What are liver function tests. How do AST and ALT enzymes indicate liver health. What are normal ranges for liver enzymes. When should you be concerned about elevated liver enzyme levels. How are liver function tests performed and interpreted.

The Importance of Liver Function Tests in Assessing Liver Health

Liver function tests (LFTs) are crucial diagnostic tools used to evaluate the overall health and functionality of the liver. These blood tests measure various enzymes, proteins, and substances produced by the liver, providing valuable insights into potential liver damage or disease. Among the most significant components of LFTs are two aminotransferase enzymes: aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

Why are liver function tests important? These tests serve as early indicators of liver damage, often detecting issues before symptoms become apparent. By monitoring enzyme levels, healthcare providers can identify potential liver problems, assess the severity of existing conditions, and track treatment progress.

Understanding AST and ALT: Key Indicators of Liver Health

AST and ALT are enzymes primarily found in liver cells. When liver cells are damaged or die, these enzymes are released into the bloodstream, causing elevated levels in blood tests. While both enzymes are associated with liver health, they have distinct characteristics and distributions within the body.

Aspartate Aminotransferase (AST)

AST, formerly known as serum glutamic oxaloacetic transaminase (SGOT), is present in various tissues throughout the body, including the liver, heart, muscles, kidneys, and brain. Due to its widespread distribution, elevated AST levels may indicate damage to multiple organs, not just the liver.

• Normal AST range: 5 to 40 units per liter of serum
• Found in liver, heart, muscle, kidney, and brain tissues
• Less specific to liver damage compared to ALT

Alanine Aminotransferase (ALT)

ALT, previously called serum glutamic pyruvic transaminase (SGPT), is primarily concentrated in the liver. This enzyme’s specificity to liver tissue makes it a more reliable indicator of liver health and potential liver damage.

• Normal ALT range: 7 to 56 units per liter of serum
• Primarily found in liver cells
• More specific indicator of liver health compared to AST

Interpreting AST and ALT Levels: What Do They Mean?

Interpreting AST and ALT levels requires considering both the individual values and their relationship to each other. How can healthcare providers use these enzyme levels to assess liver health?

1. Normal levels: When both AST and ALT fall within their respective normal ranges, it generally indicates a healthy liver.
2. Elevated levels: Increased AST and ALT levels may suggest liver damage or disease. The extent of elevation often correlates with the severity of liver injury.
3. AST/ALT ratio: The ratio between AST and ALT can provide additional insights into the nature of liver damage.

Is there a specific AST/ALT ratio that indicates liver problems? In most types of liver disease, the ratio of AST to ALT is less than 1. However, in alcoholic liver disease, the ratio is often greater than 2, which can help distinguish it from other causes of liver damage.

Common Causes of Elevated Liver Enzymes

Elevated liver enzymes can result from various factors, ranging from temporary conditions to chronic diseases. What are some common causes of increased AST and ALT levels?

• Viral hepatitis (e.g., hepatitis A, B, C)
• Alcoholic liver disease
• Nonalcoholic fatty liver disease (NAFLD)
• Medications and drug-induced liver injury
• Autoimmune hepatitis
• Cirrhosis
• Liver cancer
• Heart failure (particularly affecting AST levels)
• Muscle damage or intense exercise (can increase AST levels)

It’s important to note that temporary elevations in liver enzymes can occur due to factors such as recent alcohol consumption, certain medications, or strenuous exercise. This is why healthcare providers often recommend retesting after a period of abstinence or lifestyle modification to confirm persistent elevations.

When to Be Concerned About Elevated Liver Enzymes

While minor elevations in liver enzymes may not always indicate severe liver disease, persistent or significant increases warrant further investigation. At what point should you be concerned about elevated AST and ALT levels?

Generally, AST or ALT levels more than three times the upper limit of normal are considered significant and may require additional testing. However, the interpretation of these results should always be done in the context of a patient’s overall health, symptoms, and risk factors.

Symptoms Associated with Liver Problems

In addition to elevated enzyme levels, what symptoms might indicate liver issues?

