What are liver function tests. How do liver enzymes indicate liver health. What causes abnormal liver enzyme levels. How are liver enzyme tests interpreted. What symptoms suggest liver problems. When should you consult a doctor about liver enzymes.

What Are Liver Function Tests and Why Are They Important?

Liver function tests (LFTs) are a crucial set of blood tests used to assess the overall health and functionality of the liver. These tests measure various enzymes, proteins, and substances produced by the liver, providing valuable insights into its condition. LFTs are essential for detecting liver damage, monitoring liver health, and diagnosing potential liver diseases.

The liver, a vital organ responsible for numerous metabolic processes, produces various enzymes that typically remain within liver cells. However, when the liver is injured or damaged, these enzymes are released into the bloodstream. By measuring the levels of these enzymes in the blood, healthcare professionals can gain important information about liver health and function.

Key Components of Liver Function Tests

• Albumin: A protein produced by the liver
• Total protein: Measures the overall amount of protein in the blood
• Alkaline phosphatase (ALP): An enzyme produced by the liver
• Alanine transaminase (ALT): An enzyme specific to liver cells
• Aspartate aminotransferase (AST): An enzyme found in various tissues, including the liver
• Gamma-glutamyl transferase (GGT): Another liver enzyme
• Bilirubin: A waste product processed by the liver
• Lactate dehydrogenase (LD): An enzyme released during cell damage
• Prothrombin time (PT): A protein involved in blood clotting

When one or more of these substances fall outside the normal range, it may indicate liver disease or dysfunction.

Understanding Aminotransferase Enzymes: ALT and AST

Among the most important liver enzymes are the aminotransferases, particularly ALT (alanine aminotransferase) and AST (aspartate aminotransferase). These enzymes play a crucial role in amino acid metabolism and are key indicators of liver health.

Alanine Aminotransferase (ALT)

ALT, also known as serum glutamic pyruvic transaminase (SGPT), is primarily found in liver cells. It is considered a more specific indicator of liver health compared to AST. Elevated ALT levels in the blood often signify liver cell damage or death, even before clinical symptoms appear. This makes ALT a valuable early marker for liver diseases such as viral hepatitis.

Aspartate Aminotransferase (AST)

AST, formerly known as serum glutamic oxaloacetic transaminase (SGOT), is present in various tissues, including the liver, heart, muscles, kidneys, and brain. While AST elevations can indicate liver damage, its presence in other tissues means it’s less specific to liver health than ALT. Elevated AST levels may result from liver injury, but can also occur due to damage in other organs, particularly heart or muscle tissue.

Normal Ranges for Liver Enzymes: What’s Considered Healthy?

Understanding the normal ranges for liver enzymes is crucial for interpreting liver function test results. However, it’s important to note that these ranges can vary slightly between laboratories and may be influenced by factors such as age, sex, and the specific testing methods used.

Typical Normal Ranges for ALT and AST

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

Are these ranges universally applicable? Not necessarily. Factors such as age, gender, body mass index, and even time of day can influence enzyme levels. Additionally, what’s considered “normal” may vary among different populations and ethnic groups. Therefore, it’s crucial to interpret results in the context of an individual’s overall health profile and in consultation with a healthcare provider.

Elevated Liver Enzymes: Causes and Implications

When liver enzyme levels exceed the normal range, it often indicates some form of liver stress or damage. However, the degree of elevation and the specific enzymes involved can provide clues about the underlying cause and severity of the liver issue.

Common Causes of Elevated Liver Enzymes

1. Viral hepatitis (e.g., hepatitis A, B, C)
2. Alcohol-related liver disease
3. Nonalcoholic fatty liver disease (NAFLD)
4. Medications and drug-induced liver injury
5. Autoimmune liver diseases
6. Metabolic disorders (e.g., hemochromatosis, Wilson’s disease)
7. Liver tumors or cancer
8. Congestive heart failure
9. Obesity
10. Celiac disease

How significant is the elevation? Mild elevations (less than 5 times the upper limit of normal) may be due to less severe conditions or temporary factors. Moderate elevations (5-15 times normal) often suggest more significant liver damage, while severe elevations (more than 15 times normal) typically indicate acute and potentially severe liver injury.

Low Liver Enzyme Levels: What Do They Mean?

