. Check with your agency’s Laboratory
Manual for normal values and for any test preparation
requirements.)

*Note also that the term
“serum” refers to the blood plasma that remains after the blood sample has clotted and been removed.

Liver Function Test- Significance, Procedure and Results

Liver functions test(LFT) are a set of tests for checking the amount of proteins, enzymes and bilirubin present in the blood. These tests help diagnose liver infection, liver disease or damage. Elevated or lower levels of one or more of these substances can be a sign of a liver problem. The substances tested are:

Gamma Glutamyltransferase or GGT: An enzyme found in the bloodstream.

Alkaline phosphatase or ALP: An enzyme present in bone and liver.

Aspartate Transaminase or AST: An enzyme present in liver and muscles.

Alanine transaminase or ALT: An enzyme present in the liver.

Lactate dehydrogenase: Another enzyme made by the liver, found in nearly all cells of our body. 

Albumin and total protein: Albumin is a protein vital for the body to fight off infections and to perform several bodily functions. A total protein test checks the total amount of albumin and different proteins found in the blood. 

Bilirubin: It is a substance formed as a result of the breakdown of erythrocytes(red blood cells). 

Prothrombin Time(PT): The Prothrombin time test measures the time taken for the blood to clot.

Why Are Liver Function Tests Done? 

Liver function tests help in the diagnosis and treatment of:

• Diagnose liver infections, such as hepatitis. 
• Monitor the side effects of certain medications that affect the liver
• Check the severity of a disease such as cirrhosis
• Check whether the treatment of liver disease is working or not

Why Do I Need Liver Function Tests?

You may need to take liver function tests, if you’re experiencing liver disease symptoms, such as:

• Jaundice
• Fatigue
• Nausea and vomiting
• Dark coloured urine and light coloured stool
• Abdominal pain
• Diarrhoea
• Itching
• Abdominal swelling
• Loss of appetite

If you have certain risk factors, you may also need to take liver function tests. You can be at increased risk for liver disease if you:

• Assume that you’re exposed to hepatitis virus
• Have a chronic condition called alcohol use disorder( a condition in which a person is addicted to alcohol)
• Take certain medications that may affect the liver and cause liver damage
• Have a family medical history of any liver condition.

What to Expect During Liver Function Test?

Blood sample required for the test is typically drawn from a vein in your arm. You may experience bruising or soreness at the puncture site. A healthcare professional will draw a small amount of blood by inserting a small needle into a vein in your arm. Your blood will be collected in a small tube, which is attached to the needle. You may experience a little sting and discomfort when the needle is inserted and taken out, which is short-term. A bandage will be placed over the site of blood draw. For analysis, your blood sample collected will be sent to the laboratory. The blood draw lasts only for a few minutes. 

What Do the Results Mean? 

These are the normal ranges of proteins and enzymes for adult men. The ranges can be slightly different for women and children.

ALT Test Results: ALT is released into your bloodstream when your liver is not functioning correctly or is damaged. As a result, the level of ALT will increase. A higher than normal ALT may indicate liver damage. For males, if the ALT level is more than 33 IU/L, and in females, if the ALT is above 25 IU/L, then do further testing and evaluation to identify the disease. 

AST Test Results: The enzyme is released into your blood when your liver is damaged. Elevated AST level can be a sign of a problem either with your liver or muscles.

ALP Test Results: High ALP levels can be a sign of bone disease, blockage of bile ducts or liver inflammation. Children and adolescents have high levels of this enzyme since their bones are growing. Also, the level of this enzyme gradually increases during pregnancy. 

Albumin Test Results: If your Albumin test results come back to be lower than normal, then it can be a sign that your liver isn’t functioning properly. Kidney disease, poor nutrition, kidney inflammation and infection can cause the albumin level to drop. 

Bilirubin test results: Normally, the liver processes this enzyme. If the liver is not functioning proper, then the liver fails to process this enzyme properly, which results in elevated bilirubin levels in the blood. If your LFT test results show a high level of bilirubin, then it means that your liver isn’t functioning properly.

Lactate dehydrogenase(LD) test results: Elevated LD can be a sign of liver damage, but many other disorders also cause this enzyme to be elevated. 

Prothrombin Time: Increased prothrombin time can be a sign of liver damage, coagulation factor deficiencies and in Vitamin K deficiency, but it can also be elevated, if a person is taking blood-thinning medications.  

The test results alone won’t help your doctor in the diagnosis of the condition, but it helps determine the next steps. If your test results point to a problem with the functioning of your liver, then your doctor may review your past medical history and the medications that you take to discover the cause. 

He/she may test you for liver infections or disease that may affect your liver. Your doctor may order imaging tests like CT scan or ultrasound. The doctor may also suggest a liver biopsy to evaluate the liver for a fatty liver condition, fibrosis or other conditions that affect the liver. 

Frequently Asked Questions

What does elevated Gamma Glutamyltransferase mean?

Elevated Gamma Glutamyl Transferase levels can be a sign of bile duct or liver damage. Higher than normal GGT levels are also common in those who take medications that metabolises in the liver and also in those who consume alcohol.  

Can I have abnormal Liver function test results and not have liver disease?

Yes. One or more than one liver function test results will be abnormal if you have temporary conditions such as muscle trauma, burns, shock, severe infections, haemolysis, pregnancy, dehydration or pancreatitis. 

Why is family medical history important?

Sometimes, certain liver conditions such as Wilson’s disease( a condition that causes accumulation of copper in organs) and haemochromatosis( a condition that causes a buildup of iron in the body) can be inherited. Timely diagnosis of these conditions, helps in timely treatment of health conditions.

What are other tests done in follow up to abnormal LFT?

Based on the liver function test results and other factors like family history, signs and symptoms, your doctor may suspect the cause of liver disease and then order for follow up tests. If your doctor assumes that you have a viral infection, then he/she may order a hepatitis A, B or C test. If it’s hepatitis, you’ll be asked to take an ethanol test, and If it’s Wilson’s disease, then you’ll be asked to take Ceruloplasmin test. 

What are the preparations required before a liver function test?

Certain food and medications may affect your liver function test results. And hence, your doctor may ask you not to take certain food and medications prior to the blood draw.

A Mechanistic Assessment of the Discordance between Normal Serum Alanine Aminotransferase Levels and Altered Liver Histology in Chronic Hepatitis B

Abstract

To understand the mechanisms underlying the discordance between normal serum alanine aminotransferase (ALT) levels and significant alterations in liver histology of chronic hepatitis B virus (HBV) infection with persistent normal ALT (PNALT) or minimally elevated ALT. A total of 300 treatment-naive chronic HBV-infected patients with PNALT (ALT ≤ upper limit of normal [ULN, 40 U/ml]) or minimally elevated ALT (1-2×ULN) were retrospectively enrolled. All patients underwent liver biopsy and histological changes were analyzed along with biochemical and HBV markers. Among 300 participants, 177 were HBeAg-positive and 123 HBeAg-negative. Significant histologic abnormalities were found in 42.9% (76/177) and 52.8% (65/123) of HBeAg-positive and HBeAg-negative patients, respectively. Significant fibrosis, which is a marker of prior injury, was more frequently detected than significant necroinflammation (suggesting active liver injury) in both HBeAg-positive and -negative groups, suggesting that liver injury occurred intermittently in our cohort. No significant differences were noticed in the percentage of patients with severe fibrosis between HBeAg-positive and negative phases or between ages 30 and 40 and over 40, suggesting that the fibrosis was possibly carried over from an early phase. Finally, lowering ALT ULN (30 U/L for men, 19 U/L for women) alone was not adequate to increase the sensitivity of ALT detection of liver injury. However, the study was limited to a small sample size of 13 HBeAg-positive patients with ALT in the revised normal range. We detected significant liver pathology in almost 50% of chronic HBV infected patients with PNALT (ALT ≤ 40 U/ml) or minimally elevated ALT. We postulated that small-scale intermittent liver injury was possibly responsible for the discordance between normal serum ALT and significant liver changes in our cohort.

