What are normal liver function numbers. How do high and low AST and ALT levels affect health. What causes abnormal liver enzyme results. What symptoms indicate potential liver issues.

The Vital Functions of the Liver

The liver, situated in the upper right abdomen beneath the rib cage, performs numerous crucial functions essential for life. These include:

• Detoxifying blood
• Producing clotting factors, albumin, and other important proteins
• Metabolizing medications and nutrients
• Processing waste products from hemoglobin and other cells
• Storing vitamins, fat, cholesterol, and bile
• Producing glucose during periods of fasting

Given its multifaceted role, maintaining optimal liver function is critical for overall health and wellbeing.

Common Liver Function Blood Tests

Liver function tests are among the most frequently performed blood tests. They serve to assess liver function and detect potential liver damage. The initial step in identifying liver issues often involves measuring the levels of certain liver enzymes in the blood.

Under normal circumstances, these enzymes primarily reside within liver cells. However, when the liver sustains injury, these enzymes are released into the bloodstream. Elevated enzyme levels in the blood can therefore indicate liver damage or disease.

Key Liver Enzymes: AST and ALT

Among the most sensitive and widely used indicators of liver health are the aminotransferases, specifically:

• Aspartate aminotransferase (AST), also known as serum glutamic oxaloacetic transaminase (SGOT)
• Alanine aminotransferase (ALT), also known as serum glutamic pyruvic transaminase (SGPT)

These enzymes are predominantly found in liver cells and, to a lesser extent, in muscle cells. When liver cells are damaged, AST and ALT are released into the blood, causing their levels to rise and signaling potential liver issues.

Understanding AST and ALT Enzymes

Aminotransferases are enzymes that catalyze chemical reactions in which an amino group is transferred from one amino acid to another molecule. This process is crucial for various metabolic functions in the body.

Where are AST and ALT normally found?

AST is found in various tissues, including the liver, heart, muscles, kidneys, and brain. Its presence in multiple organs means that elevated AST levels may not necessarily indicate liver-specific issues. ALT, on the other hand, is predominantly found in the liver, making it a more specific indicator of liver health.

Normal Levels of AST and ALT

Understanding the normal ranges for AST and ALT is crucial for interpreting liver function test results. What are the typical values for these enzymes?

• AST (SGOT): The normal range is typically between 5 to 40 units per liter of serum.
• ALT (SGPT): Normal values usually fall between 7 to 56 units per liter of serum.

It’s important to note that these ranges may vary slightly depending on the laboratory techniques and protocols used. Always consult with a healthcare professional to interpret your specific test results.

Causes of Elevated Liver Enzymes

Elevated liver enzymes can be indicative of various liver conditions or other health issues. What factors can lead to increased AST and ALT levels?

• Viral hepatitis (hepatitis A, B, C)
• Alcoholic liver disease
• Nonalcoholic fatty liver disease (NAFLD)
• Medications (e.g., acetaminophen, statins)
• Autoimmune hepatitis
• Hemochromatosis (iron overload)
• Wilson’s disease (copper accumulation)
• Celiac disease
• Muscle disorders or injury
• Heart conditions (for AST)

It’s crucial to understand that elevated liver enzymes are not a diagnosis in themselves but rather a sign that further investigation may be necessary to determine the underlying cause.

Symptoms of Liver Disease

While liver enzyme tests can indicate potential liver issues, what symptoms might an individual experience if they have liver disease? Common signs include:

• Nausea and vomiting
• Jaundice (yellowing of the skin and eyes)
• Fatigue and weakness
• Shortness of breath
• Easy bruising or bleeding
• Swelling in the legs and ankles
• Abdominal pain or swelling
• Dark urine color
• Pale, bloody, or tar-colored stool
• Chronic itching

If you experience any of these symptoms, especially in combination with abnormal liver function test results, it’s essential to consult a healthcare provider promptly.

Interpreting Liver Function Test Results

Interpreting liver function test results requires consideration of various factors. How can healthcare providers accurately assess these results?

1. Consider the ratio of AST to ALT: In most types of liver disease, ALT levels are higher than AST levels. However, in alcoholic liver disease, AST levels are often higher than ALT levels.
2. Evaluate the degree of elevation: Mild elevations (less than 5 times the upper limit of normal) may indicate different conditions than severe elevations (more than 15 times the upper limit of normal).
3. Assess other liver function markers: Additional tests such as alkaline phosphatase, bilirubin, and albumin can provide a more comprehensive picture of liver health.
4. Consider patient history: Factors such as alcohol consumption, medication use, and existing medical conditions can help contextualize test results.
5. Look for patterns over time: Serial measurements can help track disease progression or improvement in response to treatment.

