What are liver function tests. How do they measure liver health. What do abnormal results indicate. When should you get liver function tests done. How can you improve your liver function naturally.

What Are Liver Function Tests and Why Are They Important?

Liver function tests (LFTs) are a series of blood tests that provide crucial information about the health and functionality of your liver. These tests measure levels of various enzymes, proteins, and other substances produced or processed by the liver. By analyzing these components, healthcare professionals can gain insights into potential liver damage, disease, or dysfunction.

LFTs are essential because they can:

• Detect early signs of liver problems before symptoms appear
• Monitor existing liver conditions and their progression
• Evaluate the effectiveness of treatments for liver diseases
• Assess potential side effects of medications on liver function
• Screen for liver abnormalities in routine health check-ups

Key Components of Liver Function Tests Explained

Liver function tests typically measure several different components. Here’s a breakdown of the main elements and what they indicate:

Enzymes

Elevated enzyme levels often suggest liver cell damage or inflammation:

• Alanine Aminotransferase (ALT): An enzyme found primarily in liver cells. High levels in the blood can indicate liver damage.
• Aspartate Aminotransferase (AST): Another enzyme present in liver cells, but also found in other tissues. Elevated levels may suggest liver damage, but are less specific than ALT.
• Alkaline Phosphatase (ALP): An enzyme found in liver, bone, and other tissues. Increased levels can indicate liver or bile duct problems, as well as certain bone diseases.
• Gamma-Glutamyl Transferase (GGT): An enzyme sensitive to alcohol consumption and certain medications. Elevated levels may indicate liver or bile duct damage.

Proteins

Protein levels can provide information about liver synthesis function:

• Albumin: The main protein produced by the liver. Low levels may indicate decreased liver function or malnutrition.
• Total Protein: Measures all proteins in the blood, including albumin. Low levels can suggest liver dysfunction or other health issues.

Bilirubin

Bilirubin is a yellowish pigment produced during the breakdown of red blood cells. Elevated levels can cause jaundice and may indicate liver problems or bile duct obstruction.

Interpreting Liver Function Test Results: What Do They Mean?

Interpreting liver function test results can be complex, as various factors can influence the outcomes. It’s crucial to consider these results in the context of an individual’s overall health, medical history, and other diagnostic information.

High Enzyme Levels

Elevated enzyme levels often indicate liver cell damage or inflammation. However, the specific pattern of elevation can provide clues about the underlying cause:

• ALT and AST elevations: May suggest viral hepatitis, alcohol-related liver disease, or drug-induced liver injury
• ALP and GGT elevations: Could indicate bile duct obstruction or cholestatic liver diseases
• Isolated GGT elevation: Often associated with alcohol use or certain medications

Low Protein Levels

Decreased albumin and total protein levels may indicate:

• Chronic liver disease
• Malnutrition
• Kidney problems
• Inflammatory conditions

Elevated Bilirubin

High bilirubin levels can result from:

• Liver disease
• Bile duct obstruction
• Increased red blood cell breakdown (hemolysis)
• Certain genetic conditions, such as Gilbert’s syndrome

It’s important to note that mild abnormalities in liver function tests can sometimes be temporary and may return to normal without intervention. Your healthcare provider will consider the overall pattern of results and may recommend repeat testing or additional diagnostic procedures if necessary.

When Should You Get Liver Function Tests Done?

Liver function tests may be recommended in various situations:

1. As part of a routine health check-up
2. If you have symptoms of liver disease (e.g., jaundice, abdominal pain, fatigue)
3. To monitor known liver conditions
4. Before starting certain medications that can affect the liver
5. To evaluate unexplained symptoms or abnormal results from other tests
6. If you have risk factors for liver disease (e.g., heavy alcohol use, obesity, viral hepatitis)

Your healthcare provider will determine the appropriate frequency of liver function tests based on your individual circumstances and health status.

Common Causes of Abnormal Liver Function Test Results

Abnormal liver function test results can stem from various conditions and factors. Some common causes include:

• Viral hepatitis (A, B, C)
• Alcohol-related liver disease
• Nonalcoholic fatty liver disease (NAFLD)
• Drug-induced liver injury
• Autoimmune liver diseases (e.g., autoimmune hepatitis, primary biliary cholangitis)
• Hereditary liver disorders (e.g., hemochromatosis, Wilson’s disease)
• Liver cancer or metastases
• Gallbladder diseases
• Heart failure
• Thyroid disorders

It’s important to remember that abnormal test results don’t always indicate liver disease. Factors such as medications, recent alcohol consumption, and even intense exercise can temporarily affect liver function test results.

Beyond Blood Tests: Other Diagnostic Tools for Liver Health

While liver function tests provide valuable information, they may not always detect mild liver disease or provide a complete picture of liver health. Healthcare providers often use additional diagnostic tools to assess liver function and structure:

Imaging Studies

• Ultrasound: A non-invasive technique that uses sound waves to create images of the liver, helping detect structural abnormalities, fatty liver, or tumors.
• CT (Computed Tomography) Scan: Provides detailed cross-sectional images of the liver, useful for identifying liver tumors, cirrhosis, or other structural changes.
• MRI (Magnetic Resonance Imaging): Offers high-resolution images of the liver and can be particularly helpful in characterizing liver lesions or assessing iron overload.

Liver Biopsy

A liver biopsy involves removing a small sample of liver tissue for microscopic examination. This procedure can provide definitive information about liver health and is often used to:

• Diagnose specific liver diseases
• Determine the severity of liver damage or inflammation
• Guide treatment decisions
• Monitor the progression of liver disease or the effectiveness of treatment

Elastography

Techniques like FibroScan use ultrasound waves to assess liver stiffness, which can indicate the presence and severity of liver fibrosis or cirrhosis without the need for an invasive biopsy.

Strategies for Improving Liver Function Naturally

If you’ve received abnormal liver function test results or simply want to support your liver health, there are several lifestyle changes and natural strategies you can implement:

1. Maintain a Healthy Diet

A liver-friendly diet can help reduce inflammation and support liver function:

• Increase intake of fruits, vegetables, and whole grains
• Choose lean proteins and healthy fats (e.g., olive oil, avocados)
• Limit processed foods, saturated fats, and added sugars
• Stay hydrated with plenty of water

2. Exercise Regularly

Physical activity can help reduce fat accumulation in the liver and improve overall liver health. Aim for at least 150 minutes of moderate-intensity exercise per week.

3. Limit Alcohol Consumption

Excessive alcohol intake can lead to liver damage. If you drink, do so in moderation or consider abstaining completely, especially if you have existing liver issues.

4. Maintain a Healthy Weight

Obesity is a risk factor for nonalcoholic fatty liver disease. Losing excess weight through a combination of diet and exercise can significantly improve liver function.