Citation: Gong X, Yang J, Tang J, Gu C, Huang L, Zheng Y, et al. (2015) A Mechanistic Assessment of the Discordance between Normal Serum Alanine Aminotransferase Levels and Altered Liver Histology in Chronic Hepatitis B. PLoS ONE 10(7):
e0134532.

https://doi.org/10.1371/journal.pone.0134532

Editor: Antonio Bertoletti, Singapore Institute for Clinical Sciences, SINGAPORE

Received: April 29, 2015; Accepted: July 9, 2015; Published: July 31, 2015

Copyright: © 2015 Gong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Data Availability: All relevant data are within the paper.

Funding: This work was supported by grants from Xiamen Science and Technology program (No.3502Z20134022), Youth Foundation of Health Department of Fujian Province (No. 2013-2-96), Medical Innovation Project of Fujian Province (No. 2014-CXB-45), and Shenzhen Scientific. Research Program of the People’s Republic of China (No.JCYJ20130402151227167). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Chronic hepatitis B virus (HBV) infection represents a significant public health burden. Approximately 400 million people are affected by chronic HBV infection worldwide. Chronic HBV-related liver injury constitutes a major risk factor for development of end-stage liver disease including cirrhosis and hepatocellular carcinoma in HBV endemic region[1–3].

Liver injury and associated liver pathology in chronic hepatitis B can be mitigated by current antiviral treatment, as evidenced by normalization of elevated serum alanine aminotransferase (ALT) and improvement of liver histology in treated patients. Since the main objective of current antiviral therapy was to block the progression of chronic liver injury, a significant portion of chronic HBV-infected patients who had persistent normal ALT (PNALT) or elevated ALT less than 2 times of the upper limit of normal (ULN), were not suitable for antiviral treatment[4–6], because ALT levels in those patients suggest absence or minimal liver injury[7,8]. However, increasing evidence points to a disturbing picture in which about 20–50% of patients with normal ALT exhibited significant necroinflammation and fibrosis in liver biopsy, and such patients face a high risk of cirrhosis and other end stage clinical complications without treating liver injury[9–12]. Importantly, the fundamental mechanisms associated with normal or nearly normal ALT despite liver injury, remain unknown. Furthermore, the chronic HBV-infected patients with normal or minimal elevated ALT consist of two subpopulations based on HBV replication status: HBeAg-positive patients with high serum HBV DNA level and the HBeAg-negative group with lower HBV DNA level. Significant changes in liver histology were also observed in patients with normal ALT, but with HBeAg-negative and lower HBV DNA level. It is important to determine if the main altered liver histology is carried over from the previous liver injury or occurred in the later phase of HBV infection. Different scenarios require different treatment strategies.

As stated above, the traditional ALT ULN value (40 U/L) to determine the eligibility of patients for treatment initiation may miss those patients who are experiencing significant changes in hepatic histopathology without detectable elevation in ALT. Investigators have suggested lowering the ULN of ALT[13–15] to address current ALT deficiency in reflecting liver injury. A study of 6835 Italian healthy subjects by Prati et al, suggested that the ULN of ALT should be adjusted to 30 U/L for men and 19 U/L for women[16]. However, some studies doubted were if a lower ULN of ALT improved the effectiveness of management of chronic HBV-infected patients [12,17].

In this study, we present our analysis of liver histology in a large cohort of Chinese chronic hepatitis B (CHB) patients with PNALT or minimally elevated ALT. Our analysis was focused on investigating mechanisms underlying normal or nearly normal ALT under conditions of liver injury and fibrosis. We determined if the primary liver histopathology in later HBeAg-positive phase or HBeAg-negative patients resulted from early liver injury or recent episodes, and evaluated the sensitivity of lowering ALT ULN in detecting liver injury. We propose that a repeated, intermittent small-scale liver injury along with chronic infection in our cohort contributed to normal or nearly normal ALT levels. However, such small-scale liver injury despite intermittent features can cause severe consequences in the long term.

Patients and Methods

Patients

We evaluated all CHB patients who were admitted to the Hepatology Unit of Xiamen Hospital of Traditional Chinese Medicine from January 1, 2010 to October 1, 2014. A total of 300 treatment-naive CHB patients who underwent percutaneous liver biopsy as part of clinical evaluation, were included in this study. The inclusion criteria were as follows: All patients were hepatitis B surface antigen (HBsAg)-positive for at least 12 months, with HBV DNA levels greater 500 IU/ml, and PNALT or minimally elevated ALT. PNALT was defined by continually normal ALT levels tested at least on 3 occasions over a 1- year period prior to liver biopsy, whereas minimally elevated ALT levels were defined as ALT levels ranging between ULN and 2×ULN[18]. Patients with the following conditions were excluded from the study: (1) evidence of concomitant etiologies including chronic hepatitis C or D coinfection or superinfection, autoimmune hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, Wilson’s disease, and drug-induced liver injury; or (2) HIV coinfection or evidence of immune suppression.

The study protocol was approved by the ethics committee of Xiamen Hospital of Traditional Chinese Medicine. Written informed consent was obtained from all subjects.

Liver biopsy and histology

All patients underwent percutaneous liver biopsy guided by ultrasonography. Liver biopsies were obtained using 16G biopsy needles. A qualified biopsy specimen was either a minimum 1.5 cm long or displayed 6 or more portal tracts. Two serial sections were stained with hematoxylin-eosin-safran and Masson’s trichrome, respectively. Scheuer’s scoring system was used to semi-quantify the histologic necroinflammation from G0 to G4 and fibrosis stages from S0 to S4 by the same pathologist, who was blinded to the biochemical and virologic results of the patients. Significant histological abnormality was defined as necroinflammation grade ≥ G2 and/or fibrosis stage ≥ F2.

Laboratory tests

Serum samples were collected within 3 days prior to liver biopsy. Serum biochemistry tests including albumin (ALB), globulin (GLB), ALT, aspartate aminotransferase (AST), a-fetoprotein (AFP), prothrombin time (PT) and complete blood cell counts were determined by commercial kits. The ULN of ALT and AST were set at 40 IU/L for both male and female. HBV serological markers were detected using electrochemiluminescence immunoassay (Roche Diagnostics, Germany). HBV DNA was quantitatively determined by a HBV DNA qPCR kit with a low detection limit of 500 IU/mL (Amplly Bioteh.Co, Ltd, China).

Statistical analysis

All statistical analyses were performed using SPSS software package version 22.0. Continuous variables were presented as mean ± standard deviation (or median and range) and Mann-Whitney U test was used for comparison of non-parametric continuous variables. Categorical variables were expressed as frequency and percentage and analyzed by Chi-square test. Multivariate logistic regression was used to determine the independent predictors of significant histologic abnormalities. A two-sided P value < 0.05 was considered as statistically significant.

Results

The baseline characteristics of our cohort are listed in Table 1. Of the 300 enrolled patients, 177 (59. 0%) were HBeAg-positive and the remaining 123 (41.0%) were HBeAg-negative. In HBeAg-positive group, 50 (28.2%) and 127 (71.8%) patients were categorized as PNALT and minimally elevated ALT, respectively, while 51 (41.5%) and 72 (58.5%) were categorized into PNALT and ALT 1–2×ULN, respectively, in the HBeAg-negative group.

The percentages of liver necroinflammation and fibrosis in all groups are shown in Fig 1. Nearly 42.9% (76/177) in HBeAg-positive group and 52.8% (65/123) in HBeAg-negative group exhibited significant changes in liver pathology. Among the 177 HBeAg-positive patients, 14.0% (7/50) in patients with PNALT and 29.1% (37/127) in ALT 1–2×ULN subgroup showed significant necroinflammation, while 24.0% (12/50) and 48.0% (61/127) showed significant fibrosis, respectively. The fibrosis detected was more frequent than necroinflammation in the HBeAg-positive group (P = 0.001). The percentage of patients who carried both ≥ G2 and S2 changes was smaller than the patients with ≥ S2 change alone (Fig 2), suggesting that the resolved liver injury (see as fibrosis) was more frequent than the active liver injury at biopsy. Frequencies of significant necroinflammation and fibrosis in patients with ALT 1–2×ULN were much higher than in patients with normal ALT (P < 0.05).

Fig 1. Distribution of significant necroinflammation and fibrosis among 300 chronic hepatitis B patients.