It’s important to remember that liver function tests are just one piece of the diagnostic puzzle. Additional imaging studies, such as ultrasound or CT scans, may be necessary to visualize the liver and detect any structural abnormalities.

Treatment Options for Abnormal Liver Function

When liver function tests reveal abnormalities, what treatment options are available? The appropriate course of action depends on the underlying cause of the liver dysfunction. Some general approaches include:

• Lifestyle modifications: Reducing alcohol consumption, maintaining a healthy weight, and exercising regularly can improve liver health.
• Dietary changes: A balanced diet rich in fruits, vegetables, and whole grains can support liver function. Limiting processed foods and saturated fats is also beneficial.
• Medication adjustments: If certain medications are causing liver enzyme elevations, alternative treatments may be considered.
• Treating underlying conditions: Addressing primary diseases such as viral hepatitis, autoimmune disorders, or metabolic conditions can help normalize liver function.
• Antiviral therapy: For viral hepatitis, antiviral medications can help suppress the virus and reduce liver inflammation.
• Liver transplantation: In severe cases of liver failure, a liver transplant may be necessary.

The key to effective treatment is early detection and intervention. Regular check-ups and liver function tests can help identify potential issues before they become more serious.

Natural Remedies for Liver Health

While medical treatments are often necessary for liver conditions, certain natural remedies may support liver health. These include:

• Milk thistle: This herb contains silymarin, which may have protective effects on the liver.
• Turmeric: Curcumin, the active compound in turmeric, has anti-inflammatory properties that may benefit liver health.
• Green tea: Rich in antioxidants, green tea may help reduce fat accumulation in the liver.
• Garlic: Some studies suggest garlic may help reduce fat accumulation in the liver and have protective effects against liver damage.
• Coffee: Regular coffee consumption has been associated with a lower risk of liver disease progression.

It’s important to note that while these natural remedies may offer some benefits, they should not replace professional medical advice or prescribed treatments. Always consult with a healthcare provider before starting any new supplement regimen.

Prevention of Liver Disease

Preventing liver disease is often easier than treating it. What steps can individuals take to maintain optimal liver health?

1. Limit alcohol consumption: Excessive alcohol intake is a leading cause of liver disease. Stick to recommended guidelines or avoid alcohol altogether.
2. Maintain a healthy weight: Obesity is a risk factor for nonalcoholic fatty liver disease. A balanced diet and regular exercise can help manage weight.
3. Practice safe sex and hygiene: This can reduce the risk of contracting hepatitis B and C viruses.
4. Get vaccinated: Vaccines are available for hepatitis A and B.
5. Use medications responsibly: Follow prescribed dosages and avoid mixing medications with alcohol.
6. Avoid exposure to toxins: Be cautious when using cleaning products, insecticides, and other chemicals.
7. Stay hydrated: Adequate water intake helps the liver perform its detoxification functions more efficiently.
8. Limit processed foods: A diet high in processed foods and added sugars can contribute to fatty liver disease.

By adopting these preventive measures, individuals can significantly reduce their risk of developing liver disease and maintain healthy liver function.

The Importance of Regular Liver Function Tests

Regular liver function tests play a crucial role in maintaining overall health. Why are these tests so important?

• Early detection: Liver function tests can identify potential issues before symptoms appear, allowing for earlier intervention.
• Monitoring existing conditions: For those with known liver diseases, regular tests help track disease progression and treatment effectiveness.
• Medication management: Some medications can affect liver function. Regular tests can help healthcare providers adjust dosages or switch medications if necessary.
• Overall health assessment: Liver function is indicative of overall health, and these tests can provide valuable insights into general wellbeing.

Healthcare providers typically recommend liver function tests as part of routine check-ups, especially for individuals over 40 or those with risk factors for liver disease. However, the frequency of testing may vary based on individual health status and risk factors.

Latest Advancements in Liver Function Testing

The field of liver function testing is continually evolving. What are some recent advancements in this area?

