Liver Disease, Tests

May 07, 2021

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This sheet describes tests that may be done for liver problems. Your healthcare provider will tell you which tests you need.

Blood tests to check the liver

A small amount of blood may be taken and tested for one or more of the following:

• AFP (alpha fetoprotein). This is a protein made by the liver. A high level in the blood can be a sign of liver cancer or liver injury and regeneration in adults.
• Albumin. This is a liver function test. It measures a protein made by the liver. When a person has liver disease, the level of albumin in the blood (serum albumin) is often low.
• Alk phos (alkaline phosphatase). This is an enzyme that is mostly made in the liver and bones. It’s measured with a blood test. A high level suggests a problem with the bile ducts in the liver.
• ALT (alanine aminotransferase). ALT is an enzyme made by the liver. When the liver is damaged, ALT leaks into the blood. If a blood test finds a high level of ALT, this can be a sign of liver problems such as inflammation, scarring, or a tumor.
• Ammonia. This is a liver function test that shows when a harmful substance is left behind in the blood after digestion. Normally the liver removes ammonia from the blood and turns it into urea. This leaves the body with urine. If a blood test shows that the ammonia level is too high, this process isn’t happening as it should. This test is very inaccurate for liver function and should rarely be used.
• AST (aspartate aminotransferase). AST is another enzyme made by the liver as well as by other organs such as muscle. It too is measured with a blood test. High levels of AST may be a sign of liver injury, especially if the ALT level is also high.
• Bilirubin. This is a liver function test. It measures the yellow substance made when the body breaks down red blood cells. Bilirubin is collected by the liver to be sent out of the body with stool. When something is wrong with the liver or bile ducts, bilirubin may build up in the body. This causes yellowing of the skin and the whites of the eyes (jaundice). Two measurements may be taken from this test: total bilirubin and direct bilirubin. A high bilirubin level may be the result of liver disease or a blockage in the bile ducts. A high indirect bilirubin can mean a condition called Gilbert syndrome. Only a small portion of people have Gilbert syndrome. Gilbert syndrome is not a sign of disease. A high indirect bilirubin can also be a sign of rapid red blood cell breakdown.
• CBC (complete blood count). This is a test that measures all the parts of the blood. These are red blood cells, white blood cells, and platelets. Problems with these counts can mean infection or illness. They can also be a sign of a problem with the spleen. The spleen is an organ close to the liver that can be affected by liver disease. A low platelet count is common with advanced fibrosis of the liver. It also happens when the spleen becomes enlarged and begins to absorb platelets.
• GGT (gamma-glutamyl transpeptidase). This is a liver enzyme that’s often measured along with other enzymes to gauge liver problems. GGT is measured with a blood test. If alk phos and GGT are both higher than normal, it may be a sign that the bile ducts in the liver may be diseased or blocked. It also can be a sign of fatty liver or alcohol damage.
• Glucose. This is a sugar in the blood and the body’s most important source of energy. A healthy liver helps the body maintain a normal glucose level. If a blood test shows that glucose is low, this may mean the liver is not working properly.
• Infectious hepatitis. This is a disease and can be found with antibody and antigen tests for Hepatitis A, B, C, D, and E.
• PT (prothrombin time) or INR (international normalized ratio). This checks how long it takes for blood to form clots. The liver makes a protein that helps with clotting. Problems with clotting can be a sign of liver disease. 
• 5NT (5′-nucleotidase). This is enzyme is made is several organs, but only released into the blood by the liver. A high or low level may be a sign of liver disease.
• SBA (serum bile acid). This test measures the amount of bile acid in the blood. A high level may mean that bile ducts are blocked or that the liver is unable to excrete bile acid. This test is rarely done.
• Vitamins A, D, E, and K. These vitamins are stored in the liver and fat and released over time (fat-soluble). They are absorbed by the liver, with help from bile. If a blood test shows that these vitamin levels are low, this could mean the liver is not absorbing them properly.
• Zinc. This is a nutrient that is absorbed by the liver. If a blood test shows a low zinc level, this could mean the liver isn’t absorbing zinc properly. This can worsen conditions brought on by high levels of ammonia.

Several other lab tests may be done to check for specific liver problems once liver damage is found. These include:

• Autoimmune antibodies
• Ceruloplasmin (Wilson disease)
• An iron panel (hemochromatosis)
• Alpha-1-antitrypsin (alpha-1-antitrypsin deficiency)

Other tests to check the liver

The tests below may be done to check the liver’s condition or function. These tests can also check related organs, such as the gallbladder or bile ducts.