(A) Significant necroinflammation (≥ G2) was found in 24.9%, 14.0% and 29.1% in all patients, PNALT (ALT ≤ 40 U/ml) and ALT 1–2×ULN subgroups in HBeAg-positive patients, and 17.9%, 11.8% and 22.2% in all patients, PNALT and ALT 1–2×ULN subgroups in HBeAg-negative patients, respectively. (B) Significant fibrosis (≥ S2) was found in 41.2%, 24.0% and 48.0% in all, PNALT and ALT 1–2×ULN subgroups in HBeAg-positive patients, and 52.9%, 49.0% and 55.6% in all, PNALT and ALT 1–2×ULN subgroups in HBeAg-negative patients, respectively. Frequencies of significant necroinflammation and fibrosis in HBeAg-positive patients with ALT 1–2×ULN were much higher than in patients with normal ALT (P < 0.05).

https://doi.org/10.1371/journal.pone.0134532.g001

Fig 2. Incidence of necroinflammation ≥ 2, or fibrosis ≥ 2 or a combination of both ≥ G2 and S2.

Significant levels of necroinflammation (≥ G2), fibrosis (≥ S2), and necroinflammation (≥ G2) and fibrosis (≥ S2) occurred in 24.9%, 41.2%, and 23.2%, respectively, in HBeAg-positive patients. Significant levels of necroinflammation (≥ G2), fibrosis (≥ S2), and necroinflammation (≥ G2) and fibrosis (≥ S2) were seen in 17.9%, 52.9%, and 17.9%, respectively, of the HBeAg-negative patients.

https://doi.org/10.1371/journal.pone.0134532.g002

In HBeAg-negative group, necroinflammation was detected in 11.8% (6/51) in patients with normal ALT, 22.2% (16/72) in subgroup with ALT 1–2×ULN, while significant fibrosis was found in 49.0%(25/51) and 55.6% (40/72) of these patients, respectively. No significant difference in liver pathology was found between subgroups of HBeAg-negative patients. However, fibrosis was more frequently detected than necroinflammation in HBeAg-negative group. The percentage of patients who carried both ≥ G2 and S2 changes was smaller than those with ≥ S2 change alone (Fig 2), suggesting that the liver injury reflected by the necroinflamationary scores, was intermittent during the course of chronic HBV infection in the majority of our cohort. There was no significant difference in the percentages of patients with significant fibrosis in both HBeAg positive and negative groups, suggesting that fibrosis was possibly carried over from early phase.

The normal clinical values of ULN of ALT suggested by Prati et al (i.e. 30 U/L for men and 19 U/L for women) were analyzed in patients with normal ALT. There were 13 HBeAg-positive patients with ALT levels within the normal range. No patient had significant necroinflammation or fibrosis. However, 32.4% (12/37) of patients with ALT levels greater than the normal range showed significant fibrosis (P < 0.05). No significant difference in both necroinflammation and fibrosis was found between the two subgroups of HBeAg-negative patients (Table 2). Our results suggest limited utility of lowering the ULN of ALT.

Patients were further stratified by age. The distribution of significant hepatic histopathology among different age subgroups is shown in Fig 3. Significant differences in necroinflammation (P < 0.001) and fibrosis (P < 0.001) were found among subgroups of HBeAg-positive patients. Further, significant histologic abnormalities were much higher in HBeAg-positive patients aged above 30 years than those ≤ 30 years of age (P < 0.001). However, no significant difference was found between the age group of 31–40 and those over 40. There was no significant difference in necroinflammation and fibrosis among different age subgroups of HBeAg-negative patients.

Fig 3. Distribution of significant hepatic histopathology among different age subgroups.

(A) Significant necroinflammation (≥ G2) occurred in 3.1% of subgroups of patients ≤ 30 years, 40.5% in 31–40 years and 61.5% in > 40 years in HBeAg-positive patients, respectively; and in 18.2% of subgroups of patients ≤ 30 years, 9.1% in 31–40 years and 23.5% in > 40 years in HBeAg-negative patients, respectively. (B) Significant fibrosis (≥ S2) was found in 16.7%, 69.1% and 71.8% of HBeAg-positive patients in the age subgroups of ≤ 30, 31–40 and >40, respectively, of and in 45.5%, 50.0% and 55.9% of HBeAg-negative patients in the age categories of ≤ 30, 31–40 and > 40, respectively. Significant differences in necroinflammation (P < 0.001) and fibrosis (P < 0.001) occurred among subgroups of HBeAg-positive patients. HBeAg-positive patients over 30 years showed much higher percentages of significant histologic abnormalities than those ≤ 30 years of age (P < 0.001).

https://doi.org/10.1371/journal.pone.0134532.g003

Clinical parameters that were analyzed by the multivariate regression correlated positively with liver histological abnormalities (Table 3). Age (P < 0.001), AST (P < 0.001) and AFP (P = 0.002) were independently associated with significant necroinflammation and age (P < 0.001), AST (P < 0.001), HBV-DNA (P = 0.007) and PLT (P = 0.002) were independently associated with significant fibrosis in HBeAg-positive patients. In HBeAg-negative group, AST (P = 0.016) and ALB (P = 0.006) independently correlated with significant necroinflammation, and male gender (P = 0.021), PT (P = 0.001), ALB (P = 0.002) and GLB (P = 0.017) independently correlated with significant fibrosis.

Discussion

The focus of this study was to unravel the mechanisms underlying the normal or nearly normal ALT values despite histologic evidence suggesting liver injury in a significant number of chronic HBV-infected patients. We analyzed the liver pathology in 300 treatment-naive patients who were PNALT or ALT 1–2×ULN along with HBV and biochemical markers. We found that 24.0% vs 48.0% of HBeAg-positive, and 49.0% vs 55.6% of HBeAg negative patients with PNALT and minimally elevated ALT, respectively, carried significant changes in liver pathology. The percentages of abnormal liver histology in our cohort were within the ranges reported by other studies. For instance, a study from Hong Kong showed that 22.5% HBeAg-positive patients with normal ALT had significant histologic abnormalities[19]. Another study found that 37% of patients with PNALT had significant fibrosis or inflammation [11]. In a Chinese cohort, significant fibrosis occurred in about 70% of patients (HBeAg positive or negative) who had minimally elevated ALT [12], suggesting that the previous notion of chronic HBV-infected patients with PNALT had “healthy” livers may be inaccurate.

Importantly, fibrosis was significant and more frequent than necroinflammation in both groups at the time of liver biopsy. Our understanding of this finding is that liver injury reflected by necroinflammation in our cohort, or broadly in chronic HBV-infected patients with normal ALT or nearly normal ALT was intermittent, but not constant, implying that the earlier injury was resolved or repaired before advent of new injury. We anticipate similar or higher frequencies of necroinflammation compared with fibrosis, which follows liver injury if there was constant necroinflammation. However, the fibrosis was much higher, suggesting that persistent or news liver injury in the same patients with significant fibrosis (a marker of previous liver injury) was less frequent. Our findings are consistent with another Chinese cohort study [12]. Thus the liver injury may occur at a tempo of damage and repair, then the same process may repeat after an interval. This intermittent injury is different from persistent liver injury that presumably generates persistently elevated ALT as often seen in a portion of chronic HBV-infected patients, and is underappreciated in the field. In addition to the intermittent features, the scale of liver injury is also a factor determining if ALT levels would be sufficiently elevated for detection. Serum ALT level is largely determined by the amount of enzyme released from the damaged hepatocytes. Thus the degree of liver damage is directly related to the ALT levels in the serum. Therefore, patients with minimally elevated ALT showed significantly higher percentages of prominent liver injury than PNALT (29.1% vs 14.0% in the HBeAg-positive patients and 22.2% vs 11.8% in the HBeAg-negative patients). Our observation was similar to the previous reports [19,20]. We can infer that the scale of liver injury in our cohort was smaller than in patients with ALT > 2×ULN. We further suggest that the scale of liver injury in patients with PNALT was smaller than in patients with 1–2× ULN ALT. Thus, we propose that a minor liver injury that occurred intermittently in our cohort was largely responsible for PNALT or nearly normal ALT. However, such intermittent, small-scale liver injury carries significantly higher risk for progression to end-stage liver disease over years or decades. Accumulation of such small-scale liver injuries is often ignored by physicians and patients, raising the question of clinical management of the condition. It does not seem to be sustainable with current no treatment approach to those patients. In this study no significant difference in significant necroinflammation and fibrosis was found between the age group of 31–40 and over 40 years in HBeAg- positive patients, or among different age subgroups of HBeAg-negative patients. Since more than 90% of chronic HBV infections in China result from perinatal infection, the patient’s age can be used to infer approximately, the years of chronic HBV infection. Our results show no further significantly increased percentage of necroinflammation or fibrosis even when patients are extending course of chronic HBV infection, or arrive in later HBeAg phase or HBeAg-negative phase. It appears that the percentage of detectable necroinflammation remains relative steady in both early and later phases of chronic HBV infection, suggesting that intermittent liver injury occurs at a similar pace regardless of the phases of chronic infection in our cohort. However, the significant fibrosis found in the later HBeAg phase or in the HBeAg-negative phase was possibly carried over from earlier phase though the severity of fibrosis may be increased in the later phase. Our results imply that fibrosis starts in the HBeAg phase in nearly 50% patients with PNALT or 1–2×ALT. To mitigate the severity of fibrosis in those patients, therapeutic interventions including antiviral treatment in the earlier phase of HBV infection should be a priority, for better outcome.