• Non-invasive imaging techniques: FibroScan and magnetic resonance elastography (MRE) can assess liver fibrosis and steatosis without the need for a biopsy.
• Genetic testing: Identifying genetic markers associated with liver diseases can help predict risk and guide personalized treatment strategies.
• Biomarker panels: Comprehensive panels that combine multiple biomarkers can provide a more accurate assessment of liver health and disease progression.
• Artificial intelligence: Machine learning algorithms are being developed to interpret liver function test results more accurately and predict disease outcomes.
• Liquid biopsies: These blood-based tests can detect circulating tumor DNA, offering a less invasive method for diagnosing and monitoring liver cancer.

These advancements are improving the accuracy of liver disease diagnosis and enabling more personalized treatment approaches. As research continues, we can expect even more sophisticated tools for assessing and managing liver health in the future.

The Role of Liver Function in Overall Health

The liver’s influence extends far beyond its immediate functions. How does liver health impact overall wellbeing?

• Metabolism: The liver plays a crucial role in processing nutrients, affecting energy levels and weight management.
• Immune function: A healthy liver supports the immune system, helping to fight off infections and diseases.
• Hormone balance: The liver metabolizes hormones, influencing everything from mood to reproductive health.
• Cardiovascular health: Liver function is closely tied to cholesterol metabolism and cardiovascular risk.
• Brain function: Liver disease can lead to hepatic encephalopathy, affecting cognitive function.
• Skin health: Liver issues can manifest in skin problems, such as jaundice or pruritus.

Given its wide-ranging influence, maintaining optimal liver function is essential for overall health and quality of life. Regular check-ups, a healthy lifestyle, and prompt attention to any liver-related concerns can help ensure that this vital organ continues to perform its many crucial functions effectively.

Liver Function 101 – Geoff Beats Leukemia

What are the basic functions of the liver?

The liver is located in the right upper portion of the abdominal cavity just beneath the rib cage. The liver has many functions that are vital to life. Briefly, some of the important functions of the human liver are:

• Detoxification of blood
• Production of important clotting factors, albumin, and many other important proteins
• Metabolizing (processing) medications and nutrients
• Processing of waste products of hemoglobin and other cells
• Storing of vitamins, fat, cholesterol, and bile
• Production of glucose (gluconeogenesis or glucose synthesis/release during starvation)

What are common liver blood function tests?

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Liver blood tests are some of the most commonly performed blood tests. These tests can be used to assess liver functions or liver injury. 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.

Among the most sensitive and widely used liver enzymes are the aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are normally predominantly contained within liver cells and to a lesser degree in the muscle cells. If the liver is injured or damaged, the liver cells spill these enzymes into the blood, raising the AST and ALT enzyme blood levels and signaling liver disease.

Other blood tests pertaining to the liver are measurements of some of the other enzymes found the liver. In addition to AST and ALT, alkaline phosphatase, 5′ nucleotidase, and gamma-glutamyl transpeptidase (GGT) are a few of the other enzymes located in the liver. The focus of this article is mainly on the most common liver enzymes, AST and ALT.

Liver Disease Symptoms

The liver has multiple functions. It makes many of the chemicals required by the body to function normally, it breaks down and detoxifies substances in the body, and it also acts as a storage unit. When the liver is damaged from disease, medication, alcohol, or other factors., a person may have symptoms of liver disease such as

• nausea and vomiting
• jaundice (yellowing of the skin),
• fatigue,
• weakness,
• shortness of breath,
• excessive bruising or bleeding, and
• leg swelling.

Read more about liver disease »

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What are the aminotransferases enzymes (ALT, AST)?

The aminotransferases 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).

To put matters briefly, AST = SGOT and ALT = SGPT; they are enzymes produced by the liver, and other types of cells).

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Normally, where are AST and ALT (aminotransferase enzymes)?

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

What are normal levels of AST and ALT?

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• 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.

However, 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.

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What do high (elevated) liver tests (AST and ALT) mean?

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

Do AST and ALT test results indicate liver function?

It is important to clarify that ALT and AST levels do not reflect the function of the liver, even though in the medical community and in medical publications they commonly, and incorrectly, are referred to as liver function tests. Even in conditions when AST and ALT are very elevated, the liver still may function properly. Consequently, if you have “elevated liver enzymes” or a high or abnormal liver test, you need to ask your physician exactly what all of the tests indicate.

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What blood tests are done to detect liver function?

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The blood tests that truly reflect liver function are the following; normal values (ranges) listed are for adult men – women and children have similar but slightly different ranges of normal test values

• 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.

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What blood tests are done to detect liver function? (Continued)

• 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. Conversely, a large number of people 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.

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What are some common liver tests?