• Jaundice (yellowing of the skin and eyes)
• Abdominal pain or swelling
• Chronic fatigue
• Nausea or loss of appetite
• Dark urine or pale stools
• Itchy skin
• Easy bruising or bleeding

If you experience these symptoms along with elevated liver enzymes, it’s crucial to consult with a healthcare provider for a comprehensive evaluation.

Additional Components of Liver Function Tests

While AST and ALT are key components of liver function tests, several other substances are typically measured to provide a more comprehensive picture of liver health. What other elements are included in a standard liver function panel?

• Albumin: A protein produced by the liver, low levels can indicate advanced liver disease.
• Total protein: Measures all proteins in the blood, including albumin.
• Alkaline phosphatase (ALP): An enzyme that can be elevated in various liver and bone disorders.
• Gamma-glutamyl transferase (GGT): Another enzyme that can indicate liver or bile duct problems.
• Bilirubin: A waste product processed by the liver; elevated levels can cause jaundice.
• Prothrombin time (PT): Measures blood clotting function, which can be impaired in liver disease.

How do these additional tests complement AST and ALT in assessing liver function? Each of these markers provides unique insights into different aspects of liver health, from protein synthesis to bile flow and detoxification processes. Together, they offer a comprehensive view of liver functionality and can help pinpoint specific areas of concern.

Lifestyle Factors Affecting Liver Enzyme Levels

Various lifestyle factors can influence liver enzyme levels, sometimes leading to temporary elevations that may not necessarily indicate liver disease. What lifestyle choices can impact AST and ALT levels?

1. Alcohol consumption: Even moderate drinking can cause temporary increases in liver enzymes.
2. Diet: A high-fat or high-sugar diet can contribute to fatty liver disease and elevated enzymes.
3. Exercise: Intense workouts can temporarily raise AST levels due to muscle breakdown.
4. Medications: Certain drugs, including over-the-counter pain relievers, can affect liver enzyme levels.
5. Obesity: Excess weight is a risk factor for nonalcoholic fatty liver disease and elevated enzymes.
6. Supplements: Some herbal supplements and high-dose vitamins can impact liver function.

How can you minimize the impact of these factors on your liver health? Adopting a balanced diet, maintaining a healthy weight, limiting alcohol intake, and consulting with healthcare providers about medications and supplements can help support optimal liver function and keep enzyme levels within normal ranges.

Diagnostic Procedures for Liver Health Assessment

When liver function tests reveal abnormal results, healthcare providers may recommend additional diagnostic procedures to further investigate liver health. What are some common follow-up tests used to assess liver function and diagnose potential liver diseases?

• Ultrasound: A non-invasive imaging technique that can detect structural changes in the liver, such as fatty deposits or tumors.
• CT scan: Provides detailed cross-sectional images of the liver and surrounding organs.
• MRI: Offers high-resolution images of liver tissue and can help identify specific liver conditions.
• Fibroscan: A specialized ultrasound that measures liver stiffness, indicating the presence and extent of fibrosis or cirrhosis.
• Liver biopsy: Involves removing a small sample of liver tissue for microscopic examination, providing definitive diagnosis of many liver conditions.

How do healthcare providers determine which diagnostic tests are necessary? The choice of follow-up procedures depends on various factors, including the severity of enzyme elevations, the presence of symptoms, risk factors, and suspected underlying conditions. A comprehensive approach combining blood tests, imaging studies, and sometimes tissue analysis allows for accurate diagnosis and appropriate treatment planning.

The Role of Genetic Factors in Liver Enzyme Levels

Genetic variations can influence an individual’s baseline liver enzyme levels and their susceptibility to certain liver conditions. How do genetic factors impact AST and ALT levels?

Research has identified several genetic polymorphisms that can affect liver enzyme levels independently of liver health. For example, some individuals may have naturally higher or lower baseline enzyme levels due to genetic variations. Additionally, genetic factors can influence an individual’s risk for conditions like nonalcoholic fatty liver disease or their ability to metabolize alcohol efficiently.