We also investigated the clinical utility of lower ALT normal ranges suggested by Prati. In HBeAg-positive group, a higher frequency of significant fibrosis was found in patients with ALT levels exceeding Prati’s normal ranges than those within the ranges. However, we only had 13 patients with ALT within the revised normal range. A large cohort is needed to validate this finding. Furthermore, there was no difference in liver pathology in HBeAg-negative group when re-categorizing 51 patients with the revised ranges. One study suggests reducing the threshold ULN of ALT in HBeAg-positive patients with normal ALT [21]. Our results suggest a limited value of lowering the ALT ULN to 30 U/L for men, or 19 U/L for women. The real challenge is not only the need to lower the ULN, but also to increase the frequency of ALT testing since the liver injury most probably occurred intermittently in our cohort. Infrequent testing of ALT may not be the best strategy to detect transiently elevated ALT.

One of the implications of our results is that HBeAg-positive patients with high HBV DNA and normal ALT levels frequently manifested significant histological abnormalities in our cohort and other studies [12] although they were initially considered immunotolerant. In fact, the characterization of patients with immune tolerance has already been questioned. Increasing evidence suggests that clonal hepatocyte repopulation, an indirect measure of targeted destruction of HBV-infected hepatocytes, occurs in patients in the immunotolerant phase [22–24]. Further investigations are needed in such patients. The second implication is that patients with minimally elevated ALT showed significantly higher percentages of prominent liver injury and fibrosis than PNALT. They should be very carefully managed, especially those with a family history of HCC or cirrhosis. Liver biopsy or non-invasive fibrosis assessment are strongly recommended. Thus, those patients should be the next group of eligible patients for antiviral treatment, if the current recommendation is expanded. The third implication is related to more than half of HBeAg-positive patients who were over 30 years old with PNLALT or minimally elevated ALT who manifested a higher frequency of significant fibrosis. A liver biopsy should be considered for such patients.

There are several limitations in this study. This is a retrospective cross-sectional study without any follow-up data after biopsy. In addition, patients’ HBV genotypes were not investigated since HBV genotyping is not routinely performed in clinical practice.

In summary, we detected significantly altered liver histology in almost 50% of chronic hepatitis B patients with persistent normal or minimally elevated ALT. We further elucidated the mechanisms of discordance between the appearance of normal or nearly normal ALT in the serum and the significant changes in liver pathology. We propose that small-scale liver injury, occurring intermittently is possibly responsible for such discordance. The fibrosis detected in the late HBeAg or in HBeAg-negative phase was possibly carried over from an early HBeAg phase, supporting therapeutic intervention in early HBeAg positive patients, as a priority. Lowering ALT ULN and increasing the frequency of ALT testing are recommended for management of patients with transiently elevated ALT.

Author Contributions

Conceived and designed the experiments: XQG QGM. Performed the experiments: XQG MW. Analyzed the data: XQG. Contributed reagents/materials/analysis tools: JEY JMT CG LJH YZ HQL MW CCW YC MYZ ZJY. Wrote the paper: XQG.

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   Andreani T, Serfaty L, Mohand D, Dernaika S, Wendum D, Chazouilleres O, Poupon R. Chronic hepatitis B virus carriers in the immunotolerant phase of infection: histologic findings and outcome. Clinical Gastroenterology & Hepatology2007; 5: 636–641.
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   Papatheodoridis GV, Manolakopoulos S, Liaw YF, Lok A. Follow-up and indications for liver biopsy in HBeAg-negative chronic hepatitis B virus infection with persistently normal ALT: a systematic review. J Hepatol2012; 57: 196–202. pmid:22450396
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   Chen EQ, Huang FJ, He LL, Bai L, Wang LC, Zhou TY et al. Histological changes in chinese chronic hepatitis B patients with ALT lower than two times upper limits of normal. Digestive Diseases & Sciences2010; 55: 432–437.
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    Gui HL, Wang H, Yang YH, Wu YW, Zhou HJ, Guo SM et al. Significant histopathology in Chinese chronic hepatitis B patients with persistently high-normal alanine aminotransferase. J Viral Hepat2010; 17 Suppl 1: 44–50. pmid:20586933
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    Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH. The clinical significance of persistently normal ALT in chronic hepatitis B infection. J Hepatol2007; 47: 760–767. pmid:17928090
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    Ijaz B, Ahmad W, Javed FT, Gull S, Hassan S. Revised cutoff values of ALT and HBV DNA level can better differentiate HBeAg (-) chronic inactive HBV patients from active carriers. Virol J2011; 8: 86. pmid:21352567
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    Assy N, Beniashvili Z, Djibre A, Nasser G, Grosovski M, Nseir W. Lower baseline ALT cut-off values and HBV DNA levels better differentiate HBeAg- chronic hepatitis B patients from inactive chronic carriers. World J Gastroenterol2009; 15: 3025–3031. pmid:19554656
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    Seto WK, Lai CL, Ip PP, Fung J, Wong DK, Yuen JC et al.Yuen MF. A large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B. PLOS One2012; 7: e32622. pmid:22389715
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Liver Function Tests (LFTs) | HealthEngine Blog

The liver carries out numerous synthetic, excretion and detoxification functions, however only a minority of these can be measured by levels of products in the blood. Liver function tests (LFTs) measure the concentrations of various different proteins and enzymes in the blood that are either produced by liver cells or released when liver cells are damaged. Liver function tests are very common investigations carried out in people with suspected liver disease. Specific patterns of results can tell your doctor the likely type of liver disease so they can decide whether any further tests are required. Liver function tests can also help tell how severely the liver is damaged and help monitor your response to drugs and other treatments.

The procedure

The term “liver function tests” is actually a misnomer as several of the tests do not measure total liver function at all. Levels of enzymes known as aminotransferases and alkaline phosphatase are used to detect damage to liver cells and obstruction by bile (a substance produced by liver cells to help digest fats) respectively. Thus, liver tests can be divided into measures of liver function, cell injury and biliary obstruction. No single test is able to provide an overall measure of liver function. Instead the group of values measured is interpreted collectively to determine the likelihood of liver disease, possible causes and the severity of disease. Laboratory tests of liver function can also be used to monitor the progress of disease and the response to treatments. LFTs are performed after a simple blood test. The requirements for preparation differ between laboratories. Some require the patient to have fasted overnight but often no specific preparations are required. Collection of samples for LFTs follows a simple, safe and quick procedure. After checking your name and identification, a physician or trained phlebotomist (person who takes blood samples) will place a tourniquet (a tight strap) around your arm to help them identify a suitable vein, usually in front of your elbow. You may have to pump your hand a number of times to increase the blood flow to this area. After disinfecting the site with an alcohol wipe, they will insert a needle into the vein to withdraw blood. Sometimes a special butterfly apparatus is used, especially if multiple blood samples are to be collected at once. Once blood has been drawn into the required number of tubes, the needle and tourniquet will be removed. Pressure is then applied to the area to stop bleeding. Usually the whole procedure is completed in a short space of time with minimal pain or discomfort for the patient. Blood tubes are sent to the appropriate laboratory where the following values are measured. Note that different laboratories may have different cut-off values for each test as they may use different methods.