A series of blood tests can often find out if the liver is inflamed, injured, or working normally. These tests can also tell the difference between acute and chronic liver disorders. And they can tell the difference between hepatitis (infection or inflammation of the liver) and cholestasis (problems with the flow of bile). 

The most common blood tests are below.

Liver function tests

• Serum bilirubin test. This test measures the levels of bilirubin in the blood. Bilirubin is made by the liver and is excreted in the bile. High levels of bilirubin may mean there is a blockage of bile flow. Or it could mean a problem with how the liver processes bile.

• Serum albumin test. This test is used to measure the level of albumin. Albumin is a protein in the blood. The test may help in the diagnosis of liver disease. Low levels of albumin may mean the liver is not working normally. 

• International normalized ratio (INR). This used to be known as the prothrombin time (PT) test. This test measures how long it takes for blood to clot. Blood clotting needs vitamin K and a protein that is made by the liver. Blood that takes a long time to clot may mean liver disease. Or it may mean low levels of certain clotting factors.

Liver enzyme tests

• Serum alkaline phosphatase test. This test is used to measure the blood level of an enzyme called alkaline phosphatase. This enzyme is found in many tissues. The highest amounts are in the liver, biliary tract, and bones. This test may be done to check liver function. And it may be done to find liver lesions that may cause bile blockage, such as tumors or abscesses.

• Alanine transaminase (ALT) test. This test measures the level of alanine aminotransferase. This is an enzyme found mostly in the liver. It is released into the bloodstream after acute liver cell damage. This test may be done to check liver function. Or it may be done to check on the treatment of acute liver disease, such as hepatitis.

• Aspartate transaminase (AST) test. This test measures the level of aspartate transaminase. This is an enzyme that is found in the liver, kidneys, pancreas, heart, skeletal muscle, and red blood cells. This enzyme is released into the bloodstream after acute liver cell damage.

• Gamma-glutamyl transpeptidase (GGT) test. This test measures the level of gamma-glutamyl transpeptidase. This is an enzyme that is made in the liver, pancreas, and biliary tract. This test is often done to check liver function, to give information about liver diseases, and to see if a person has had alcohol.

• Lactic dehydrogenase test. This test can find tissue damage and may help in the diagnosis of liver disease. Lactic dehydrogenase is a type of protein. It is also called an isoenzyme. It is involved in the body’s metabolic process. But this is a very nonspecific liver test. It is rarely used for liver disease assessment.

Other diagnostic tests

Other diagnostic liver tests may be done if a specific disease is suspected. These tests include:

• Alpha-fetoprotein (AFP) test. Alpha-fetoprotein is a blood protein made by fetal tissue and by tumors. This test may be done to predict the risk for primary liver cancer (hepatocellular carcinoma). It is also done to see how well therapy is working to treat certain cancers, such as hepatoma (a type of liver cancer).

• Antimitochondrial antibodies (AMAs). These antibodies in the blood can mean primary biliary cirrhosis, chronic active hepatitis, or other autoimmune disorders. Many other antibodies are also suggestive of liver disease and can be found in blood.

• Serum alpha-1 antitrypsin test (A1AT). This test measures the levels of alpha-1 antitrypsin in the blood. This test is done to help find a rare form of emphysema in adults. And it is done to find a rare form of liver disease (cirrhosis) in children and adults.

• Viral hepatitis tests. These check if you have or had hepatitis A, B, C, D, or E. In the U.S., hepatitis D and E are uncommon.

• Certain blood tests can suggest metabolic liver disease in people with obesity, diabetes, high blood pressure, heart disease, and high cholesterol.

Online Medical Reviewer:
Jen Lehrer MD

Online Medical Reviewer:
L Renee Watson MSN RN

Online Medical Reviewer:
Marianne Fraser MSN RN

Date Last Reviewed:
5/1/2022

© 2000-2023 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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Direct bilirubin in a blood test: value and norms