Understanding the genetic component of liver enzyme levels is crucial for accurate interpretation of test results. In some cases, genetic testing may be recommended to identify specific variations that could explain persistent enzyme elevations or to assess the risk of hereditary liver diseases.

Strategies for Maintaining Healthy Liver Enzyme Levels

Maintaining healthy liver enzyme levels is crucial for overall liver health and function. What strategies can individuals employ to keep their AST and ALT levels within normal ranges?

1. Limit alcohol consumption: Excessive alcohol intake is a leading cause of liver damage and elevated enzymes.
2. Maintain a healthy weight: Obesity is closely linked to nonalcoholic fatty liver disease and elevated liver enzymes.
3. Follow a balanced diet: A diet rich in fruits, vegetables, whole grains, and lean proteins supports liver health.
4. Exercise regularly: Moderate exercise can help reduce liver fat and improve enzyme levels.
5. Avoid unnecessary medications: Consult with healthcare providers about the potential liver effects of medications and supplements.
6. Protect against viral hepatitis: Practice safe sex, avoid sharing needles, and consider vaccination for hepatitis A and B.
7. Manage chronic conditions: Properly control conditions like diabetes and high cholesterol, which can impact liver health.
8. Stay hydrated: Adequate water intake supports overall liver function and detoxification processes.

How effective are these strategies in improving liver enzyme levels? Many individuals with mildly elevated liver enzymes can see significant improvements by implementing these lifestyle changes. However, it’s important to work closely with healthcare providers, especially if elevations persist or are accompanied by symptoms of liver disease.

The Impact of Stress on Liver Enzyme Levels

Chronic stress can have far-reaching effects on overall health, including liver function. Can stress influence AST and ALT levels?

While stress itself may not directly cause significant elevations in liver enzymes, it can contribute to behaviors and conditions that impact liver health. Stress can lead to increased alcohol consumption, poor dietary choices, and disrupted sleep patterns, all of which can affect liver function. Additionally, stress-related hormones like cortisol can influence metabolism and potentially contribute to fatty liver disease.

Managing stress through techniques such as meditation, regular exercise, and adequate sleep can support overall liver health and potentially help maintain normal enzyme levels.

Emerging Research in Liver Function Testing

The field of liver function testing is continually evolving, with researchers exploring new biomarkers and technologies to enhance diagnostic accuracy and provide earlier detection of liver diseases. What are some promising developments in liver function assessment?

• Novel biomarkers: Researchers are investigating new proteins and metabolites that may offer more specific indications of liver damage or disease progression.
• Non-invasive imaging techniques: Advanced imaging methods, such as magnetic resonance elastography, are being refined to assess liver fibrosis and steatosis without the need for biopsy.
• Genetic and epigenetic markers: Studies are exploring how genetic variations and epigenetic changes can predict liver disease risk and progression.
• Artificial intelligence: Machine learning algorithms are being developed to analyze complex patterns in liver function data, potentially improving diagnostic accuracy and predicting disease outcomes.

How might these advancements impact future liver health assessments? As research progresses, we may see more personalized approaches to liver function testing, taking into account individual genetic profiles, lifestyle factors, and specific disease risks. This could lead to earlier detection of liver problems and more targeted interventions to prevent disease progression.

The Role of Gut Health in Liver Function

Emerging research is highlighting the intricate relationship between gut health and liver function, often referred to as the gut-liver axis. How does gut health influence liver enzyme levels and overall liver health?

The gut microbiome plays a crucial role in metabolizing nutrients, producing beneficial compounds, and maintaining the intestinal barrier. Disruptions in gut health can lead to increased intestinal permeability, allowing harmful substances to enter the bloodstream and potentially impact the liver. This process, known as “leaky gut,” has been associated with various liver conditions, including nonalcoholic fatty liver disease and alcoholic liver disease.

Supporting gut health through a balanced diet rich in fiber, probiotics, and prebiotics may contribute to maintaining healthy liver function and enzyme levels. Future liver function assessments may incorporate markers of gut health to provide a more comprehensive picture of liver status and disease risk.

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.