5. Avoid Toxins

Minimize exposure to environmental toxins and be cautious with medications that can affect the liver. Always follow dosage instructions and consult your healthcare provider about potential liver effects.

6. Consider Liver-Supporting Supplements

Some natural supplements may support liver health, but it’s crucial to consult with a healthcare professional before starting any new supplement regimen. Potential options include:

• Milk thistle
• N-acetyl cysteine (NAC)
• Turmeric
• Artichoke leaf extract

7. Manage Stress

Chronic stress can negatively impact liver function. Incorporate stress-reduction techniques such as meditation, yoga, or deep breathing exercises into your daily routine.

8. Get Adequate Sleep

Quality sleep is essential for overall health, including liver function. Aim for 7-9 hours of sleep per night and maintain a consistent sleep schedule.

By implementing these lifestyle changes and working closely with your healthcare provider, you can support your liver health and potentially improve abnormal liver function test results. Remember that consistency is key, and it may take time to see significant improvements in your liver function tests.

The Role of Liver Function Tests in Overall Health Management

Liver function tests play a crucial role in overall health management, extending beyond just liver-specific concerns. Here’s how these tests contribute to a comprehensive health assessment:

Early Detection of Systemic Diseases

Abnormal liver function tests can sometimes be the first indication of systemic diseases that affect multiple organs, such as:

• Metabolic disorders
• Autoimmune conditions
• Certain cancers
• Infections

Medication Management

Liver function tests are crucial for:

• Monitoring potential liver toxicity of certain medications
• Adjusting dosages of drugs metabolized by the liver
• Guiding the choice of medications in patients with existing liver disease

Assessing Nutritional Status

Protein levels measured in liver function tests, particularly albumin, can provide insights into a person’s nutritional status and overall health.

Cardiovascular Risk Assessment

Some components of liver function tests, such as GGT, have been associated with cardiovascular risk. Elevated levels may prompt further cardiovascular evaluation.

Monitoring Alcohol Use

Certain patterns in liver function tests can indicate excessive alcohol consumption, even in the absence of other clinical signs. This can be valuable for early intervention and prevention of alcohol-related health issues.

Given the liver’s central role in metabolism and detoxification, liver function tests provide a window into overall bodily health and can guide preventive strategies and treatments across various medical specialties.

In conclusion, liver function tests are a valuable tool in assessing and monitoring liver health, as well as overall bodily function. While interpreting these tests can be complex, they provide crucial information that helps healthcare providers make informed decisions about diagnosis, treatment, and prevention strategies. By understanding the significance of these tests and implementing liver-friendly lifestyle choices, individuals can take proactive steps towards maintaining optimal liver health and overall well-being.

Liver function tests (LFT) | Health Navigator NZ

A liver function test (LFT) is a blood test that measures the levels of several substances (enzymes and proteins) excreted by your liver. Levels that are higher or lower than normal can indicate liver problems.

What is a liver function test?

A liver function test (also called LFT) is a blood test that can provide information about how your liver is working. The test measures the levels of a number of proteins and enzymes that are either produced by liver cells or released into the blood when liver cells are damaged. Liver function tests cannot tell you what exactly is the condition that is causing your liver damage, however, it can provide some important clues about possible problems and further tests that can be done to find out the cause.

What conditions does the liver function tests measure?

The liver function tests is usually performed to:

• find out whether you have evidence of liver damage or inflammation
• monitor the progression and severity of your liver disease if you have an existing liver disease
• determine how well a treatment is working
• monitor side effects if you are taking prescription or non-prescription medicines that can affect liver functioning.

Causes of liver damage or inflammation include:

• infections such as hepatitis A, B or C
• gallstones
• certain medicines such as paracetamol, antibiotics or some poisons
• autoimmune diseases such as autoimmune hepatitis, primary biliary sclerosis or primary sclerosing cholangitis
• alcohol
• tumour or cancer
• physical injury or trauma
• obesity
• genetic diseases such as haemochromatosis and Wilson’s disease.

Read more about liver disease.

What does the result indicate if the result is high?

Interpreting liver function test results is not always easy and is best done in consultation with your healthcare team. They will know what is normal for you and how these results relate to your clinical picture. Often, if there is a mild abnormality, all that may be needed is to repeat the test in a month or two’s time as many changes can be temporary and return to normal.

• Alanine aminotransferase (ALT) – ALT is an enzyme in your liver. When your liver is damaged, ALT is released into your bloodstream and levels increase.
• Alkaline phosphatase (ALP) – ALP is an enzyme in your liver. Higher than normal levels may indicate liver damage such as a blocked bile duct or certain bone diseases.
• Aspartate aminotransferase (AST) – AST is an enzyme in your liver. An increase in AST levels may indicate liver damage.
• Gamma-glutamyl transferase (GGT) – GGT is an enzyme in your liver. Higher than normal levels may indicate liver or bile duct damage, side effects of certain medicines or drinking too much alcohol.
• Bilirubin – bilirubin is produced during the normal breakdown of red blood cells. Raised levels of bilirubin (called jaundice) may indicate liver damage or disease, there is blockage of your bile flow in your liver or your body is breaking down more red blood cells than usual.

What does the result indicate if the result is low?

• Albumin and total protein – albumin is the main protein made by the liver and tells whether or not the liver is making an adequate amount of this protein. Lower than normal levels of albumin and total protein may indicate liver damage or disease.

Talk to your doctor or GP to find out what your liver function tests results mean to you.

Learn more

The following is further reading that gives you more information on the full blood count test. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Blood test safety information Labtests, NZ
Liver function tests Patient Info, UK
Lab tests online  Australasian Association of Clinical Biochemists

Liver Function Tests | Liver Doctor

Some of the standard or routine blood tests that your doctor will order to check “liver function” are in reality only able to detect liver damage. These tests may not be sensitive enough to accurately reflect whether your liver is functioning at its optimum level.

These tests will usually be abnormal in significant liver disease or liver distress; however, they can still give normal readings in some cases of mild liver disease. This is why imaging tests of the liver and gallbladder, such as ultrasound scans or CAT scans or MRI scans are important. These imaging tests can determine the degree of liver disease and if there are any tumours, cysts, gallstones or fatty accumulations which change the texture of the liver.

Thankfully it is often possible to return abnormal liver function tests to normal with our dietary program.

A routine blood test for liver function will be processed by an automated multi-channel analyser, and will check the blood levels of the following:

The normal range is 0 to 20 umol/L or 0.174 to 1.04 mg/dL. This test measures the amount of bile pigment in the blood. If blood levels of bilirubin become very elevated, the patient may have a yellow colour to the skin and eyes and this is known as jaundice.