• Liver biopsy. This is a test to look for damage in liver tissue. A needle is used to take a small amount of tissue from the liver. The tissue is sent to a lab, where it is checked for signs of inflammation, scarring, or other problems.
• CT scan. A CT scan is a series of X-rays that make a 3-D picture of the liver and gallbladder. This can show gallstones, abscesses, abnormal blood vessels, or tumors.
• ERCP (endoscopic retrograde cholangiopancreatography). This test can show if the bile ducts are blocked or narrowed. It can also take pictures of the gallbladder. During this test, a small flexible tube (endoscope) is put into the mouth. The tube is moved down the esophagus and stomach to the top of the small intestine. This is where the bile ducts are. Dye is released through the tube to make the bile ducts show up on an X-ray. The healthcare provider may also use small tools to take tiny samples of tissue or fluid. These are sent to a lab to be studied.
• HIDA scan. This test checks gallbladder and liver function. A small amount of radioactive fluid is put into the body. This fluid will be seen on a scan as it travels through the liver to the gallbladder and into the intestine. It can show if bile ducts are missing or blocked. It can show if the gallbladder is working properly. It can also show other problems in the bile ducts.
• MRI. This test uses magnets, radio waves, and a computer to create an image of the organs and tissues in your body.
• MRCP (magnetic resonance cholangipancreatography). This is a type of MRI that is more detailed than a standard MRI. It can show abnormal or narrow bile ducts, tumors, gallstones, or all three.
• Ultrasound (sonogram). This test uses harmless sound waves and a computer to create a picture of the liver, gallbladder, and bile ducts. It can show gallstones, tumors, or fat in the liver. It is also used to check the condition of the blood vessels and look for bile collections where bile may leak out of the liver. A special ultrasound called elastography gives more information about scarring in the liver (cirrhosis.)

StayWell last reviewed this educational content on 3/1/2020

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Gilbert’s syndrome – NHS

In Gilbert’s syndrome, slightly higher than normal levels of a substance called bilirubin build up in the blood.

Bilirubin is a yellow substance found naturally in the blood. It forms as a by-product when old red blood cells are broken down.

Symptoms of Gilbert’s syndrome

Most people with Gilbert’s syndrome have occasional and short-lived episodes of yellowing of the skin and whites of the eyes (jaundice). It’s caused by the build-up of bilirubin in the blood.

Jaundice may be less obvious if you have brown or black skin, but you may notice the white part of your eyes looks yellow.

As Gilbert’s syndrome usually only causes a slight increase in bilirubin levels, the yellowing of jaundice is often mild. The eyes are usually affected most.

Around 1 in 3 people with Gilbert’s syndrome do not experience any symptoms at all.

You may not realise you have Gilbert’s syndrome until tests for an unrelated problem are carried out.

When to see a GP

See a GP if you have an episode of jaundice for the first time.

The jaundice of Gilbert’s syndrome is usually mild, but jaundice can be associated with more serious liver problems, such as cirrhosis or hepatitis C.

It’s important to get immediate medical advice from a GP if you have jaundice. If you cannot get in touch with a GP, call NHS 111 or your local out-of-hours service for advice.

If you have been diagnosed with Gilbert’s syndrome, you do not usually need to get medical advice during an episode of jaundice, unless you have additional or unusual symptoms.

Causes of Gilbert’s syndrome

Gilbert’s syndrome is a genetic condition that runs in families.

People with the syndrome have a faulty gene, which causes the liver to have problems removing bilirubin from the blood.

Normally, when red blood cells reach the end of their life (after about 120 days), haemoglobin, the red pigment that carries oxygen in the blood, breaks down into bilirubin.

The liver converts bilirubin into a water-soluble form, which passes into bile (a fluid produced by the liver to help with digestion) and is eventually removed from the body in pee or poo.

In Gilbert’s syndrome, the faulty gene means bilirubin is not passed into bile at the normal rate. Instead, it builds up in the bloodstream, giving the skin and whites of the eyes a yellowish tinge.

Other than inheriting the faulty gene, there are no known risk factors for developing Gilbert’s syndrome. It’s not related to lifestyle habits, environmental factors or serious underlying liver problems, such as cirrhosis or hepatitis C.

Triggers of jaundice episodes

People with Gilbert’s syndrome often find there are certain triggers that can bring on an episode of jaundice.

Episodes are often linked to things that can cause physical or mental stress including:

• being dehydrated
• going without food for long periods of time (fasting)
• drinking too much alcohol (keep within the recommended weekly units of alcohol)
• being ill with an infection
• heavy physical exertion
• not getting enough sleep
• having surgery
• having a period

Where possible, avoiding known triggers can reduce your chance of having episodes of jaundice.