While elevated liver enzymes often receive more attention, low levels of certain liver enzymes can also provide important health information. Low levels of liver enzymes are less common but may indicate specific health issues or nutritional deficiencies.

Implications of Low Liver Enzyme Levels

• Low ALT levels: May be associated with vitamin B6 deficiency or chronic kidney disease
• Low AST levels: Can occur in pregnancy or with certain medications
• Low alkaline phosphatase (ALP): Might indicate malnutrition, zinc deficiency, or rare genetic disorders

Do low enzyme levels always indicate a problem? Not necessarily. In some cases, lower-than-average enzyme levels may simply reflect individual variation or excellent liver health. However, consistently low levels, especially when accompanied by other symptoms, warrant further investigation.

Symptoms of Liver Problems: When to Be Concerned

While abnormal liver enzyme levels often don’t cause noticeable symptoms in their early stages, certain signs and symptoms may indicate underlying liver issues. Recognizing these symptoms can prompt timely medical evaluation and intervention.

Common Symptoms of Liver Problems

• Jaundice (yellowing of skin and eyes)
• Abdominal pain or swelling
• Chronic fatigue
• Nausea or loss of appetite
• Dark urine
• Pale, bloody, or tar-colored stools
• Itchy skin
• Bruising easily
• Swelling in the legs and ankles
• Confusion or difficulty concentrating

How urgent are these symptoms? While some liver symptoms may develop gradually, others, like sudden severe abdominal pain or jaundice, require immediate medical attention. It’s important to consult a healthcare provider if you experience persistent or concerning symptoms, especially if you have risk factors for liver disease.

Interpreting Liver Function Test Results: Beyond the Numbers

Interpreting liver function test results requires more than simply comparing numbers to a reference range. A comprehensive approach considers the overall pattern of abnormalities, the degree of elevation, and the individual’s clinical context.

Key Factors in Interpreting Liver Function Tests

1. Pattern of enzyme elevations: The ratio of AST to ALT can provide clues about the type of liver damage
2. Magnitude of elevation: Mild, moderate, or severe elevations suggest different levels of liver injury
3. Presence of other abnormal markers: Changes in bilirubin, albumin, or clotting factors can indicate more severe liver dysfunction
4. Patient’s medical history: Pre-existing conditions, medications, and lifestyle factors influence interpretation
5. Trend over time: Serial measurements can show whether liver function is improving, worsening, or stable

Is a single abnormal test result cause for alarm? Not always. Transient elevations can occur due to temporary factors like recent exercise or minor illnesses. Persistent abnormalities or significant elevations, however, typically warrant further investigation.

Lifestyle Factors Affecting Liver Enzyme Levels

Various lifestyle factors can significantly impact liver enzyme levels, either positively or negatively. Understanding these influences can help individuals make informed choices to support liver health and interpret test results more accurately.

Lifestyle Factors That Can Affect Liver Enzymes

• Alcohol consumption: Even moderate drinking can elevate liver enzymes
• Diet: High-fat, high-sugar diets can contribute to fatty liver disease and enzyme elevations
• Exercise: Intense workouts can temporarily increase enzyme levels
• Weight: Obesity is associated with nonalcoholic fatty liver disease and elevated enzymes
• Medications: Many common drugs can affect liver enzyme levels
• Herbal supplements: Some supplements can cause liver damage and enzyme elevations
• Smoking: Can exacerbate liver damage and influence enzyme levels

How quickly can lifestyle changes impact liver enzymes? Some changes, like reducing alcohol intake or stopping hepatotoxic medications, can lead to improvements in liver enzyme levels within weeks. Other interventions, such as weight loss in fatty liver disease, may take months to show significant effects on enzyme levels.

Strategies for Improving Liver Health

1. Maintain a healthy weight
2. Limit alcohol consumption
3. Eat a balanced, liver-friendly diet rich in fruits, vegetables, and whole grains
4. Exercise regularly
5. Avoid unnecessary medications and supplements
6. Get vaccinated against hepatitis A and B
7. Practice safe sex and avoid sharing needles to prevent viral hepatitis

Implementing these lifestyle changes can not only help normalize liver enzyme levels but also improve overall liver health and function.