AST (aspartate aminotransferase), which was previously called SGOT, can also be elevated in heart and muscle diseases and is not liver specific.

The normal range of AST is 0 to 45 U/L

ALT (alanine aminotransferase), which was previously called SGPT, is more specific for liver damage.

The normal range of ALT is 0 to 45 U/L

ALP (alkaline phosphatase) is elevated in many types of liver disease, but also in non-liver related diseases.

The normal range of ALP is 30 to 120 U/L

GGT (gamma glutamyl transpeptidase) is often elevated in those who use alcohol or other liver-toxic substances to excess.

The normal range of GGT is 0-45 U/L.

Why do all or some of these enzymes become elevated in cases of liver disease?

Normally these enzymes are mostly contained inside the liver cells; they only leak into the blood stream when the liver cells are damaged. Thus, measuring liver enzymes is only able to detect liver damage and does not measure liver function in a highly sensitive way.

These proteins are manufactured by the liver and are measured in the blood test for liver function.

Their normal ranges are as below:

• Total protein: Normal range is 60 to 80g/L or 6 to 8g/dL
• Serum albumin: Normal range is 38 to 55g/L or 3.8 to 5.5g/dL Serum albumin is a good guide to the severity of chronic liver disease. A healthy liver manufactures plenty of albumin and falling levels of blood albumin show deteriorating liver function.
• Globulin protein: Normal range is 20 to 32g/L or 2 to 3.2g/dL. Blood levels of globulin may be abnormal in chronic liver disease. Elevated levels of globulin proteins in the blood usually mean excessive inflammation in the liver and/or immune system. Very high levels may be seen in some types of cancers.

Interpreting your blood test results

Doctors generally look first at the level of the liver enzyme GGT. Generally speaking in “normal liver function tests” the level of GGT is not greater than 45.

If your GGT is greater than 100, the doctor will look at the levels of the other liver enzymes to try and work out possible causes of liver damage. Let’s take a look at some possible combinations of abnormally high liver enzymes and what that could mean.

For example:

If your GGT is above 100, and your ALT is less than 80 and your ALP is less than 200
This could mean that:

• You are drinking too much alcohol
• You are taking recreational drugs such as ice or heroin
• You have diabetes
• You have a fatty liver
• You have very high levels of the blood fat called triglycerides
• You are taking certain prescribed drugs that have stimulated your liver to make more enzymes for example – barbiturates, benzodiazepines, anticonvulsants, warfarin, tricyclic antidepressants, paracetamol, pain killers or immunosuppressants.

Note: in some people it is normal for GGT levels to be as high as 120, with no liver problems being found.

If your GGT is above 100, and your ALT is less than 80 and your ALP is above 200
This could mean that:

• The flow of bile is being slowed down or obstructed and this could be from a gall stone in the bile ducts, very inflamed bile ducts or a tumour inside the liver or a tumour outside the liver which is pressing on the bile ducts.
• Excess drugs or alcohol can slow the flow of bile
• Scarring of the liver (known as cirrhosis) can distort the bile ducts and cause slowing/obstruction to the flow of bile.
• You have liver disease plus bone disease, as the enzyme ALP can also be elevated by some bone diseases

Note: when the flow of bile is obstructed or slowed, the level of bile (bilirubin) becomes elevated in the blood to above 20 and the patient may turn yellow (jaundiced).

If your GGT is above 100, and your ALT is above 80 and your ALP is less than 200
This could mean that:

• The liver cells are inflamed by certain viruses such as the Hepatitis A, B or C viruses or the glandular fever virus (Epstein Barr Virus).
• You are taking liver toxic drugs or drinking excess alcohol
• You have a fatty liver

If your GGT is above 100, and your ALT is above 80 and your ALP is above 200
This could mean that the liver cells are damaged plus there is slowing or obstruction to the flow of bile and this can occur in the following liver diseases:

• Acute hepatitis from viral infections or drug or alcohol toxicity
• Chronic (long term) hepatitis from viral infections, alcohol excess or autoimmune diseases
• Tumours inside or near the liver which obstruct the flow of bile
• Scarring of the liver (cirrhosis)

Note: in alcoholic liver disease the level of the other liver enzyme AST is often elevated to high levels as well, and is usually higher than the level of ALT.

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) represents the most common form of liver disease and is considered to be the liver manifestation of Syndrome X (the metabolic syndrome).

Within the degrees and types of NAFLD, simple fatty accumulation (hepatic steatosis) is not considered to be highly dangerous in itself although it can lead to weight excess and diabetes. However the more severe form of fatty liver known as non-alcoholic steato-hepatitis (NASH) may progress to cirrhosis and liver failure. The distinction can be made by liver biopsy.

There is not complete agreement on the criteria for diagnosis or the features used for grading and staging lesions. Both types of fatty liver disease are reversible and the key is earlier diagnosis and the use of nutritional medicine.

For the diagnosis of fatty liver, physical examination, blood tests, imaging techniques and liver biopsy are being used.

The following tests are generally recommended

• If the liver enzymes are only slightly elevated and there are no physical signs of liver disease, blood tests for liver function can be done every 6 months. If the liver function does not deteriorate and the patient remains well there is no need for liver biopsy. The liver function blood test should continue to be checked every 6 months.
• An ultrasound scan of the liver should probably be done every year.

If there is any concern that the degree of fatty liver damage is rapidly progressive, or that there could be other undetected liver disease present, a liver biopsy should be seriously considered.

I personally think that if you follow our dietary principles, and your liver function and wellbeing are improving, you do not have to panic and rush into a liver biopsy.

If despite your best efforts to heal your liver with nutritional medicine, your liver function and health are deteriorating then a liver biopsy is indicated. At the end of the day it will be your decision and you must also listen to your own doctor’s advice.

Fibroscan Test

Fibroscan uses ultrasound to create waves and measures the speed at which these waves are reflected by the liver. The speed of the wave determines the degree of liver stiffness.  The more scarred the liver the stiffer it becomes and the stiffer the liver the quicker the waves are reflected.

Fibroscan was invented to assess the amount of scarring (fibrosis) present in the liver which develops in cirrhosis. It does this by measuring the stiffness or elasticity of the liver.

Results are presented as a number in kilopascals (kPa). The higher the number, the stiffer and thus more scarred the liver.

Until several years ago, the only accurate way of finding out how much scarring was in a liver was by having a liver biopsy. Blood tests can tell you if you have liver inflammation or infection with viruses, but they can’t show how damaged your liver tissue is.

Ultrasounds and CAT scans often don’t show the difference between liver scarring damage caused from chronic liver diseases such as viral hepatitis, iron overload, alcoholism or fatty deposits. A fibroscan will accurately detect the amount of scarring, which is the most important thing as it predicts and monitors liver cirrhosis which can lead to liver failure, irrespective of the cause.