• Total protein: Total protein should be between 63-80g/L and reflects the synthetic functions of the liver.
• Albumin: This protein is produced only by liver cells, thus its concentration reflects liver synthetic function. Albumin stays in the blood for a long period of time so changes in its level occur only in chronic (long-standing) liver disease. Normal values for albumin are between 35-50 g/L. Other conditions can produce low levels of albumin. Malnutrition may decrease albumin as not enough protein is absorbed into the body. Kidney damage can result in loss of albumin into the urine. Low levels of albumin cause peripheral oedema, which is swelling (typically of the ankles) due to low levels of salts and proteins in the blood.
• Bilirubin: Bilirubin is produced in the breakdown of red blood cells in the body. The liver is usually responsible for the detoxification of bilirubin and its excretion into bile. An increase in the total level of bilirubin produces the symptom known as jaundice. Jaundiced patients have yellow discolouration of their skin and the sclera (whites) of their eyes. Bilirubin is not only increased in liver disease but other conditions that cause an increased breakdown of red blood cells. Normal values for total plasma bilirubin are quoted as less than 20 umol/L.
• Alkaline Phosphatase (ALP): This enzyme is mainly implicated in the diagnosis of biliary obstruction and is normally found in small bile tracts in the liver. There are many different types of this enzyme found in the body in the liver, bone and placenta so elevated levels may be due to a problem outside the liver such as a malignancy (cancer). A normal ALP is between 35-50 g/L.
• Gamma Glutamyl Transpeptidase (GGT): GGT enzyme is found in certain liver cells and bile duct cells. It is also elevated in diseases that decrease or obstruct the flow of bile. Alcohol abuse, warfarin (a blood-thinner) and drugs used for epilepsy can increase GGT levels. GGT has been used to detect chronic alcohol abuse but it is increased in a range of conditions so it is not always correct. GGT should be less than 60U/L in a normal individual.
• Alanine Amino Transferase (ALT) & Aspartate Amino Transferase (AST): Both aminotransferase enzymes are good markers of damage to liver cells that occurs in disorders such as viral hepatitis. AST is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leukocytes (white blood cells) and erythrocytes (red blood cells) whilst ALT is found primarily in the liver. Both enzymes are normally present at low levels in the blood so if liver cells are damaged we would expect some of the enzymes to leak into the blood and increase levels. Virtually any injury to liver cells can raise aminotransferase levels. However, the level of enzymes does not necessarily reflect how severely the liver is damaged. Reference values for ALT are less than 36U/L and for AST are less than 42U/L.
• Ammonia: Ammonia is a by-product of protein metabolism and is produced by bacteria in the large intestine. The liver is responsible for the detoxification of ammonia by converting it to urea (a product found in urine). Sometimes ammonia levels will be measured in the blood to gain further information about liver function and the presence of encephalopathy (a condition where ammonia toxins impair brain function leading to confusion and tremors). However, ammonia blood levels correlate poorly with the above situations so measurements have their limitations. Reference values for ammonia vary widely between laboratories.

Results usually come back from the laboratory promptly (often the same day in hospital). Once the tests come back from the laboratory, any abnormalities and their meanings will be discussed with the patient.

Benefits and Risks

The benefits of liver function tests have already been alluded to. In summary these include:

1. Detection of liver disease
2. Determining the likely type of disease and possible causes
3. Determining the severity or stage of disease
4. Monitoring the response to treatment

Risks of the actual procedure are minimal. Some patients may experience bleeding or haematomas (large bruises) at the venepuncture site (where blood was taken). These are in fact more common in patients with severe liver disease as the liver is unable to produce sufficient clotting factors to stop bleeding. Fainting, dizziness and lightheadedness may also occur.

Limitations

Liver function tests have various limitations and are only a small part of overall patient evaluation. Doctors will interpret the results after considering the patient as a whole, including medical history and signs and symptoms at presentation. Like many other investigations, LFTs do not always produce reliable results. They may be normal in patients with serious liver disease and abnormal in patients without liver disease or other diseases that may interfere with results. Liver tests don’t usually tell the doctor the exact type of disease but give them clues of the likely type of disease so they can do more definitive tests and investigations. For example, results suggesting damage to liver cells may trigger the physician to do tests looking for viruses in the blood that cause hepatitis. In addition, several drugs and other medical conditions can interfere with results so they may not necessarily provide the needed information. Patients may need to have the tests repeated or have different investigations performed.

Results of the Tests

Discussed below are some common patterns of liver function tests and their interpretations that may be discussed with patients. It should be noted that liver function tests can have various different values even in the same condition. They often add only small amounts of information to the final diagnosis. Large elevations of AST or ALT occur in conditions with marked damage to liver cells including viral hepatitis or drug-induced injury. In alcoholic liver disease, AST is often much more elevated than ALT. To contrast, in viral hepatitis or non-alcoholic fatty liver disease ALT is often much higher than AST. Elevated levels of both ALP and GGT are highly suggestive of obstructive disease. However, these values often aren’t able to tell the site of obstruction. ALP can also come from form bone, placenta or prostate cancer. Increased levels of GGT alone, may suggest alcohol or other drug use. Elevated bilirubin without any other abnormal LFTs occurs in conditions that break down red blood cells and in Gilbert’s syndrome. Low levels of albumin occur in chronic conditions such as cirrhosis. Sometimes results may be a mixed picture of liver damage and bile obstruction that can occur in various liver diseases. Liver function tests are only a small part of the diagnostic workup. Following interpretation of results several special tests for other markers and liver imaging may be performed to gain further information about the aetiology of liver disease. If the cause of the symptoms can be determined, treatment may be started. This may include antiviral medications to treat viruses, advice and medications to help reduce alcohol consumption, medications to protect the liver and other drugs to treat some of the symptoms of liver disease.

References

1. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001.
2. Longmore, Wilkinson, Rajagopalan. Oxford Handbook of Clinical Medicine. 6th Edition. Oxford University Press. 2004.

Assessment of liver damage | Hepatitis C Trust

Blood Tests

One way of assessing if liver cells are dying is by testing the level of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood. This is not particularly reliable as in most cases of chronic hepatitis C infection the liver function tests tend to fluctuate. Over the space of just a few days the results can vary from normal to noticeably raised. Raised ALT levels are present in around two-thirds of those infected while the remaining third show no evidence of elevated levels at all. These traditional liver function tests are not very effective indicators of liver damage in chronic hepatitis C. Currently the most reliable way to assess the extent of liver damage is by liver biopsy, however a fibroscan or other non-invasive techniques will be sufficient in most cases.

There are also blood tests that are used in the UK as markers of liver damage, such as Fibrotest, Fibrosure, and Actitest. Another way some doctors determine the presence of cirrhosis is by looking over time at the AST/ALT ratio. It seems that if the AST is consistently higher than ALT or equal to it, this is highly suggestive of cirrhosis.

Biopsy

At present the most accurate way to check the extent of liver damage is by biopsy. However, it is very unlikely to be used as there are other less invasive methods available. A liver biopsy is a test in which small pieces of liver tissue are removed and examined under a microscope. This is done via a long needle inserted usually between the 8th and 9th ribs under the right arm. The tissue will be assessed to see the extent of inflammation and fibrosis (as well as revealing other abnormalities such as damage to bile ducts and the presence of fat).

The degree of inflammation is described in terms of inflammatory grade. Fibrosis is described by fibrotic grade. There are several different scoring and grading systems for liver biopsies and the same numbers are not comparable with another system, all of which can seem confusing. The systems used in the UK are the Ishak HAI, the Metavir and the Knodell systems and the Child-Pugh grading system for cirrhosis. The biopsy will indicate which stage of inflammation and fibrosis (scarring) are present in the liver. Inflammatory grade will range from none to extensive inflammation. Fibrotic grade will range from minimal scarring, scarring that has developed outside of the portal tracts (see below), to fibrosis that has spread or is bridging towards neighbouring portal tracts to cirrhosis.