Content

• 1 Direct bilirubin in a biochemical blood test: features and value of the indicator
  • 1. 1 Direct bilirubin: what is it?
  • 1.2 How is direct bilirubin formed in the body?
  • 1.3 The value of direct bilirubin in the blood
    • 1.3.1 Why measure the level of direct bilirubin in the blood?
  • 1.4 What diseases are accompanied by changes in the level of direct bilirubin?
  • 1.5 How is direct bilirubin tested?
  • 1.6 Normal levels of direct bilirubin in the blood
  • 1.7 Elevated level of direct bilirubin: what does it mean?
  • 1.8 Causes of an increase in the level of direct bilirubin in the blood
  • 1.9 Decrease in the level of direct bilirubin in the blood: causes and consequences
  • 1.10 What reasons can there be for a decrease in the level of direct bilirubin?
  • 1.11 What measures should be taken if the level of direct bilirubin in the blood changes?
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What is direct bilirubin?
      • 1.13.0.2 What is the significance of direct bilirubin in a blood test?
      • 1. 13.0.3 What are normal direct bilirubin values?
      • 1.13.0.4 What diseases can cause elevated levels of direct bilirubin?
      • 1.13.0.5 What symptoms may indicate an elevated level of direct bilirubin?
      • 1.13.0.6 How can direct bilirubin be reduced?

Direct bilirubin is one of the indicators of a biochemical blood test, which is important for the diagnosis of diseases of the liver and biliary tract. Find out what direct bilirubin is and what are the reasons for its increase and decrease.

One of the main indicators of a blood test is bilirubin. It is a breakdown product of hemoglobin and its correct amount in the blood is the main indicator of the normal functioning of the liver and biliary tract. Bilirubin can be indirect and direct. If indirect bilirubin is responsible for toxicity and excretion of bile, then direct is responsible for the process of excretion of bilirubin with bile.

Direct bilirubin is diagnosed with blood. The value of this type of bilirubin can show the presence of diseases of the liver, biliary tract. In addition, direct bilirubin can also indicate chronic and congenital diseases such as hemolytic jaundice.

The degree of direct bilirubin deviation from the norm is important for determining the doctor’s further actions. Remember that only an experienced specialist will be able to give a definitive diagnosis, but the earlier the deviation is established, the better the prognosis for recovery.

Important to remember! Find out your level of direct bilirubin during a preventive examination. Diseases can noticeably degrade your health, and in time a certain disease completely solves the problem.

Direct bilirubin: what is it?

Direct bilirubin is one of two types of bilirubin that enters the blood after biliverdin is oxidized. It is a hematic pigment, which is formed from the heme contained in the hemoglobin of erythrocytes during their destruction.

Direct bilirubin gets its name from its ability to react directly with reagents in biochemical analyzers, which is different from total bilirubin.

Direct bilirubin analysis allows diagnosing a number of diseases of the liver and biliary tract, such as hepatitis, cholelithiasis, cirrhosis and others.

How is the formation of direct bilirubin in the body?

Direct bilirubin is a breakdown product of hemoglobin that is formed in the liver and excreted into bile. The process of formation of direct bilirubin begins with phagocytosis (absorption) of red blood cells, which are then destroyed in macrophages located in the spleen and bone marrow. As a result of the destruction of hemoglobin, unbound bilirubin is formed, which is transported through the blood to the liver.

In the liver, unbound bilirubin combines with glucuronic acid to form direct bilirubin, which is readily soluble in water and can be excreted from the body through bile and urine. Direct bilirubin is important for the proper functioning of the liver and gallbladder, and its level in the blood may indicate the presence of diseases in these organs.

The normal level of direct bilirubin in the blood is not more than 5.1 µmol/l. An increase in the level of direct bilirubin may indicate diseases of the biliary tract, liver, and other pathologies. It is important to regularly monitor the level of direct bilirubin in the blood in order to timely detect the presence of possible diseases and begin their treatment.

Direct bilirubin value in blood

Why measure direct bilirubin in blood?

Direct bilirubin is a bile pigment that is produced in the liver and is responsible for removing waste products from the body. Because of this, measuring direct bilirubin is one of the main blood tests to help diagnose gallbladder and liver disease.

Measurement of direct bilirubin can also be used to monitor the progress of treatment and evaluate its effectiveness. All of the above speaks to the importance of measuring the level of direct bilirubin in the blood for the diagnosis, treatment and control of diseases of the liver and gallbladder.

What diseases are accompanied by changes in the level of direct bilirubin?

Direct bilirubin is an indicator of the function of the liver and biliary tract. A change in the level of direct bilirubin may indicate the presence of certain diseases:

• Cholestasis – a decrease in the production and excretion of bile, which is accompanied by an increase in the level of direct bilirubin. This may be caused by an obstruction of the bile ducts or by liver dysfunction such as cirrhosis.
• Hepatitis – Inflammation of the liver can lead to elevated levels of direct bilirubin.
• Hepatosis – a metabolic disorder in the liver, which can be caused by alcoholism, diabetes and other factors, can also increase the level of direct bilirubin.
• Hemolytic anemia – increased destruction of red blood cells can increase direct bilirubin levels.