Now we have the Fibroscan test to do this in a safe way. The fibroscan does not expose you to needles or irradiation or drugs and unlike a liver biopsy is risk free!

This simple ten-minute test can detect liver damage but it does have some limitations. For example, the Fibroscan is very good at detecting a healthy normal liver or a liver with severe extensive fibrosis (cirrhosis) but it is much less sensitive at detecting mild or moderate liver fibrosis.  Fibroscan will only measure liver fibrosis and will not help to diagnose the cause of the liver damage. In these cases a Liver biopsy may still be necessary.

Fibroscan is very useful for following the progression of liver fibrosis over years and because it is non-invasive can be repeated regularly without risk (unlike liver biopsy).

In the early stages of liver disease, symptoms are uncommon and vague and conventional ultrasounds may not be very helpful.  It is often difficult for people to know whether their liver is significantly damaged or not until it is in the advanced stages of scarring which is cirrhosis. By the time you notice any symptoms of liver disease, the damage may be too great to reverse. Fibroscan helps with early and accurate detection of liver disease which improves a cure as the liver is able to repair and regenerate itself.

New test for Cirrhosis – Fibrosure or Fibrotest

A new test to determine if fibrosis (cirrhosis) is present in the liver is now available and is a breakthrough for patients with liver disease. This new test is called a Fibrosure or Fibrotest.

In the past, the standard test to determine the physical state of the liver tissue was a liver biopsy. During a liver biopsy a fine needle is pushed into the liver and a sample of liver tissue is taken and then sent to a laboratory where a pathologist examines it under a powerful microscope. The pathologist can see if the liver cells are damaged and how much scar tissue is present in the liver tissue. If there is a lot of scar tissue the patient is diagnosed with cirrhosis. The amount of scar tissue determines the stage of cirrhosis from mild to severe.

There are several problems and limitations with a liver biopsy

• Only a small area of the liver is sampled – thus the biopsy may miss other parts of the liver which are more or less diseased
• There are risks to the procedure such as bleeding and infection
• The procedure is unpleasant, scary and incurs some discomfort.

Thus it’s easy to understand why a new non-invasive blood test to check for cirrhosis is a huge welcome relief for patients with chronic liver disease.

The Fibrosure test is a blood test which measures several different naturally occurring substances in the blood which give an indirect indication of chronic liver inflammation and through a mathematical calculation this is converted to a score for fibrosis. Fibrosis is the same as scarring.  Scar tissue consists of hard fibrous tissue. Cirrhosis is caused by scar tissue building up in the liver.

The Fibrosure blood test measures the amount of the following substances in your blood:

Alpha 2 macroglobulins (normal range = 110 to 276 mg/dL) Haptoglobulin (normal range = 34 to 200 mg/dL) Apolipoprotein A-1 (normal range = 110 to 205 mg/dL) Bilirubin total (normal range = 0 to 1. 2 mg/dL) GGT (normal range = 0 to 60 IU/L) ALT (normal range = 0 to 40 IU/L)

No need for you to remember these parameters, they are just included in case you want to research them further. The important thing is that these values are combined mathematically to create a score for you which will determine the following:

Fibrosis Score (normal range = 0 to 0.21) – you want this to be low Fibrosis stage from 1 to 5 – you want this to be low Necro-inflammatory activity score (normal range = 0 to 0.17) – you want this to be low Necro-inflammatory activity grade – this is graded from mild to severe – you want this to be mild

The Fibrosis score and stage determine the amount of scarring in your liver. The Necro-inflammatory activity score and grade determine the amount of inflammation in your liver and this is important because chronic inflammation in the liver causes the scar tissue to build up and destroys healthy liver cells.

If we can reduce the inflammation with nutritional medicine we can reverse some of the damage and even better, prevent the scar tissue from increasing anymore.   Remember that of all the organs in the body, the liver is most able to repair and regenerate itself.  For more information see my book The Liver Cleansing Diet.

Liver Biopsy

For information about Liver Biopsy, click here

The Breath Test – is a possible alternative to liver biopsy

A test known as the 13C-caffeine breath test has been developed by researchers at the University of Sydney and Concord Hospital, which is able to detect fibrosis (scarring) in the liver. It has been used in patients with hepatitis B and has been shown to accurately detect fibrosis when compared to the patient’s liver biopsy results. In a study of 33 patients with hepatitis B who had different degrees of fibrosis, the breath test was found to accurately predict severe liver scarring which leads to cirrhosis of the liver.

How is the breath test done?

The patient must fast overnight and then drinks a caffeine beverage containing a special carbon tag. The patient’s breath is analyzed by a process known as continuous flow isotope ratio mass spectrometry. The greater the degree of liver scarring the less carbon will be detected in the breath; this allows accurate quantification of the degree of liver scarring.

Researchers are predicting that this new breath test can be used as an accurate way to assess the degree of liver scarring in people with fatty liver. The test is already being used at Concord Hospital in Sydney in selected patients to avoid liver biopsy but is not yet generally available. The new breath test will be good news for the future because liver biopsies are expensive and their interpretation can be inaccurate. The breath test is of great practical value because a significant number of cases of fatty liver will progress to liver scarring and fibrosis (cirrhosis) and if the breath test shows that this is happening, a more aggressive approach to treatment is essential.

Imaging Techniques to visualize the Liver

Ultrasound scans of the liver

Ultrasound scans are very useful to detect fatty changes in the liver and are inexpensive and do not expose you to any radiation or danger. If fatty changes are found in more than 30% of liver lobules a diagnosis of fatty liver is made.

The ultrasonic features of a fatty liver include:

• Bright pattern
• Vascular blurring
• Deep attenuation

It is useful to compare the brightness of the kidneys to the liver and if the liver is much brighter it is fatty. Kidneys do not develop fatty changes.

The sensitivity of ultrasound scans in the diagnosis of fatty liver approaches 100 percent. The correlation of fatty liver in ultrasound scans and liver biopsy tissue examination is 73.6%. Therefore, the degree of fatty infiltration seen in ultrasound scans is significantly correlated with degree of fatty accumulation of liver.

Cat scans and MRI scans of the liver

CAT scan of upper abdomen

Non-enhanced CAT scans and MRI scans are comparable in their estimation of the degree of fat accumulation in the liver (hepatic steatosis). However for detecting mild grades of fatty liver, MRI scans are better than un-enhanced CAT scans. CAT scans expose you to significant radiation whereas MRI scans do not.