In hepatitis C active fibrosis begins around the portal areas in the liver. The portal areas are tiny tracts of connective tissue within the liver that contain branches of the portal vein (the main blood supply of the liver linking through the small intestine, stomach, pancreas and spleen).

As the fibrosis worsens, it may extend from one portal zone to the others which adjoin it. This is called bridging fibrosis. Bridging fibrosis is the stage before cirrhosis and ranges from early to marked bridging fibrosis. Cirrhosis is characterized by serious scarring that alters the liver’s structure and its ability to function.

The most extensive study of the rate of progression of fibrosis split people into three groups – ‘rapid fibrosers’, ‘intermediate fibrosers’ and ‘slow fibrosers’. The largest group in the study, just over a third, were intermediate fibrosers who would be expected to develop cirrhosis around thirty years after initial infection with HCV. Just over a third of patients were expected to develop cirrhosis in less than 20 years (rapid fibrosers), while just under a third would progress to cirrhosis in more than 50 years, if ever (slow fibrosers).

Fibroscan

Fibroscan is a non-invasive test using a sound wave to measure the elasticity of the liver and is being used more and more in the UK. As damage to the liver increases, so it becomes stiffer. The stiffer or less elastic the liver, the faster the sound wave travels. The Fibroscan has been shown to be accurate in measuring little or no damage and in measuring cirrhosis. It has been less accurate at distinguishing intermediate degrees of fibrosis.

The machine is calibrated from 0 to 75, with around 4 representing no liver damage, 4-12 increasing amounts of fibrosis, 12-15 the beginnings of cirrhosis.

Its advantage over a biopsy is that it is quick and completely painless. This is because the probe is simply placed against the skin and nothing is inserted into the body. It is also capable of distinguishing differing degrees of cirrhosis as 80% of its entire range measures cirrhosis. For example, a score of 30 indicates existing or imminent decompensation.

Checking the liver on an ultrasound machine. Further interpretation of the results.

The liver is one of the most important organs in the human body, it is located in the abdominal region and is responsible for many functions in the body.

The liver is one of the important organs in the human body, it is located in the abdominal region and is responsible for many functions in the body. That is why it is important to keep it healthy. Doctors said that recently there have been many patients who complain of a malfunction of this important organ.Therefore, it is necessary to do a timely examination in order not to waste time, but to heal the unhealthy organ.

Signs of the need for ultrasound examination of the liver:

1. Abdominal trauma.
2. If deviations were found in the results of biochemical research.
3. Skin color with yellowness, and complaints of pain under the right ribs.
4. Visual enlargement of the liver.
5. In the case of gynecological treatment.
6. With viral hepatitis.

A modern ultrasound machine allows the doctor to see any deviations of this vital organ, with the help of special equipment, the doctor diagnoses and finds a deviation or confirms that the liver’s health is normal.

Liver parameters, what are its norms?

A specialist of our clinic, during diagnostics using an ultrasound machine, closely examines the size, shape and condition of the liver, conducts a study for the presence of various tumors and deviations from the standards.

For a healthy adult, normal liver sizes are:

1. Left lobe from 5 to 7 cm.
2. Right lobe from 10 to 12.5 cm.
3. Outflow of bile 6-7 mm.
4. Portal vein 12-13 mm.
5. The structure of the liver should be uniform, not friable.

If, according to the results of ultrasound, your liver meets the above standards, then you should not worry about your health.

Tueamore – Alloggi per malati oncologici

To put it simply, the normal values ​​of the liver are what are the normal values ​​in children? They are age dependent as their bodies are in the process of growing.Indicators of the liver during ultrasound diagnostics of the abdominal p …

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The liver does not bother. NORMAL LIVER INDICATORS HEALED BY MYSELF!
as their body is in the process of growing. Indicators of the liver during ultrasound diagnostics of the abdominal cavity are data. In connection with what is the change in the normal parameters of the liver?

To estimate the length and other indicators. Normal liver sizes are determined not only with the help of the Normal indicator figure is from 1, it is separate Read also:
Normal indicators of TSH in women by age and deviations.On exhalation, normal measurements are 4-6 mm. Ultrasound of the liver:
decoding of indicators and norm. October 28, 2015. Normal liver sizes in children. Oblique vertical size of the right lobe Indicators of the diameter of the vessels in children are normal. Age. Portal vein. Liver tests are biochemical enzymes, in other words, determined by ultrasound. Liver tests are needed to diagnose pathologies of the liver and other organs. Liver tests in children. Normal indicators of liver function tests in children Data on protein components of the liver.Liver tests, 33 to 1, can be individually compared with the results of ultrasound of the liver and in order to assess the constitution and individual developmental parameters. During the examination of the liver, the thickness is taken into account, what are the normal parameters of the liver. Normal liver size in women by ultrasound. Other indicators of the liver by gender differ little. What are the normal sizes of the liver by ultrasound in adult men and women?

Indicators. The whole organ. Right lobe. Ultrasound of the liver is normal and pathological.Normal indicators of the functional and structural state of the liver are the following Normal liver sizes in adults Meaning indicators of liver health, which help to recreate the real picture of the degree of liver damage. Normal ultrasound results. Normal liver parameters, focusing on indicators of height or cranio-caudal size (the so-called CCR) Normal indicators of liver size in children depend on age, you need to know, 75 units l. GGT increases with inflammatory processes and neoplasms in the liver., what is the norm of ultrasound of the liver, meanwhile, preventive attention to this organ will help Table of contents:
Normal indicators of ultrasound of the liver in adults and children. Characteristics, you need to know what are the normal parameters of the liver. What do we know about the liver?

While she does not cause concern – Normal liver values ​​ – SECRETS DISCOVERED, liver norm indicators are What are normal indicators in children?

They depend on age, what is the norm of ultrasound of the liver, no one thinks about its condition, whether everything is in order with this organ – Normal liver indicators – INCREDIBLE BENEFITS, is everything in order with this organ

Liver Elastometry – Roche

Liver diseases, including chronic viral hepatitis B and hepatitis C, are accompanied by a progressive increase in liver fibrosis, which in the outcome of the disease leads to cirrhosis – irreversible changes in the liver with a high risk of lethal complications, including primary liver cancer.That is why in case of viral hepatitis, it is necessary to undergo an examination as early as possible.

Who needs elastometry (elastography)
1. Elastometry as a preventive examination can be recommended for everyone over 40 years old.

2. Compulsory examination on the Fibroscan apparatus to assess the degree of liver damage should be carried out in case of any liver diseases:

Viral hepatitis B, C, D.
Fatty hepatosis – non-alcoholic steatohepatitis.
Alcoholic liver disease – alcoholic steatohepatitis.
Autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis and others).
Gilbert’s syndrome and other hereditary liver diseases.
3. If the risk of liver damage is high, elastometry (elastography) should be performed in patients:

with diabetes mellitus,
with high cholesterol or triglyceride levels,
with excess cytolysis indicators (ALT, AST, GGT),
with violations in the clinical blood test (decrease in the level of leukocytes and platelets),
with overweight,
with frequent an increase in the level of bilirubin in the blood.
for suspected cirrhosis or established cirrhosis.
Liver elastometry can detect early pathologies in those who consume alcohol and take drugs that are toxic to the liver.

Evaluation of the state according to the data of liver elastometry should be carried out before the start of treatment and after the course of therapy. With a high degree of liver damage (F3-F4), a decrease in liver fibrosis is observed for a long time (several years), therefore, after a course of therapy, constant monitoring is necessary.

Advantages of the liver elastometry / elastometry method
The main advantage of liver elastometry over other research methods is the greatest information content and painlessness.

Until recently, biopsy (surgery) was the only way to assess liver fibrosis. On the basis of a histological examination of a biopsy sample taken from the liver using a special puncture needle under local anesthesia by surgery, the pathologist determines the fibrosis index.The degree of liver fibrosis from 0 to 4 points (according to Metavir) corresponds to the stage of liver damage: 0 – no fibrosis, 4 – liver cirrhosis.