When to Consult a Doctor About Liver Enzyme Levels

While minor fluctuations in liver enzyme levels are common and often harmless, certain situations warrant medical attention. Knowing when to consult a healthcare provider about liver enzyme results is crucial for timely diagnosis and treatment of potential liver issues.

Situations That Require Medical Evaluation

• Persistently elevated enzyme levels on multiple tests
• Significant elevations (more than 3-4 times the upper limit of normal)
• Enzyme elevations accompanied by symptoms of liver disease
• Abnormal results in other liver function tests (e.g., bilirubin, albumin)
• Known risk factors for liver disease (e.g., heavy alcohol use, hepatitis exposure)
• Unexplained weight loss or fatigue along with abnormal liver tests

How soon should you seek medical advice? For mild elevations without symptoms, discussing results at your next scheduled appointment may be sufficient. However, for significant elevations or if you’re experiencing symptoms of liver disease, it’s best to consult a healthcare provider promptly.

What to Expect During a Liver Health Evaluation

1. Detailed medical history and physical examination
2. Review of medications and supplements
3. Additional blood tests to investigate specific liver diseases
4. Imaging studies (e.g., ultrasound, CT scan, or MRI) of the liver
5. In some cases, a liver biopsy may be recommended

Early detection and management of liver issues can prevent progression to more serious conditions and improve overall health outcomes.

Liver Function Tests-Ranges-High & Low

Liver Function Tests (LFT)

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

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

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

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

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

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

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

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

Aminotransferase Enzymes (ALT, AST)

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

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

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

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

Alanine aminotransferase (ALT)

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

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

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

Aspartate Aminotransferase (AST)

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

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

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

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

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

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

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

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

High (Elevated) Levels of AST and ALT

Following are the normal ranges of AST and ALT:

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

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

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

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

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

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

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

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

Types of Liver Function Tests (LFT)

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

Following are some of the blood tests reflect liver function:

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

Reasons for Abnormal Liver Tests

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

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

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

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

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

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

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

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

Pain Relief Medications

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

Anti-seizure Medications

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

Antibiotics

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

Cholesterol Lowering Drugs (Statins)

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

Cardiovascular Drugs

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

Other Drugs

• Antidepressant drugs of the tricyclic type

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

Diseases that can cause very high AST or ALT levels

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

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

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

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

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Liver Panel Test – Testing.com

Test Quick Guide

A liver panel is a test with multiple measurements that help assess the health and function of the liver. The test is conducted with a blood sample that is normally taken from a vein in your arm.

A liver panel can be used to help diagnose and monitor liver diseases. It can also provide information about other health conditions that affect the liver, such as viral or alcoholic hepatitis. If you are taking medications that can impact the liver, the test results can determine whether side effects are occurring.

About the Test

Purpose of the test

The liver panel has many applications in medical care. While sometimes called a liver function test, it is better understood as a method of detecting liver disease and/or other health problems, including many that involve the liver.

Some of the specific ways that a liver panel can be used include:

• Diagnosis: Although a liver panel alone is not able to diagnose liver diseases, its measurements can help identify the type of problem if you have symptoms of liver conditions. The test can also help in the diagnostic process of other health concerns.
• Evaluating disease severity: A liver panel can help determine the extent of illness if you have known liver problems.
• Screening: You may have a liver panel as part of broader blood testing, known as the comprehensive metabolic panel, during routine medical checkups. If screening is abnormal, it may warrant more specific follow-up testing.
• Monitoring: Follow-up testing can provide information about how well treatment for liver problems is working. A liver panel can also monitor for side effects when you take medications that can impact liver health.

What does the test measure?

As a panel test, the liver panel involves multiple measurements. When the test is ordered, doctors can modify exactly which measurements to take.

For this reason, there is not a universal standard for what is measured on a liver panel. Nevertheless, some components of the test are more common. In most cases, a liver panel includes the following measurements:

• Aspartate aminotransferase (AST): This is a type of protein called an enzyme that is found in the liver as well as many muscles and organs.
• Alanine aminotransferase (ALT): This is an enzyme found primarily in the liver.
• Alkaline phosphatase (ALP): This is an enzyme found in the liver, bones, and other tissues in the body.
• Bilirubin: Bilirubin is a yellow-colored waste product that is the result of the normal breakdown of red blood cells. The liver works to remove bilirubin from the body.
• Albumin: Albumin is the most abundant protein in the blood and is made by the liver which prevents fluids from leaking out of the bloodstream.