Of course, an increased level of direct bilirubin may be due to other reasons, but in any case, an additional examination and consultation with a doctor is required to establish an accurate diagnosis and prescribe treatment.

How is direct bilirubin tested?

Direct bilirubin is one of the indicators of the functioning of the liver and biliary tract. It is involved in the formation of bile and its excretion from the body through the intestines.

To test for the level of direct bilirubin in the blood, you must pass a complete blood count or a biochemical blood test. Usually, blood serum is used for analysis, which is taken from a vein on an empty stomach.

About possible preparation for the test: Alcohol and drugs should be avoided a few days before the test, unless otherwise instructed by the doctor. Blood for analysis must be taken strictly on an empty stomach so that the results are not distorted.

Normal levels of direct bilirubin in the blood

Direct bilirubin is part of the total bilirubin that is formed in the liver and excreted in the bile into the intestines. The normal level of direct bilirubin in the blood should be less than 4. 3 µmol/L.

This value may vary slightly depending on the testing laboratory and the age of the patient. The level of direct bilirubin in newborns can be elevated up to 17 µmol/l, and this is considered normal during the first two weeks of life.

If the level of direct bilirubin in the blood exceeds the norm, this may be a sign of various pathologies associated with the liver, biliary tract or hematopoietic system. Therefore, if an increased level of direct bilirubin is detected, it is necessary to consult a doctor for diagnosis and treatment.

Elevated direct bilirubin: what does it mean?

Direct bilirubin is an important indicator in the composition of total bilirubin, which is a breakdown product of hemoglobin and other breakdown products of red blood cells. Direct bilirubin is glucuronidated bilirubin that is secreted into the intestine and excreted from the body in the feces during the process of bile formation. Elevated levels of direct bilirubin often indicate a reduced level of bile acids in the intestine or impaired bile transport, which indicates the presence of bile-producing or bile-excreting pathology.

Norms of direct bilirubin in the blood vary depending on the methods of determination. Usually its rate does not exceed 4.3 µmol / l. If the level of direct bilirubin is higher than normal, then it is necessary to conduct an additional examination to identify the reasons for the increase in the indicator and prescribe adequate therapy.

Causes of an increase in the level of direct bilirubin in the blood

Impaired liver function. An increase in direct bilirubin levels may be associated with impaired liver function, since this organ is the main site of bilirubin metabolism in the body. These can be liver diseases such as hepatitis, cirrhosis, cancer, and others.

Obesity. Usually with obesity, the level of direct bilirubin increases against the background of other abnormal liver function. Obesity and metabolic syndrome are a great health hazard, as they can cause the development of serious diseases.

Diseases of the biliary tract. Bile flow disorders such as cholelithiasis, cholangitis, gallbladder dyskinesia can lead to increased levels of direct bilirubin in the blood.

Violation of the processes of formation and decay of hemoglobin. In some diseases, including congenital metabolic disorders, globinopathy, trauma and blood loss, there is a violation of the formation and breakdown of hemoglobin, which can lead to an increase in the level of direct bilirubin in the blood.

Taking drugs. Some drugs, such as antibiotics, anesthetics, antiemetics, can cause an increase in the level of direct bilirubin in the blood. Therefore, before starting any medication, it is necessary to consult a doctor and report the presence of any diseases.

Reduced direct bilirubin in the blood: causes and consequences

Direct bilirubin is a bile pigment produced in the liver from the breakdown of red blood cell hemoglobin. The level of direct bilirubin in the blood is an important indicator of the function of the liver and biliary tract. A decrease in direct bilirubin levels can have various causes and consequences, which we will discuss below.

Causes of decreased direct bilirubin:

1. Violation of the liver when it cannot produce enough direct bilirubin;
2. Obstruction of the bile ducts, when direct bilirubin cannot enter the intestine and be excreted in the feces, leading to its accumulation in the blood;
3. Congenital disorders of bilirubin metabolism, such as Gilbert’s syndrome, in which the activity of enzymes involved in the formation of direct bilirubin is reduced.

Consequences of decreased direct bilirubin:

• Various diseases of the liver and biliary tract, such as hepatitis, cirrhosis, cholelithiasis;
• Violation of iron metabolism, which can lead to anemia;
• Violation of the metabolism of drugs, since bilirubin affects their metabolism in the liver.