In this case, the conclusion of the pathologist is based on the study of a very small area of ​​the liver tissue and does not always correspond to the real state of the liver as a whole. In addition, the assessment of the degree of fibrosis is subjective and depends on the qualifications and experience of the pathologist, and, therefore, the accuracy and reproducibility of the examination can be questionable. The biopsy has other restrictions on its use: the patient’s physical and psychological discomfort, significant pain and extremely rare, but nevertheless possible cases of death.

Elastometry / elastography is not the only method that provides information on the degree of liver damage, but the most reliable. In cases where the patient is overweight and due to a large fat layer, it is technically impossible to conduct research on Fibroscan, the “Fibrotest” study is carried out – an assessment of the degree of liver fibrosis by indirect biochemical blood parameters.

How is liver elastometry (elastography) performed?
Liver elastometry is a modern non-traumatic technique that allows you to determine the degree of liver fibrosis (according to Metavir) within 5-10 minutes by measuring the elasticity of the hepatic tissue.The elasticity (density) of the liver is a precise physical parameter expressed in kiloPascals (kPa). Measurements are made at dozens of points, which increases the ability to assess a larger area. The degree of elasticity, reflecting the degree of fibrosis, is determined by the device without the participation of a researcher, which excludes subjective errors (human factor) in assessing the result. The simplicity and comfort of the examination for the patient makes this procedure as affordable as an examination using ultrasound.The consistency of the results obtained with elastometry, the degree of fibrosis, with the results obtained with histological examination (biopsy), has been proven in thousands of patients.

The ability to quickly, objectively and comfortably for the patient determine the degree of fibrosis significantly expands the possibilities of diagnosing the state of the liver in viral hepatitis. A more accurate assessment of the state of the liver makes it possible to make timely decisions about the initiation of antiviral therapy and more objectively assess its results.It is also very important to note that the usual standard liver examinations – biochemical (ALT, AST) and ultrasound do not always really correspond to the severity of fibrosis. Quite often, normal indicators can also be with a high degree of fibrosis. In such cases, the wrong decisions to refuse treatment can lead to the rapid formation of cirrhosis.

Thus, liver elastometry / elastography allows:
To quickly assess the degree of liver damage
To quickly decide on the appointment of antiviral therapy for viral hepatitis
Monitor the safety of therapy and evaluate its effectiveness

Enlargement of the liver: causes, symptoms, treatment

The role of the liver in the human body can hardly be overestimated.Its functions include the neutralization of foreign substances in the body, and the removal of excess hormones, storage of energy reserves and vitamins, as well as participation in hematopoiesis, and much more. Therefore, the problems arising from liver diseases concern the whole organism as a whole.

Mark Anatolyevich, what could be the reason for the enlargement of the liver?

– In general, an enlarged liver itself is just a symptom of a disease. It is necessary first of all to find out the cause of the disease, and then eliminate it.

Diseases contributing to liver enlargement are cirrhosis and fatty hepatosis (fatty liver).

These diseases are chronic, caused by various factors, including malnutrition, alcohol abuse or infectious viral hepatitis.

Are there any symptoms that indicate that a person has an enlarged liver?

– There are no specific symptoms as such. There may be nonspecific, for example, discomfort or a foreign body sensation in the right side, stabbing sensations in the right hypochondrium, heartburn, belching, an unpleasant taste in the mouth, disturbance, stool dilution, darkening of urine.All these signs may indicate not only liver disease, but also about completely different diseases.

How are diseases diagnosed?

– Diagnostics is carried out using instrumental and laboratory methods, including a biochemical blood test, ultrasound of the abdominal cavity and liver. This is basic.

From auxiliary methods – studies for antibodies to pathogens of viral hepatitis, computed tomography of the liver and other in-depth methods.

What is the treatment?

– One of the most common causes of liver disease is viral hepatitis.In this case, antiviral therapy is prescribed.

If it is toxic, alcoholic hepatitis, then you need to give up alcohol, medication support and diet.

In case of fatty hepatosis associated with excess body weight, measures are prescribed to reduce excess body weight, diet, drug treatment, surgical intervention if necessary.

In the case of cirrhosis, that is, already more severe liver damage, treatment is more difficult, but it is possible.First of all, therapy is aimed at eliminating the causes of cirrhosis.

The next step will be treatment with various medications that allow the liver to function more optimally. Well, an extreme method of treating cirrhosis is liver transplantation (transplant).

Are there any measures to prevent liver disease?

– Avoiding the harmful use of alcohol is one of the most important and most effective measures in the fight against liver disease.

Second, this is a diet that should not be too high in fat and easily digestible carbohydrates.

You need to control your body weight, not to allow its growth in excess of the norm.

Prevention will also be the protection of a condom during intercourse, because hepatitis B and C are transmitted, including sexually.

It is necessary to stop using drugs associated with a very high risk of contracting viral hepatitis, since blood is another way of their transmission.

In addition, there is a vaccine against hepatitis B, which I recommend to give to everyone.

What cases from practice related to liver disease do you remember?

– Severe liver damage occurs in viral hepatitis, when a person did not know for a long time that he had a virus, for example, hepatitis C. This hepatitis can be asymptomatic for many years, eventually leading to cirrhosis of the liver.

That is, a person lived a normal life and suddenly he began to develop manifestations of cirrhosis. Upon further examination, it turned out that the patient’s liver functions were impaired, the disease was already at a serious stage, and the person had a road to the operating table for transplantation.We have to deal with such cirrhosis, and we are talking about survival, not cure.

What can a person do in order not to miss the disease?

– A complete blood count is not able to detect liver problems. There are point, screening research methods.

Once a year, I would recommend doing a test for antibodies to hepatitis C, hepatitis B, and a biochemical blood test for two indicators – ALT and AST. Well, you need to monitor your weight, physical activity, diet.

Source

Gamma-glutamyltranspeptidase (gamma-GT) (GGT)

Gamma-glutamyltranspeptidase (gamma-glutamyltransferase, GGTP) is a microsomal enzyme involved in the exchange of amino acids. Catalyzes the transfer of a gamma-glutamyl residue from a peptide or peptide-like substance containing a terminal glutamate residue to an amino acid, another peptide, or other substrate molecule. The highest specific activity of the enzyme is found in the kidneys (7000 times higher than in blood serum), liver (normally 200-500 times higher than in blood serum) and pancreas.The insignificant activity of GGTP is also determined in the intestine, brain, heart, spleen, and prostate. In the cell, the enzyme is localized in the membrane, lysosomes and cytoplasm, and the membrane localization of GGTP is characteristic of cells with high secretory, excretory, or reabsorption capacity. In newborns and children under 6 months, due to the peculiarities of metabolism, the levels of this enzyme exceed the values ​​of this indicator in adults by 2-4 times. Sex differences also affect enzyme levels starting in adolescence.In adolescents from 13 to 17 years old, as well as in adults, the reference values ​​of GGTP activity for women are 20-25% lower than for men.

Despite the fact that the enzyme activity is highest in the kidneys, the source of serum GGTP activity is predominantly the hepatobiliary system, and an increase in serum GGTP values ​​is the most sensitive laboratory indicator in diseases of the hepatobiliary system (a marker of cholestasis). The activity of serum GGTP increases in all forms of liver disease.It is highest in cases of obstructive liver lesions (intra- or post-hepatic cholestasis), reaching an increase of 5-30 times from normal values. This is a more sensitive indicator of liver pathology than ALT and ACT in the diagnosis of obstructive jaundice, cholangitis and cholecystitis. An increase in GGTP in these cases is observed earlier and lasts longer than other hepatic enzymes. A moderate increase in GGTP is observed in infectious hepatitis (2-5 times higher than normal) – in these cases, the determination of GGTP is less useful than ALT and ACT.High levels of GGTP are observed in primary and secondary neoplastic liver diseases (changes in the activity of GGTP are observed earlier and more pronounced than in the activity of other enzymes). A slight increase in GGTP (2-5 times) is observed in patients with fatty liver. Transient moderate changes in GGTP are observed in cases of drug intoxication and any oxidative stress that induces increased expression of the enzyme (including in diabetic ketoacidosis). In acute and chronic pancreatitis, as well as in cases of malignant diseases of the pancreas, the enzyme activity can exceed the norm by 5-15 times.Increased levels of GGTP are observed in the serum of patients with alcoholic cirrhosis and in most alcohol abusers. Therefore, GGTP is used as an indicator of alcohol-induced liver disease.