Magnetic Resonance Elastography or MRE

Researchers at The Mayo Clinic have invented a diagnostic imaging test which is able to detect very early stages of liver disease. It is called Magnetic Resonance Elastography or MRE and it is now being used at Mayo Clinic for patients who are at risk for liver diseases. MRE measures the elasticity of the liver and can detect abnormal hardening or stiffness of liver tissue – in a way you could say that MRE allows doctors to “feel” the liver by imaging it. Scar tissue is very fibrous and makes the liver hard whilst healthy liver tissue is elastic and makes the liver soft and MRE can easily detect the difference.

MRE is extremely accurate – its sensitivity for diagnosing liver fibrosis is 98 percent and its specificity level (absence of false positives) is 99 percent.

The MRE (“liver elastogram”) provides color images of the liver that look amazing! To see pictures of liver elastograms visit www. mayoclinic.org/magnetic-resonance-elastography/
The wonderful thing about MRE is that it can spare some patients the need for a liver biopsy. Such early and accurate diagnosis of liver disease allows doctors to initiate early and specific treatment before it progresses to cause irreversible damage.

Damage to liver cells by fat, toxins or infections etc, causes inflammation, which can lead to hard scar tissue or fibrosis.  A liver that has developed widespread fibrosis is firmer, and if the condition progresses to cirrhosis, the liver can become almost rock-hard. The vital thing is, if detected early, fibrosis of the liver can in many cases be reversed. If the scar tissue progresses to widespread cirrhosis, the condition is usually irreversible. About 50% of patients diagnosed with cirrhosis will die within five years unless they receive a liver transplant.

Having an MRE test done is not unpleasant – it does not involve needles, physical pain, deep palpation or radiation. A small circular drum-like device is strapped around the abdomen before going into the MRI machine. The machine vibrates in different rhythms and generates shear waves that pass into the liver.

Many patients don’t have a sufficiently high probability of liver disease to justify the risk of an invasive liver biopsy. As well as those with fatty liver, this includes the hundreds of millions of people in the world who have hepatitis B and C. Because only a small percentage of these individuals will develop progressive liver fibrosis, many could be candidates for an MRE screening test.

Other important blood tests to have if you have been diagnosed with a fatty liver

• Fasting blood sugar and insulin levels – if these are elevated it is wise to have a 2-hour Glucose Tolerance Test (GTT)
• Glycosylated hemoglobin – abbreviated to GHB or HbA1c – this test shows the average level of sugar (glucose) that has been present in your blood over the previous 3 months
• Fasting blood fats (lipids) – cholesterol and triglycerides
• A serum ferritin test to check the level of iron in your body. If your ferritin level is elevated you should have further blood tests known as “serum iron studies”. You may also need a blood test for the genetic disease of iron overload called hemochromatosis. Excess iron in the liver can lead to severe liver disease. If you have a fatty liver PLUS excess levels of iron in your liver, these two factors will work together to accelerate the amount of liver damage.
• If you have a fatty liver and suffer with bowel or digestive complaints, it is worthwhile having a blood test to see if you are intolerant to gluten. Gluten is the protein found in specific grains namely wheat, oats, rye and barley. Some people are genetically prone to poor health if they eat gluten. The most accurate blood test to ask your doctor for is “test your genotype for the genes that predispose to gluten intolerance”. If you have these genes, you may find that your liver health and immune system improve greatly, by avoiding gluten containing foods.

Cholesterol Tests

Elevated insulin levels stimulate your liver cells to produce abnormally large amounts of cholesterol. In those with Syndrome X there will be low levels of the good HDL cholesterol, and excessively high levels of the bad LDL cholesterol.

Around 80% of the body’s cholesterol is made in the liver and the cells of the small intestine, and only around 20% comes from the diet. If you eat more cholesterol your liver will make less and if you do not eat any cholesterol, your liver will manufacture all the cholesterol that you need. If you have a healthy liver, the balance of the good cholesterol (HDL) and the bad cholesterol (LDL) will be favourable in the vast majority of cases. It is not so much the avoidance of dietary cholesterol that is important, but the state of your liver that is important.

Fasting levels of the blood fats

You will need to have your blood taken in the fasting state, which means that you should not eat/drink anything apart from pure water, for 12 to 14 hours before the blood is taken. It is easiest to fast overnight and have your blood taken before breakfast.

Total Cholesterol divided by HDL gives a ratio which is predictive of your risk of heart disease

Triglycerides

Triglycerides are lightweight small fatty particles that have only a very small amount of protein attached to them. Most of the triglycerides are stored as fat in your fat deposits and a small amount is sent to the muscle cells for energy. The triglyceride fats are manufactured in the liver, which converts them to very low-density lipoproteins abbreviated to VLDL. High levels of triglycerides and VLDL will not only increase weight gain and fatty liver, they will increase your risk of cardiovascular disease.

Those with Syndrome X have a build up of “triglyceride – rich – lipoproteins” (fatty protein particles) in the blood after eating. High blood levels of insulin cause the liver to produce very low-density lipoprotein triglyceride (VLDL-TG). This is very dangerous and predisposes to fatty liver, atherosclerosis, and obesity.

Today, many people have become obsessed with cholesterol and think it is the main predictor of heart disease. Indeed many overweight people never bother to have their triglyceride levels checked, often because their doctor does not think it is important. However, high triglyceride levels by themselves, irrespective of cholesterol levels, are a potent risk factor for heart disease. Indeed high triglyceride levels are just as important as smoking, obesity and high blood pressure in increasing your chances of heart disease and strokes. High triglycerides make your blood thick and sticky so that it does not flow freely around inside your blood vessels – this increases the risk of blood clots. Fish oil supplements are able to reduce triglyceride levels and reduce the risk of blood clots.

A study at Harvard University way back in 1966 showed that very high triglyceride levels could be reduced greatly with a very low carbohydrate diet. A diet high in refined carbohydrates (and low in protein and fat), will increase insulin levels, which will cause an elevation in the triglyceride levels. Conversely a diet low in carbohydrates, and particularly low in refined carbohydrates, will lower triglycerides.

Normal triglyceride levels = 0.1 to 2.0mmol/L or 9 to 177mg/dL

The lower they are within this normal range the better off you are.

Make sure that you are fasting (do not eat/drink anything but water for 12 to 14 hours before the blood test), when you have your blood taken to measure the triglyceride levels. This is because triglyceride levels can be temporarily much higher just after eating.

Blood Sugar Level (BSL)

Your fasting blood sugar (glucose) level should be below 6.1mmol/L (110mg/dL).
If it is above this level, this means that insulin is starting to lose control over your blood sugar levels. This is a sign of insulin resistance which causes Syndrome X and fatty liver

Glucose Tolerance Test

The Glucose Tolerance Test (GTT) measures the tolerance of an individual for an extra load of administered glucose. If your tolerance for this extra load of glucose is normal, then your blood levels of glucose will remain within the normal range. If your tolerance for this extra load of glucose is impaired, your blood sugar levels will become higher than the normal range (see table X).