Who’s affected

Gilbert’s syndrome is common, but it’s difficult to know exactly how many people are affected because it does not always cause obvious symptoms.

In the UK, it’s thought at least 1 in 20 people (probably more) are affected by Gilbert’s syndrome. It’s more common in people with type 1 diabetes.

Gilbert’s syndrome affects more men than women. It’s usually diagnosed in a person’s late teens or early 20s.

Diagnosing Gilbert’s syndrome

Gilbert’s syndrome can be diagnosed using a blood test to measure the levels of bilirubin in your blood and a liver function test.

When the liver is damaged, it releases enzymes into the blood. At the same time, levels of proteins that the liver produces to keep the body healthy begin to drop.

By measuring the levels of these enzymes and proteins, it’s possible to build up a reasonably accurate picture of how well the liver is functioning.

If the test results show you have high levels of bilirubin in your blood, but your liver is otherwise working normally, a confident diagnosis of Gilbert’s syndrome can usually be made.

Sometimes, a genetic test may be necessary to confirm a diagnosis of Gilbert’s syndrome.

Living with Gilbert’s syndrome

Gilbert’s syndrome is a lifelong condition. But it does not require treatment because it does not pose a threat to health and does not cause complications or an increased risk of liver disease.

Episodes of jaundice and any associated symptoms are usually short-lived and eventually pass.

Changing your diet or the amount of exercise you do will not affect whether you have the condition.

But it’s still important to make sure you eat a healthy, balanced diet and get plenty of exercise.

You may find it useful to avoid the things you know trigger episodes of jaundice, such as dehydration and stress.

If you have Gilbert’s syndrome, the problem with your liver may also mean you’re at risk of developing jaundice or other side effects after taking certain medicines, such as medicines for high cholesterol like statins.

You should talk to a GP before taking any new medicine and make sure you mention that you have Gilbert’s syndrome to any doctors treating you for the first time.

Page last reviewed: 10 November 2021
Next review due: 10 November 2024

Aspartate aminotransferase (AST)

Aspartate aminotransferase (AST)

Aspartate aminotransferase

Aspartate Aminotransferase

Aspartate aminotransferase (AST) is an enzyme from the group of transferases. It is present in the tissues of various organs: the largest amount is found in the liver and heart, a little less in the muscles, pancreas, kidneys and brain. As a result of the destruction of the cells of these organs, the enzyme is released and enters the blood, where its concentration increases.

The level of AST is determined for the purpose of diagnosing and monitoring the course of myocardial infarction. After 6 – 8 hours from the moment of damage to the heart cells, the level of AST begins to rise, reaching a maximum amount after 24 hours, and normalizes on days 5 – 6.

An increase in both AST and ALT activity is observed in patients with diseases of the liver and biliary tract, such as hepatitis, cirrhosis, metastatic lesions. However, the level of AST increases to a lesser extent than with lesions of the cardiovascular system

In order to determine if the hepatic system or the cardiovascular system is damaged by an elevated level of AST, use the de Ritis coefficient. This is an indicator of the ratio of AST to ALT. Normally, it is 0.9 – 1.75. With lesions of the cardiovascular system, the coefficient will be more than 2, and with liver lesions – less than 0.9.

General patient preparation

Restrictions:

• in agreement with the attending physician, stop taking drugs that have a toxic effect on the liver 7 days in advance

Material: blood serum

Vehicle: vacutainer with clotting activator with/without gel phase, 5.5 ml or 8.5 ml 900 03

Sample stability:

• 8 hours at +15 – +25 ⁰ C
• 48 hours at +2 – +8 ⁰ C
• 30 days at -20 ⁰ C
• freeze only 1 time

Method: kinetic

Analyzer : Bio Chem FC-200

9 0005 Test System: Aspartate Aminotransferase Reagent Set. , High Technology inc., (USA)

Reference values ​​(normal):

The main indications for the appointment of the analysis:

• diseases of the liver and biliary tract, monitoring the effectiveness of their treatment
• diseases of the cardiovascular system
• skeletal muscle injuries
• examination of patients who take drugs toxic to the liver
• poisoning and intoxication
• infectious diseases
• purulent-septic conditions
• encephalopathy
• preoperative preparation
• autoimmune diseases

Interpretation of results:

Increased concentration:

• diseases of the liver and biliary tract (acute and chronic hepatitis, tumors, impaired bile flow, intoxication, poisoning, cirrhosis)
• diseases of the cardiovascular system (myocardial infarction, ischemia, myocarditis, pulmonary thrombosis)
• diseases or injuries of skeletal muscles (dermatomyositis, muscular dystrophy, injuries)
• acute pancreatitis
• alcohol intoxication
• purulent-septic conditions
• infectious mononucleosis
• kidney disease
• taking drugs: allopurinol, aminosalicylic acid, diclofenac, oral contraceptives, nicotinic acid, ibuprofen, indomethacin, methotrexate, papaverine, sulfonamides, captopril, cephalosporins, aminoglycosides, penicillins, fluoroquinolones, clotrimazole, heparin

Reduced concentration:

• severe liver damage, decompensated cirrhosis
• pregnancy
• chronic vitamin B deficiency ₆
• dialysis patients
• taking drugs: ascorbic acid, progesterone, rifampicin

Treatment of chronic hepatitis

Chronic hepatitis is an inflammation of the liver that lasts at least 6 months. Chronic hepatitis is much less common than acute hepatitis and can last for years or even decades. The disease is usually mild and does not cause symptoms or significant liver damage. In some cases, continuous inflammation gradually damages the liver, leading to the development of cirrhosis and liver failure.

Symptoms of chronic hepatitis

About a third of cases of chronic hepatitis develop after acute viral hepatitis; the rest – gradually, without previous acute illness.

In most cases, chronic hepatitis is asymptomatic.

General symptoms:

Malaise.
Decreased appetite.
Fatigue.

In some cases, there are:
A slight increase in body temperature.
Discomfort in the upper abdomen.
Jaundice.
Symptoms of chronic liver disease may gradually develop:
Enlargement of the spleen.
The appearance of “asterisks” of blood vessels on the skin.
Fluid retention (ascites, edema).
Other symptoms are possible, especially in young women with autoimmune hepatitis. They can appear in almost any organ system.

These symptoms include:
Acne.
Cessation of menses.
Pain in the joints.
Pulmonary fibrosis.
Inflammation of the thyroid gland and kidneys.
Anemia.

All symptoms: swelling, fever, jaundice, joint pain, lack of menstruation (amenarrhea), anemia, heaviness in the right hypochondrium, spider veins on the skin

Causes of chronic hepatitis

A common cause of chronic hepatitis is the hepatitis C virus : in 75% of cases, acute hepatitis C becomes chronic.

Less common chronic infection is caused by the hepatitis B virus, sometimes in combination with the hepatitis D virus.
Hepatitis A and E viruses do not cause chronic hepatitis.
Drugs such as methyldopa, isoniazid (tubazid), nitrofurantoin (furadonin), and possibly paracetamol can also cause chronic hepatitis, especially when taken long-term.
In children and young adults, chronic hepatitis is caused by hepatolenticular degeneration, a hereditary pathology in which copper accumulates in the liver.
In many cases, the cause of chronic hepatitis cannot be determined. It is likely that an overreaction of the immune system plays a role here, leading to the development of chronic inflammation. This condition, called autoimmune hepatitis, is more common in women.

Diagnosis of chronic hepatitis

Biochemical blood test: signs of liver pathology – increased bilirubin and liver enzymes.
Ultrasound of the liver: reveals inflammation.
Liver biopsy required for more accurate diagnosis. This makes it possible to assess the severity of inflammation and determine whether fibrosis or cirrhosis has developed, and sometimes allows you to identify the cause of hepatitis.
Serological blood test: detects antibodies to viruses B and C.
Virological test: detects the corresponding virus.
Immunological examination: detects antibodies to components of liver cells.

Spa treatment of chronic hepatitis

In chronic hepatitis, there are often pains in the right hypochondrium of a non-permanent nature, rarely paroxysmal, periodically occurring due to errors in diet or physical exertion. The pains are in the nature of aching, dull, accompanied by a feeling of pressure, heaviness, awkwardness in the right hypochondrium. Most patients have symptoms of concomitant cholecystitis. Pain can radiate to the right shoulder blade, right shoulder, right half of the chest.

Patients often have decreased appetite, nausea, sometimes belching with air or food, bitterness in the mouth, general weakness, increased fatigue, tendency to diarrhea, itching of the skin. Subicteric sclera, soft palate mucosa, liver enlargement, soreness of its edge and its varying degrees of compaction, skin hyperesthesia, pain in the gallbladder on palpation, symptoms of cholecystitis may appear; in 20% of patients, the spleen is enlarged.

Chronic hepatitis may progress to cirrhosis of the liver. In this case, the liver increases, acquires a dense, sometimes bumpy texture, its edge is pointed, but there may be no pain on palpation. A characteristic sign of liver cirrhosis is an enlarged spleen, jaundice and ascites often appear. With a far advanced disease, weakness, headache, insomnia, sometimes dilation of the veins on the anterior abdominal wall, esophagus and hemorrhoidal plexus appear.