Thus, a decrease in the level of direct bilirubin is an important symptom that may indicate various diseases and disorders in the body. If you notice changes in direct bilirubin levels in a blood test, see your doctor for diagnosis and treatment.

What are the reasons for the decrease in the level of direct bilirubin?

Direct bilirubin is one of the main indicators used in a blood test to assess the functioning of the liver and biliary tract. A decrease in the level of direct bilirubin in the blood may indicate the presence of various diseases and abnormalities.

• Insufficient liver performance. If the liver is not working properly, then the production of direct bilirubin may decrease.
• Viral infections. Some viruses (eg viral hepatitis) can affect the functioning of the liver and lead to a decrease in the level of direct bilirubin.
• Disorders of bile secretion. Improper functioning of the biliary tract can lead to a decrease in the production of direct bilirubin.
• Gallbladder disease. Diseases such as cholecystitis or gallstones can make it difficult for bile to flow back and lead to low direct bilirubin levels.

Thus, a decrease in the level of direct bilirubin may indicate various diseases and abnormalities in the liver and biliary tract. To identify a specific cause, additional diagnosis and consultation with a doctor is necessary.

What measures should be taken if the level of direct bilirubin in the blood changes?

A change in the level of direct bilirubin in the blood may indicate various diseases of the liver, gallbladder channels, blood or other organs. If the level of direct bilirubin is elevated, the following measures should be taken:

• Get additional tests: To determine the cause of the increase in direct bilirubin, you need to have an additional test, such as a liver ultrasound, MRI, CT scan, liver biopsy, or other tests.
• Initiate treatment of the disease: After determining the cause of the increase in direct bilirubin, it is necessary to begin treatment of the disease that caused this change. Treatment may include medication, surgery, or other methods, depending on the disease.
• Seek medical attention: If your direct bilirubin level is elevated, you should see a doctor who can help determine the cause and prescribe the necessary treatment. Self-medication can lead to complications and worsening of the condition.

An increase in the level of direct bilirubin in the blood is a serious symptom that requires careful and timely treatment. Unpleasant consequences can be prevented with proper diagnosis and treatment.

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Q&A:

What is direct bilirubin?

Direct bilirubin is a type of bilirubin that is formed in the liver when indirect bilirubin is processed.

What is the significance of direct bilirubin in a blood test?

Direct bilirubin is an important indicator of liver function. High levels of direct bilirubin may indicate problems with bile secretion or other liver diseases.

What are the normal values ​​of direct bilirubin?

The normal level of direct bilirubin in an adult is usually 0 to 5.1 µmol/L. In children, normal values ​​may vary depending on age.

What diseases can cause an increased level of direct bilirubin?

An elevated level of direct bilirubin may indicate the presence of various diseases, such as hepatitis, cirrhosis of the liver, gallstone disease and other diseases associated with a violation of the outflow of bile.

What symptoms may indicate an elevated level of direct bilirubin?

Symptoms that may indicate elevated direct bilirubin levels may include jaundice, skin itching, abdominal pain, nausea, and vomiting. However, usually these symptoms do not appear immediately, but only with a significant increase in bilirubin levels.

How can direct bilirubin levels be reduced?

Decreased direct bilirubin levels may be associated with treatment of the disease causing the increase. Drugs that improve the excretion of bile and reduce the level of bilirubin in the blood may also be prescribed. However, it is not recommended to try to lower the level of bilirubin on your own, as this can be dangerous to health.

How to understand liver elastography results (FibroScan®)

This information will help you understand FibroScan results. Your doctor will discuss your results with you and provide additional information at the time of your appointment.

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About Liver Elastography and FibroScan

Liver Elastography is a non-invasive test your healthcare provider can use to look at your liver. “Non-invasive” means that no instruments are inserted into your body.

FibroScan is a type of liver elastography. FibroScan is a special ultrasound technology that measures the stiffness (hardness) of the liver and fatty liver. These measurements give the healthcare provider more information about your liver disease.

Below are some useful terms related to FibroScan results.

• Fibrosis: scarring of liver tissue.
• Stiffness of the liver: hardness of the liver associated with scarring of its tissues.
• Fatty degeneration: abnormal accumulation of fat in the liver.
• Steatosis: a condition caused by excessive fat in the liver.
• CAP score: is the index of fat degeneration in percentage terms.