If you have impaired glucose tolerance, this will be because you have insulin resistance, meaning that your insulin is incapable of controlling your blood sugar levels. If your blood sugar levels become even higher, you will be classed as a diabetic, which could be due to severe insulin resistance or insulin deficiency (pancreatic failure).

The GTT will only be accurate if you follow a relatively high carbohydrate diet (200 grams daily) for 4 days before the test.

The GTT measures your blood sugar (glucose) levels after you ingest a test dose of glucose. The blood sugar levels are measured over a period of several hours, depending on whether the doctor has ordered a 2-hour GTT, or a GTT which goes for longer.
Subtle abnormalities in the GTT often occur in those with fatty liver and/or Syndrome X, a long time before the onset of diabetes.

Blood Sugar Levels during GTT as measured in mmol/L

Time	Normal Levels	Impaired Glucose Tolerance	Diabetes
Fasting	3.6 to 6.1 (65 to 110mg/dL)	6. 1 to 6.9 (113 to 124mg/dL)	over 6.9 (over 124)
2 hour	Less than 7.1 (128mg/dL)	7.2 to 11.0 (130 to 198mg/dL)	over 11 (over 198)

The one-hour blood glucose level is not always reported, but generally speaking a level over 9.0mmol/L (162mg/dL) is considered abnormal, and is indicative of impaired glucose tolerance.

Ideally insulin levels should be tested along with the blood glucose levels, at least for the first 2 hours of the GTT. The fasting level of insulin should be checked, as well as the insulin level 2 hours after the patient ingests the glucose. The 2-hour insulin level is abnormally elevated if it is 1.5 times your age, up to the age of 50.

Using this method a 2-hour insulin level of 75 would be abnormally high for any person.

Serum Insulin Levels

It is a worthwhile endeavour to measure blood insulin levels, as it is the high insulin levels, which are the cause of Syndrome X and many cases of fatty liver.
A laboratory accustomed to measuring insulin levels should do the testing of your insulin levels. The specimen of blood should be frozen and the test must be completed within 24 hours of taking the blood. If these procedures are not followed the results may be inaccurate.

Excessive blood levels of insulin (hyperinsulinemia) are diagnosed by finding an elevated fasting blood insulin level and/or by finding elevated insulin levels two hours after giving the patient a 75-gram dose of pure sugar (glucose).

Generally speaking, if your fasting insulin level is over 10mU/ml, you probably have some degree of Syndrome X, meaning that you are developing insulin resistance. The greater your fasting insulin level is over 10, the greater is your insulin resistance. If we use 10 as the upper limit of normal for fasting insulin levels, a result of 30 would mean that it requires 3 times the normal amount of insulin to keep your blood sugar levels at their current value.
Some laboratories will set the upper normal limit of fasting insulin levels as high as 20, but this will miss some people with insulin resistance, who have not yet lost control of blood sugar levels.

Normal insulin levels during a GTT are considered to be the following:

Some laboratories have different “normal ranges” for serum insulin, which are higher than the above values, and may miss some people with Syndrome X. For example some laboratories will state that insulin levels below 70 are normal, while insulin levels above 80 indicate insulin resistance. They qualify this by saying that insulin levels in between 70 to 80 are in a “grey area” and may indicate insulin resistance. I think the lower levels in the table are more realistic, and if used for evaluation, will not miss as many people who are in the early stages of Syndrome X.

Because of the wide variation in insulin levels during a GTT, most endocrinologists evaluate the fasting insulin level only, and if this is not raised a diagnosis of insulin resistance is thought to be unlikely.

Glycosylated haemoglobin levels

Glycosylated haemoglobin levels can be abbreviated to Hgb A1 or HbA1c or GHB, which is helpful to know if you are looking at your own blood test results.

The level of GHB measures the average amount of sugar that has been present in your blood over the previous 3 months.

The normal laboratory range of GHB is 4 to 6%.

The lower your level of GHB, the better you will be, as far as blood sugar control is concerned.

In type 2 diabetics good blood sugar control is present when the GHB is less than 7%. Diabetics who keep their GHB levels close to or below 7%, have a much better chance of preventing diabetic complications, such as diseases affecting the eyes, kidneys and nerves, compared to those diabetics whose GHB levels are 9% or greater.
You should aim for your GHB level to be at the lower limit of the normal range, and certainly not towards the upper limit. If your GHB level is above the normal range you are certainly suffering with the insulin resistance of Syndrome X, and indeed may be pre-diabetic or even diabetic.

Serum iron studies

If you have fatty liver disease it is worth checking that your body does not contain excess amounts of the mineral iron. High levels of iron can inflame the liver and if the iron levels are very high, can increase the risk of severe liver disease such as cirrhosis. The excess iron will work synergistically with the excess fat in the liver to increase the amount of liver damage; thus it is important to remove the excess iron from the body to protect your liver.

This can be safely and effectively achieved by having some of your blood removed regularly and this procedure is called venesection. Your blood should be removed on a regular basis until your iron levels become normal and this can be arranged by your local doctor. You can also achieve a desirable reduction in your body iron levels by becoming a regular blood donor.

If you have a blood test for iron studies this is what the results will look like:

If the levels of iron are high and the saturation is high you have too much iron in your blood, which could get into the liver and damage the liver. The ferritin parameter measures the total amount of iron stored in your body and if this is high, chances are that there is too much iron stored in your liver. High ferritin levels are also a sign of liver inflammation.

These statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any diseases.

Liver Function Tests – an overview

INVESTIGATIONS

Liver function tests (LFTs) refer to measurements of serum bilirubin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), and albumin, but they should also include the prothrombin time (PT). In general, conditions affecting the liver cell (hepatitis) cause a rise in AST and ALT, whereas biliary tree disorders (cholestasis) cause raised ALP and GGT. It is important to recognize that these enzymes are also present in other sites of the body, and when interpreting isolated elevation extrahepatic sources should be considered (Table 78-1). Raised liver enzymes often overlap between hepatitis and cholestatic patterns in clinical practice. Aminotransferases (AST, ALT) can also be elevated in both intra- and extrahepatic cholestasis.²⁶ Extrahepatic biliary obstruction causing irritation and secondary inflammation of hepatocytes results in mildly raised serum transaminases, and hepatitis can lead to a degree of cholestasis with consequent rise in ALP and GGT. In practice, when faced with this situation, it is helpful to recognize the pattern of the so-called dominant distribution of raised enzymes.²⁷ If the serum bilirubin is elevated to greater than twice the upper limit of the normal reference range, then the patient will be clinically jaundiced. Bilirubin can be raised in most types of hepatobiliary pathology,²⁷ often with an associated rise in liver enzymes. Initial evaluations should determine whether the hyperbilirubinemia is conjugated (direct) as seen in most types of liver disease, or unconjugated (indirect).²⁸ A low-serum albumin level and prolonged prothrombin time (PT) are sensitive indicators of impaired hepatic synthetic function, occurring in both acute and chronic liver disease, and are important prognostic indicators. When interpreting the serum albumin in elderly patients it must be taken into account that other factors may result in low levels of albumin. A prolonged PT may also arise from a deficiency of vitamin K, which is required for synthesis of clotting factors II, VII, IX, and X in the liver. This may be of particular significance in the elderly as dietary insufficiency can exhaust hepatic stores of vitamin K after just 4 weeks. Vitamin K deficiency can be excluded by giving intravenous replacement of 10 mg of vitamin K and then repeating the PT.