Additional measurements may be added to a liver panel if the doctor believes they can provide more information to evaluate your situation. These measures may be tested on an initial liver panel, or included in repeat testing after an abnormal result on a previous test.

• Gamma-glutamyl transferase (GGT): An enzyme found in the liver and other organs.
• 5’ nucleotidase (5’-NT): An enzyme that exists in the liver and other organs.
• Total protein: Measures the sum of all proteins in the blood.
• Globulins: A class of proteins in the blood.
• Prothrombin time: A protein made by the liver that facilitates normal blood clotting and measures how long it takes for the blood to clot.
• Lactate dehydrogenase (LDH): An enzyme found in tissues throughout the body.

When should I get a liver panel?

There are many reasons you might decide to get a liver diagnostic test, or why a health care professional will order the lab test for you. This test can detect liver disease and other health problems involving the liver. You might be taking medications with liver damage as a side effect, and the test can measure whether the prescription is having a negative impact on your health. A liver panel can also be done as part of a metabolic panel during a routine medical visit.

A doctor might recommend a liver panel if you show common symptoms like jaundice (yellowing of the skin and eyes), nausea and vomiting, diarrhea, dark-colored urine, light-colored stool, or fatigue. The tricky thing is, aside from jaundice, these symptoms can easily be written off as “something else.”

That’s why it’s really important to consult with your doctor, who can advise whether a liver panel is necessary as part of an overall medical checkup or because of specific circumstances, such as monitoring cirrhosis or medication side effects.

Finding a Liver Panel

How can I get a liver panel?

Liver panel testing is performed in a medical setting such as a clinic, hospital, doctor’s office, or lab. Your doctor may order the liver panel, or you can purchase the test online and be referred to a nearby participating lab for the sample. Most liver panel testing happens with a blood draw and laboratory analysis. But there is a type of rapid, on-site point-of-care test that can measure certain components of the liver panel. It is not comprehensive.

Can I take the test at home?

There are at-home liver panel tests that can determine liver function by screening for proteins and enzymes like albumin, globulin, ALP, ALT, and GGT. These tests use a finger-prick sample and include materials to collect and send your specimen to the lab.

You can order a liver panel from home and get tested in a lab. Or, your doctor can prescribe the liver panel.

The at-home liver panel test is focused on liver function but does not provide the comprehensive results that an expanded liver panel does. It also tests for direct bilirubin and total bilirubin (waste produced by the liver), and AST, an enzyme found in the liver and other tissues.

How much does the test cost?

If you get a liver test ordered by a doctor, your insurance policy may cover the cost of the appointment and lab analysis. There may be a copay or deductible, however. If you order the test online, you can submit the receipt for potential reimbursement. You can find affordable liver panel testing that ranges in price from $39 to $79.

Before you order your own test from a lab or arrange a doctor-ordered liver panel, ask about costs, insurances accepted, copays, and deductibles. Be sure to refer to your doctor, lab, and health plan for details on test costs and insurance coverage.

Taking a Liver Panel Test

A liver panel requires drawing blood from a vein in your arm. The procedure is routine and performed in a medical office, clinic, hospital, or lab. There are some at-home tests available that involve a skin prick, but they are not as thorough as a liver panel from a lab.

Before the test

Plan on fasting for up to 12 hours before you take a liver panel test, only drinking water during this time. Also, be sure your doctor knows what medications you are taking because some prescription drugs and over-the-counter medications or dietary supplements can interfere with the test. Your doctor will provide specific guidelines on which medications and for how long to avoid them before a liver panel blood draw.

Not all liver panels require preparation. For example, an expanded liver panel you order online and go to a lab for testing does not require fasting. The comprehensive liver panel you can order online for lab testing does require fasting for 12 to 14 hours.

For at-home finger-prick liver tests, be sure to read the instructions carefully so you know whether the preparation is required.

During the test

A routine blood draw is all that is required to perform a liver panel. With a small needle, blood is drawn from a vein in your arm into a vial and analyzed by a lab. The phlebotomist will carefully clean the area first with antiseptic, and you might feel a sting when the needle is inserted or removed. You could experience mild bruising or soreness after the test like if you were getting blood drawn for any other medical panel. The entire process takes no more than five minutes.