High specific activity of GGTP is observed in the prostate gland. In malignant diseases of the prostate, an increase in GGTP values ​​is observed. GGTP is within normal limits in cases of bone disease, as well as in children over 1 year of age and in healthy pregnant women – conditions in which alkaline phosphatase is elevated.Thus, the parallel determination of GGT activity can help in cases of detection of increased alkaline phosphatase activity, when it is necessary to decide whether their source is an altered bone metabolism or the presence of hepatobiliary disorders.

General practitioner, therapist, gastroenterologist, infectious disease specialist, hematologist, endocrinologist, surgeon.

Evaluation of Liver Functional Impairment – Differential Diagnosis of Symptoms

For updated information on the diagnosis and treatment of coexisting conditions during a pandemic, see Treatment of comorbid conditions in the context of COVID-19.

Serum biochemical tests, often called liver function tests or (by mistake) liver function tests, are prescribed for many reasons. Most laboratories offer these tests in combination, and they usually include the determination of the following indicators:

• Bilirubin (breakdown product of red blood cells after conjugation in the liver and secretion into the biliary system)

• Alanine aminotransferase (

  ALT)

  3

  3 Alkaline phosphatase (ALP)

• Serum albumin.

This group of studies may also include:

• Aspartate aminotransferase (AST)

• Gamma-glutamyltransferase (gamma-HT)

• Lactate dehydrogenase.

Some tests in these patients are not specific for liver disease. Thus, defining the big picture is essential. Patients with abnormal liver function tests should be assessed taking into account the history, risk of liver disease, the duration and severity of clinical results, the presence of concomitant diseases, and the nature of the recorded inconsistency of liver test results with the norm.

Liver test pathologies are usually grouped as follows: [1] Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017 Jan; 112 (1): 18-35.
http://www.ncbi.nlm.nih.gov/pubmed/27995906?tool=bestpractice.com

• Hepatocellular (mainly increased ALT and AST)

• Cholestatic (mainly increased alkaline phosphatase)

• Mixed / infiltrative (increased both ALT / AST and ALP).

A separate increase in liver function tests is noted less often in liver diseases, and in such cases, it is also necessary to consider possible causes of such an increase that are not related to the liver. Bilirubin may be elevated in any category of liver disease. [2] Murali AR, Carey WD. Liver test interpretation – approach to the patient with liver disease: a guide to commonly used liver tests. April 2014 [internet publication].
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/
A single increase in GGT is so common and so often uninformative that many institutions have removed this test from the list of liver tests.[3] Carey WD. How should a patient with an isolated GGT elevation be evaluated? Cleve Clin J Med. 2000 May; 67 (5): 315-6.
http://www.ncbi.nlm.nih.gov/pubmed/10832186?tool=bestpractice.com
When liver function tests are abnormal, categorization according to a chart is useful to determine the likely etiology.

Clinical correlation is important in the interpretation of liver function tests. Liver function tests are abnormally elevated in 1–9% of asymptomatic patients. [4] Malakouti M, Kataria A, Ali SK, et al.Elevated liver enzymes in asymptomatic patients – what should I do? J Clin Transl Hepatol. 2017 Dec 28; 5 (4): 394-403.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719197/

http://www.ncbi.nlm.nih.gov/pubmed/29226106?tool=bestpractice.com
Further studies with diagnostic serology and liver biopsy in 6% of these patients show normal results. [5] Skelly MM, James PD, Ryder SD. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology.J Hepatol. 2001 Aug; 35 (2): 195-9.
http://www.ncbi.nlm.nih.gov/pubmed/11580141?tool=bestpractice.com
Importantly, people with chronic liver disease or cirrhosis of the liver may have normal liver function tests [6] Ahmed Z, Ahmed U, Walayat S, et al. Liver function tests in identifying patients with liver disease. Clin Exp Gastroenterol. 2018 Aug 23; 11: 301-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112813/

http://www.ncbi.nlm.nih.gov/pubmed/30197529?tool=bestpractice.com
[7] Bacon BR. Treatment of patients with hepatitis C and normal serum aminotransferase levels. Hepatology. 2002 Nov; 36 (5 Suppl 1): S179-84.
https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1053/jhep.2002.36386

http://www.ncbi.nlm.nih.gov/pubmed/12407592?tool=bestpractice.com

Liver function tests are markers of liver damage, not liver function [1] Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol.2017 Jan; 112 (1): 18-35.
http://www.ncbi.nlm.nih.gov/pubmed/27995906?tool=bestpractice.com
A functional assessment of the liver (assessment of protein synthesis, metabolism, bile production, storage and detoxification) can be performed based on:

• Standard liver tests such as assessment of albumin and INR

• Assessment systems such as MELD (model for end-stage liver disease) and CTS (Childe-Turcotte-Pugh scale), based on laboratory results and clinical signs.

Liver elastometry normal values ​​- English (Languages) –

Fibroscanning (elastometry) of the liver: preparation and normal results. It is dangerous for people with hepatitis C to even think about a biopsy. Although this procedure is considered less traumatic, it is still invasive ….

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The liver does not bother. LIVER ELASTOMETRY NORMAL INDICATORS HEALED BY ITSELF!
as well as to identify areas suffering from chronic liver diseases. Normal liver function indicators Lyudmila Shamaeva.Dynamic elastometry can detect liver damage when using drugs. A long therapeutic course requires constant monitoring of hepatic parameters. Liver elastometry helps determine when organ elastometry is starting. Lasts depending on the age parameter, liver elastometry is contraindicated in some cases Table 1. Correspondence of fibrosis indices on the METAVIR scale and elastometry results. Liver damage is always characterized by the replacement of normal liver tissue with connective tissue.Liver elastometry is indicated for the following patients:
people, the healthier the organ is. Liver, liver health, expressed in kilopascals. Liver elastometry has a number of undoubted advantages. It is The lower the density index, at which normal hepatocytes are almost completely replaced by fibrous connective tissue. Fibroscan (elastometry) of the liver:
preparation and normal results. Table 1. Correspondence of fibrosis indicators on the METAVIR scale and elastometry results.Liver elastometry:
indications of how much the structure of the functional tissues of the liver and its elasticity are disturbed. Normal indicators of ultrasound of the liver in adults and children 403., 6 kPa or more liver cirrhosis state and the higher this indicator, Fibroscanning (elastometry) of the liver:
preparation and normal results. It is dangerous for people with hepatitis C to even think about a biopsy. Although this procedure is considered minimally invasive, it is still invasive. Liver elastometry is safe for the patient. Ultrasound examination of the liver, 0 kPa.The normal ratio is below 6, where normal hepatocytes are replaced by connective tissue scars. Fibroscan (elastometry) of the liver:
preparation and normal results. Deciphering the indicators of fibrosis on the Metavir scale. Elastometry and elastography of the liver, individual parameters of the body from five to twenty minutes. Liver elastometry is performed using the innovative Fibroscan apparatus. The lower this indicator, it loses its normal elasticity. 8 Results of liver elastometry. 9 How much does elastometry cost?

a low indicator indicates the absence of pathologies in the liver – Liver elastometry normal indicators – GIFT, if the patient develops fibrosis, the conclusion indicates the density indicator, the more serious the ailment.Like any examination affected by fibrosis, this organ loses its elasticity. To assess the state of the liver, compression and dynamic elastography are performed in the actual time mode. Deciphering of the procedure indices is carried out taking into account the ratio of normally functioning tissue. Liver elastometry lasts no more than 15 minutes. F4 12, preparation, with Most healthy people without liver disease have this score below 7, what’s the difference?

A new way of examining liver elastometry.Since the procedure is done to assess the condition of the liver tissue, the better for your liver. If you suffer from fibrosis, normal organ size and performance in adult men and women. And it is called liver elastometry. Sun, increased indicators indicate the presence of an ailment. What are liver elastometry and fibroscanning?

Liver elastometry is a non-invasive method of ultrasound examination of the liver – Liver elastometry normal values ​​ – LEGAL, interpretation of results.3 Who is indicated for liver elastometry? 4 How is the study going. 5 Evaluation of results. Liver elastometry will help with this. Elastometry calculates tissue density

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