In chronic liver disease, blood loss from gastrointestinal bleeding as a result of upper gastrointestinal pathologies such as bleeding varices, can lead to iron deficiency anemia. This may be exacerbated by coagulopathy and thrombocytopenia secondary to the splenic enlargement seen in portal hypertension. Hypersplenism can also result in leukopenia and a mild anemia. A raised mean corpuscular volume (MCV) suggests excessive alcohol intake because of its direct toxic effect on the bone marrow. In addition, macrocytosis is also seen in patients with chronic liver disease due to failure of bone marrow to produce erythrocytes and reduced erythrocyte survival. In elderly patients, poor nutrition, particularly lack of dietary folic acid, can lead to hematinic deficiencies and may contribute to difficulties interpreting hematologic tests when there is underlying liver disease.

The true prevalence of abnormal LFTs in the elderly has yet to been clarified. However, research from the early 1980s showed 17% of elderly hospitalized patients had abnormal LFTs when screened without clinical indication.³² In the United Kingdom, there is evidence that liver disease may be missed in all age groups as abnormal LFTs are often not investigated.³³ A thorough history is a mandatory part of a “liver screen” and should include the patient’s alcohol consumption, current or recent drug use (prescribed or otherwise), risk factors for viral hepatitis, the presence of autoimmune diseases, family history of chronic liver disease, and factors such as diabetes, obesity, and hyperlipidemia. Elderly patients with elevated LFTs should be investigated initially with noninvasive serologic tests²⁸ (Table 78-2). It excludes Wilson’s disease, which is rarely diagnosed over the age of 40. Liver disease in those with homozygote α1-antitrypsin deficiency tends to become apparent in the age group of 50 to 60 years but is probably worth including as part of the screen. Serologic screening tests for celiac disease could also be included as this condition is recognized as causing asymptomatic elevation of transaminases, which subsequently normalize on a gluten-free diet.³⁴ There are several causes of LFT derangement in patients with a negative liver screen including drugs, sepsis, and other comorbidities. Many of the medications used in elderly patients can cause abnormal LFTs.³⁵ This should be borne in mind when reviewing a patient’s drug history. In a district general hospital study of hospitalized patients with jaundice, the second commonest cause after cancer was found to be sepsis/shock.³⁶ A study of liver function tests in bacteriemia not of hepatobiliary origin demonstrated significant elevations in levels of GGT and ALP, and reduced albumin levels.³⁷ Other possible causes to consider include alcohol excess, fatty liver, obesity, diabetes, thyroid disease, and Addison’s disease, which may also cause mild derangement of LFTs. Some expert reviews suggest that where there is a negative screen to treat the most likely cause of the abnormal LFTs—that is, alcohol (by abstinence), hepatotoxic drugs (by drug cessation), and nonalcoholic fatty liver disease (by weight reduction and diabetes control)—before more detailed investigation if LFTs remain abnormal after a period of observation.²⁸

What is the normal range for liver function test? – MVOrganizing

What is the normal range for liver function test?

Normal blood test results for typical liver function tests include: ALT. 7 to 55 units per liter (U/L) AST. 8 to 48 U/L.

What is a good liver function test result?

Typically the range for normal AST is reported between 10 to 40 units per liter and ALT between 7 to 56 units per liter. Mild elevations are generally considered to be 2-3 times higher than the normal range. In some conditions, these enzymes can be severely elevated, in the 1000s range.

What is SGOT and SGPT?

SGPT & SGOT are the enzymes produced by the liver & by other types of cells. High SGPT or SGOT is usually an indication of liver cell injury.

What is a bad liver function test result?

A low result on this test can indicate that your liver isn’t functioning properly. The normal range for albumin is 3.5–5.0 grams per deciliter (g/dL). However, low albumin can also be a result of poor nutrition, kidney disease, infection, and inflammation.

How quickly does liver heal?

The liver, however, is able to replace damaged tissue with new cells. If up to 50 to 60 percent of the liver cells may be killed within three to four days in an extreme case like a Tylenol overdose, the liver will repair completely after 30 days if no complications arise.

How can I tell if my liver is swollen?

What are the symptoms of an enlarged liver?

1. Fatigue.
2. Jaundice (yellowing of the whites of the eyes and skin)
3. Nausea and vomiting.
4. Pain in the upper middle or upper right side of the abdomen.
5. Filling up quickly after meals.

Is turmeric good for the liver?

It improves liver function The antioxidant effect of turmeric appears to be so powerful that it may stop your liver from being damaged by toxins. This could be good news for people who take strong drugs for diabetes or other health conditions that might hurt their liver with long-term use.

How can I detox my liver naturally?

Ways to prevent liver disease Limit the amount of alcohol you drink. Eat a well-balanced diet every day. That’s five to nine servings of fruits and vegetables, along with fiber from vegetables, nuts, seeds, and whole grains. Be sure to include protein for the enzymes that help your body detox naturally.

Can the liver recover from cirrhosis?

Advertisement. The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

What foods are good for the liver?

This article lists the 11 best foods to eat to keep your liver healthy.

1. Coffee. Coffee is one of the best beverages you can drink to promote liver health.
2. Tea.
3. Grapefruit.
4. Blueberries and cranberries.
5. Grapes.
6. Prickly pear.
7. Beetroot juice.
8. Cruciferous vegetables.

How do I know that my liver is healthy?

This condition causes darker urine and a yellowish tint in skin or the whites of your eyes. It appears when bilirubin, a pigment that forms when red blood cells break down, builds up in your bloodstream. A healthy liver absorbs bilirubin and converts it into bile. Your body then excretes it in stool.

How do I test my liver?

Blood tests used to assess the liver are known as liver function tests. But liver function tests can be normal at many stages of liver disease. Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver.