Currently, the most common opinion is that Botkin’s disease is dominant in the origin of chronic hepatitis, although this disease can often occur as a result of other acute and chronic infections, especially intestinal ones, and also due to damage to the liver by various toxic substances. To confirm the diagnosis, it is advisable to conduct a number of functional tests.

The determination of total bilirubin and its fractions in blood serum, bile pigments and urobilin in urine, protein fractions of blood serum, sediment samples, tests for the synthesis of hippuric acid, etc.

have the greatest practical value.

Recently, enzymatic tests have been widely recognized, to a certain extent reflecting the activity of an inflammatory or dystrophic process – determining the content of glutamine pyruvic and glutamine oxaloacetic transaminase in serum, as well as the results of intravital morphological examination of the liver.

Treatment of patients with liver disease should be aimed at improving the function of liver cells, reducing inflammation, congestion in the biliary tract, etc.

Patients with diseases of the liver and gallbladder are shown a diet containing a normal amount of protein, a sufficient amount of carbohydrates, a slightly reduced amount of fat, and an increased amount of vitamins. The Institute of Nutrition for these patients recommends a diet that includes white and black bread, dairy products (butter up to 70 g for the whole day, including cooking, cottage cheese up to 400 g, sour cream in limited quantities, curdled milk, kefir, fermented baked milk, milk, mild cheese), egg white dishes, vegetable oil, soups – dairy, vegetarian and fruit, meat and fish (low-fat) boiled or in the form of steam cutlets, poultry, cereals, boiled and raw vegetables (with the exception of legumes, spinach and sorrel), berries and fruits, except for very sour ones, compotes, jelly (except cranberry), biscuits, dry biscuits.

Due to the fact that each meal is accompanied by excitation of the digestive glands, including bile secretion, frequent (5-6 times a day) meals are indicated. The daily diet should contain a sufficient amount of liquid – 5-6 glasses, including 1 glass at night. During the period of exacerbation of the disease, as well as with a combination of liver and biliary tract diseases with gastritis, stomach ulcers, colitis, diet No. 5 is indicated, containing mainly liquid, pureed food. Then black bread, raw and unrubbed vegetables and fruits are excluded from diet No. 5. The diet contains mashed soups, cereals and vegetables, minced meat and fish, kissels, jelly, fruit and berry juices, stale white bread and crackers, a small amount of butter, and enough sugar. It is advisable to prescribe to such patients the so-called sugar, compote, curd-kefir days, etc., or an “anti-inflammatory” diet (according to type No. 5 with restriction of salt, protein, fat) for 3-4 days. Prohibited: meat, fish, mushroom soups and sauces, all fried foods, canned food, smoked meats, sausages, dishes containing a lot of cholesterol – egg yolks, liver, brains, fatty meat and fish, geese, ducks, cold food.

Mineral waters are prescribed for the same indications as for patients with chronic cholecystitis.

Practical experience indicates the greater effectiveness of thermal procedures for liver diseases, in particular mud applications on the right hypochondrium and segmental temperature 38-44 °, for 15-20 minutes, every other day, a total of 8-10 procedures, as well as paraffin applications, ozocerite, peat.

A contraindication to the appointment of physical factors is hepatitis in the active phase, as well as cirrhosis of the liver.

Patients with chronic hepatitis are shown sanatorium treatment, including drinking mineral water, an appropriate diet, water procedures – mineral water baths (except hydrogen sulfide) and showers, physiotherapy exercises, climate therapy, various physical factors, primarily mud therapy.

Employees of the Pyatigorsk Institute of Balneology and Physiotherapy have shown the effectiveness of resort complex treatment of patients who have had Botkin’s disease. When referring such patients to spa treatment, they propose to be guided not only by the end date of the acute period of the disease, but also by the activity of the process in the liver. For spa treatment, patients with residual effects of Botkin’s disease are indicated, mainly in the inactive phase, in the phase of fading activity (absence or presence of mild pain syndrome, liver enlargement by no more than 1-2 cm, not enlarged spleen, normal body temperature, not sharply pronounced changes in the blood picture, slight deviations in liver function tests).

Patients with hepatitis and other etiologies (after past infections, typhoid, malaria), with secondary hepatitis due to diseases of other organs of the digestive system are indicated for spa treatment.

Patients with all forms of chronic hepatitis in the phase of exacerbation of the process and the underlying disease that caused liver damage, all forms of liver cirrhosis, especially in the presence of ascites with the presence of jaundice of any origin, tumor, echinococcus, cachexia are contraindicated for spa treatment.