At-home tests require a finger prick. The kit will include a lancet or small needle. You’ll get a test strip where you apply the blood drops, and then secure it in the provided packaging to send to the lab. It takes less than a minute to gather your sample and prepare the dry blood card for the lab. Remember, test kit instructions vary, so it’s important to read all instructions before obtaining your blood sample.

After the test

There are no restrictions after getting blood drawn for a liver panel, but if you fasted for 12 to 14 hours prior to the lab test, you will probably feel weak or fatigued. Consider bringing a snack for after your test. You can return to standard activities. Other than changing an adhesive bandage, there’s little to no recovery.

Liver Panel Test Results

Receiving test results

Depending on what type of liver panel you get, you can expect test results within one to two business days for an expanded panel that measures enzymes and proteins. It many take one to two days for a comprehensive panel that assesses enzymes and proteins to determine liver function, including GGT and LD. The comprehensive panel is also called hepatic function testing.

Lab result times can vary, so ask the clinician in advance how long it will take. Even at-home tests that use a finger prick to collect a blood sample will take a few business days from the time the lab receives your sample before you get results.

The speed of results can also depend on how you get them. Labs deliver results in a number of ways, including confidential phone calls, secure emails, or via an app.

Interpreting test results

Your liver panel test results will depend on the type of test. You will see some reference ranges to understand what levels are considered abnormal. Always discuss these results with a medical professional so you can ask questions and gain a clear understanding of the report, its information, and the next steps.

There are five common measures your liver panel test results will reveal.

• Bilirubin: Total bilirubin will show whether levels are raised due to a metabolic disorder or liver disease. In infants, it can indicate whether support is needed to address a liver that is not functioning properly.
• Albumin: This protein can be a marker for liver function and reduced albumin could indicate sepsis, inflammatory disorders, and other liver problems.
• ALP: Higher levels of ALP can be found in those with liver and bone disease.
• AST and ALT: These are liver enzymes and elevation can indicate liver-related issues. ALT can be an indicator of liver cell injury.
• GGT: This is used in the diagnosis and treatment of liver disease and in the evaluation of patients with alcoholism.

When test results are abnormal, doctors often look for certain patterns of abnormalities in the specific levels that were detected.

• Conditions involving acute or chronic liver damage often show disproportionate increases in ALT and AST compared to ALP.
• Bile duct obstruction is more often associated with a disproportionate increase in ALP compared to ALT and AST.
• Disorders affecting the normal processing of bilirubin may be demonstrated by elevated bilirubin with normal levels of ALT, AST, and ALP.
• Health conditions originating outside the liver are more common when abnormal albumin or prothrombin time occurs with otherwise normal results.

Your doctor will look at these test results and take into account your health, symptoms, and medical and family history. Any drugs you take are also considered since some medications can impact test results. Liver panel results are complex, so always review results with a medical professional who understands your case and can answer your questions. Here are some to ask:

• Was any part of my test result abnormal?
• If there was an abnormal result, can you explain what was found and what it may mean?
• If results were normal, will I need to have this testing again at any point in the future?
• Are there any follow-up tests that may be beneficial given my test results?

• CMP Blood Test (Comprehensive Metabolic Panel)
  Learn More
• Alanine Aminotransferase (ALT)
  Learn More
• Alkaline Phosphatase (ALP) Test
  Learn More
• Albumin Blood Test
  Learn More
• Total Protein, Albumin-Globulin (A/G) Ratio Test
  Learn More
• Bilirubin Test
  Learn More
• GGT Blood Test (Gamma Glutamyl Tranferase/Transpeptidase)
  Learn More
• Lactate Dehydrogenase (LDH) Test
  Learn More
• PT/INR Test (Prothrombin Time and International Normalized Ratio)
  Learn More

Resources

• National Library of Medicine: Liver Diseases
• National Institute of Diabetes and Digestive and Kidney Diseases: Liver Disease
• American Liver Foundation: Diagnosing Liver Disease

Sources

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ALT and AST what is it?