Fibrosis and steatosis are measured separately. Your health care provider will discuss your results at the time of your appointment.

The following is a more detailed explanation of the FibroScan results. As you continue reading, you will learn more about your results.

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About the CAP score

Your healthcare provider will use the CAP score to determine the degree of steatosis. The CAP score is measured in decibels per meter (dB/m). It varies in the range from 100 to 400 dB/m. The CAP score and the degree of steatosis may increase or decrease over time.

The table below shows the ranges of CAP scores and their respective degrees of steatosis. It shows which part of the liver is affected by the process of fat accumulation. In a healthy liver, the amount of fatty degeneration can be up to 5%. Values ​​below 238 dB / m mean that the amount of fatty degeneration in your liver does not exceed the norm.

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About the result of measuring liver stiffness

Liver stiffness is measured in kilopascals (kPa). Normal results are usually in the range of 2 to 7 kPa. If you have liver disease, your results may be higher than normal. The maximum possible result is 75 kPa.

Using a Liver Stiffness Test to Score Fibrosis

Your healthcare provider uses a Liver Stiffness test and your medical record to determine the stage of fibrosis. Your results may range from normal to advanced.

• Normal: liver scarring is absent or mild.
• Moderate or severe: scarring of liver tissue that can be corrected (removed) by treatment of liver disease. Proper nutrition and the transition to a healthy lifestyle can slow or reverse the process of scarring of liver tissue. With moderate scarring of the liver tissue, you may not have any symptoms.
• Running stage: cirrhosis is a late form of scarring of the liver tissues in an advanced stage. This condition develops over time with chronic (long-term) liver disease.

You can use the following chart to check your liver condition. It’s based on your diagnosis, liver stiffness and fibrosis. Not all diseases are listed in the table. If you do not see your condition, ask your healthcare provider to review your results with you. If you have been diagnosed with multiple liver diseases, this table may not apply.

How to use the table:

1. Find your diagnosed liver disease in the first column on the left.
2. Find your liver stiffness measurement in the second column from the left. Follow along the line with your result. The liver stiffness ranges shown in the table are estimates (inaccurate).
3. View the rest of the values ​​in this row from left to right. The fibrosis score is listed in the third column from the left. The last column indicates the degree of scarring of the liver tissue.

Disease diagnosis	Liver stiffness result	Fibrosis stage	Your liver
Alcohol abuse disease	2-7 kPa	F0-F1	OK
	7-11 kPa	F2	Moderate hepatic scarring
	11–19 kPa	F3	Severe hepatic scarring
	19 kPa or higher	F4	Cirrhosis present
Cholestatic disease	2-7 kPa	F0-F1	OK
	7-9 kPa	F2	Moderate hepatic scarring
	9-17 kPa	F3	Severe hepatic scarring
	17 kPa or higher	F4	Cirrhosis present
Hepatitis B	2-7 kPa	F0-F1	OK
	8-9 kPa	F2	Moderate hepatic scarring
	8-11 kPa	F3	Severe hepatic scarring
	12 kPa or more	F4	Cirrhosis present
Hepatitis C	2-7 kPa	F0-F1	OK
	8-9 kPa	F2	Moderate hepatic scarring
	9-14 kPa	F3	Severe hepatic scarring
	14 kPa or more	F4	Cirrhosis present
HIV/hepatitis C co-infection	2-7 kPa	F0-F1	OK
	7-11 kPa	F2	Moderate hepatic scarring
	11–14 kPa	F3	Severe hepatic scarring
	14 kPa or more	F4	Cirrhosis present
Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH)	2-7 kPa	F0-F1	OK
	7. 5-10 kPa	F2	Moderate hepatic scarring
	10-14 kPa	F3	Severe hepatic scarring
	14 kPa or more	F4	Cirrhosis present

Pathological Conditions That May Influence the Fibrosis Result

Certain pathological conditions may cause the result of the liver stiffness measurement to be excessively elevated, causing it to be incorrect. Scarring may not be as pronounced as the result shows. It can be if you have:

• inflammation (edema) of the liver: it can be caused by a recent liver disease, as well as long-term alcohol abuse;
• benign (noncancerous) or malignant (cancerous) tumors in the liver;
• liver congestion: this means that your liver is full of blood or other fluids; it usually occurs due to heart failure.

FibroScan results may be less accurate or not available at all if you have:

• Obesity: means that your body mass index (BMI) is above 30 (high, unhealthy amount of body fat).