ALT ( alanine aminotransferase) and AST (aspartate aminotransferase) – belong to aminotransferase enzymes involved in amino acid metabolism. They are also called liver enzymes. They are found mainly in the cells of the liver and in other organs: pancreas, heart, kidneys, muscle tissue. A small amount of ALT and AST may appear in the blood due to physiological processes. However, in case of liver diseases (infectious or toxic hepatitis, tumor), damage to the liver cells occurs, the permeability of cell membranes is impaired and a large amount of ALT and AST enzymes are released into the blood – as a result, a cytolytic syndrome develops.

ALT and AST transaminases are specific markers of liver disease. Indications for their appointment may be the following:

• Presence of symptoms: nausea, vomiting, abdominal pain, yellowing of the skin and sclera, lethargy.
• laboratory diagnostics of liver diseases: viral hepatitis A, B, C, toxic hepatitis, non-alcoholic fatty liver disease (steatohepatitis), alcoholic liver disease, cirrhosis of the liver.
• Monitoring the dynamics of therapy for liver diseases.

Norms for the content of liver enzymes in the blood:

Reasons for increasing ALT, AST (hepatic and extrahepatic)

The level of ALT in acute viral or drug-induced hepatitis can rise 50 times or more. With steatohepatitis and alcoholic liver disease, the increase in ALT is moderate – no more than 5 times. In chronic hepatitis, there is an increase in ALT by about 7 times. In cirrhosis, ALT and AST values ​​increase by 3-5 times, while AST may be higher than ALT.

During pregnancy, a woman’s body experiences an increased load, so there may be a slight increase in transaminases.

Currently, macro-AST-emia syndrome has become known – this is a rare condition in which complexes are formed in the human body from the AST molecule and immunoglobulin. This condition may be hereditary or associated with liver disease. It is characterized by a prolonged and asymptomatic increase in alanine aminotransferase in the blood.

An important diagnostic value is not only an increase in the level of transaminases, but also a decrease. A decrease in ALT and AST below normal indicates end-stage cirrhosis or severe liver damage in hepatitis. This is an extremely unfavorable sign, as it indicates the total destruction of liver cells.

Liver diagnostics – ALT blood test

Alanine aminotransferase (ALT) is an enzyme found in cells. Its main amount is concentrated in the liver, so the test is used as an indicator of the presence of liver diseases. It is used to diagnose cirrhosis and hepatitis in combination with other tests. The main function of the enzyme in the body is the release of energy from food. Normally, the concentration of the enzyme should not exceed 45 U / l. This rate is set for adults over 18 years of age. In children, normal values ​​vary with age.

Indications for examination

An examination of the liver condition is performed if the patient has the following symptoms:

• fatigue;
• pain in the right hypochondrium;
• jaundice of the sclera and skin;
• abdominal enlargement;
• dark urine;
• vomiting and nausea;
• pruritus.

Indicators may increase in the following cases: with the abuse of alcohol, hereditary predisposition to liver disease, viral hepatitis, taking a number of medications. The test is often included in a preventive examination program.

General

Normally, only a small amount of the enzyme can be present in the bloodstream. The release of a large amount of ALT occurs with large-scale cell damage. This organ is located in the abdominal cavity (top right), takes part in many vital processes. The liver is involved in the processing of nutrients, the synthesis of many proteins, the production of bile, and it breaks down toxic substances that are potentially harmful to the body.

An ALT blood test is necessary to check the condition of the liver in patients who are taking drugs that are potentially harmful to this organ and in patients with hepatitis. It should be borne in mind that an increase in the level of this enzyme is not always associated with liver pathologies. It is also found in other organs, so an increase in performance may indicate their pathology.

ALT and AST are the most important liver indications . In many cases, tests for the amount of these enzymes are done at the same time. In the diagnosis, both indicators and their ratio are used (it can be used to determine the cause of liver damage). During treatment, tests are carried out several times at regular intervals to monitor the dynamics of the patient’s condition.

Interpretation of results

Reference values ​​are determined according to the age and sex of the patient. In men, normal values ​​may be higher than in women. As a rule, the results of the study are ready the next day after donating blood. For their interpretation, you must consult a doctor. Self-medication is unacceptable, as it can cause irreparable harm to health.

Reasons for the increase in ALT:

• mononucleosis;
• alcoholism;
• cirrhosis of the liver;
• malignant neoplasm;
• hepatitis;
• heart failure;
• muscle injury;
• kidney damage;
• sunstroke.