Liver function testing – MyDr.

com.au

Role of the liver

The role of the liver is to keep the body’s complex internal chemistry in balance. It takes raw nutrients from our digestive system (in the form of carbohydrates, protein, amino acids, etc) and processes them so they can be stored and sent to different parts of our body in the right form and quantity.

The liver regulates the level of sugars in our blood and manufactures bile (which breaks down fats in our stomach). It also helps remove toxins, drugs and hormones from our bloodstream.

This brief explanation does the liver little justice — it actually carries out over 1,500 complex biochemical functions. Perhaps it is because the liver is so important that, up to a certain point, like a lizard’s tail, it can rejuvenate itself.

What are liver function tests?

A liver function test (LFT) is a blood test that gives an indication of whether the liver is functioning properly. The test is also very useful to see if there is active damage in the liver (hepatitis) or sluggish bile flow (cholestasis).

Liver function tests measure the amount of particular chemicals in the blood. This gives a gauge of possible damage to liver cells — damage that can be caused by many things including HCV. So a more correct term for a liver test would actually be a liver dysfunction test.

It’s important to remember that diagnosis of liver disease depends on a combination of patient history, physical examination, various blood tests, and imaging studies such as Fibroscans or ultrasounds. Imaging studies have advanced in recent years and have replaced the need for liver biopsies. In very rare and exceptional circumstances, a biopsy might be needed. Diagnosis of hepatitis C can only be confirmed with a blood test called the PCR test or sometimes called a HCV RNA test.

People reading this page should keep in mind that abnormalities within liver tests don’t necessarily point to specific diseases. Only a physician who knows all the aspects of a specific case can reliably make a diagnosis.

Substances measured in liver function testing

Total protein

Total protein is simply a combined measure of the concentrations of proteins in the blood. This information can provide clues to several diagnostic possibilities. There are 2 major types of protein: albumin and globulin.

Albumin

Albumin provides a gauge of nutritional status. It can be reduced due to liver damage and kidney disease. Because albumin is made in the liver, levels tend to drop with cirrhosis.

Globulin

Describes the specific level of globulins — which include antibodies. This measure can be raised when liver cells are damaged due to autoimmune liver damage or to long-standing liver disease of many types, particularly when cirrhosis exists.

Bilirubin

Bilirubin is a by-product of the breakdown of red blood cells. It is the yellowish pigment responsible for jaundice. Bilirubin levels can be raised due to many different liver diseases, as well as conditions other than liver disease, e. g. gallstones. In cases of long-term liver illness (chronic hepatitis), the level usually stays within the normal range until significant liver damage has occurred and cirrhosis is present. In cases of short-term liver illness (acute hepatitis), elevated bilirubin levels indicate the severity of the acute illness.

GGT

GGT (Gamma Glutamyl Transpeptidase) is an enzyme produced in bile ducts that may be elevated due to bile duct illness. The GGT test is extremely sensitive and may be elevated due to any type of liver disease or by different drugs, including alcohol, even when liver disease is minimal. GGT levels are sometimes elevated even in the case of a normally functioning liver.

ALK Phos

ALK Phos refers to Alkaline Phosphatase, a family of enzymes produced in the bile ducts, intestine, kidneys, placenta and bones. These levels may rise when disease of the bile ducts or bone disorders occur.

ALT

ALT (Alanine Transaminase) is an enzyme produced in hepatocytes (the major type of liver cells). ALT level in the blood is increased when hepatocytes are damaged or die — all types of hepatitis (viral, alcoholic, drug-induced etc) cause hepatocyte damage. Levels of ALT may equate to the degree of cell damage but this is not always the case, particularly with hepatitis C. An accurate estimate of liver cell damage can only be made by liver biopsy.

AST

AST (Aspartate Transaminase) is similar to ALT above, but less specific for liver disease because it is also produced in body muscle cells. It does tend to be higher than ALT in cases of alcohol-related liver disease.

Platelet count

Platelets are the smallest of all blood cells and are involved in promoting clotting of the blood — normally a process of healing. In cases of chronic liver disease where cirrhosis exists, the platelet count can be lowered — although this can occur due to many conditions other than liver disease.

Adult range or normal range

This figure allows you to compare your various LFT readings with what is considered to be the upper limit of normal (by your particular laboratory). To make sense when comparing results to other people’s, someone’s readings should be quoted as 108/45, i.e. their actual result (108) as compared to their laboratory’s normal upper limit (45).

For more information about anything in this factsheet, phone the Hepatitis Infoline on 1800 803 990 or go to www.hep.org.au

This factsheet was developed by Hepatitis NSW. It was adapted with assistance from Prof Bob Batey and Prof Geoff Farrell from an article in Positive Living,using additional internet information by Dr Howard Worman (USA).

Hepatitis NSW. Hepatitis factsheets. Liver function tests. Last updated 18 August 2017. https://www.hep.org.au/wp-content/uploads/2017/09/Factsheet-Liver-function-tests.pdf (accessed Nov 2019).

Norm of bilirubin in women

Norm of bilirubin in blood in women: reference values ​​

Evaluation of both fractions of bilirubin is of clinical importance. To determine the level of bilirubin, a biochemical blood test is performed, and the content of both direct and total bilirubin is assessed. The latter includes the amount of bilirubin in general: both direct and indirect. The level of indirect bilirubin in women (however, as in men) is calculated based on the content of the total and direct fraction.The reference range for bilirubin depends on the kits used in a particular laboratory, so the reference range differs from laboratory to laboratory.

According to the literature, normal values ​​for total serum bilirubin are 3.4–20.4 µmol / L, indirect bilirubin is normally represented by values ​​up to 16.5 µmol / L, direct bilirubin – from 0 to 5.1 µmol / L. ⁹

How can elevated bilirubin levels manifest?

With an increase in the concentration of pigment in the blood, different symptoms can occur depending on the cause.With a slight deviation from the norm, there may be no signs that would allow suspecting any health problems. With a moderate increase in pigment levels, jaundice may appear – the skin and sclera become yellow.

The mechanism of development of jaundice is simple: due to an increase in the level of bilirubin in the blood, which has a yellowish tint, the color of the skin and mucous membranes changes. In addition, with an increase in the level of bilirubin in the blood, urine may turn dark, while in the feces, on the contrary, almost no bilirubin enters, therefore it becomes discolored ¹ .

Jaundice is the main symptom of hyperbilirubinemia (an increase in the level of bilirubin in the blood). It can be accompanied by a number of other symptoms, such as, for example, an enlarged liver and / or an enlarged spleen ^1.2 .

Jaundice of the skin associated with an increase in the level of bilirubin in women can be a symptom of several
dozens of diseases and conditions. Let’s consider the most common ones.

Cholelithiasis (cholelithiasis) – chronic disease in which stones form in the biliary tract.It is detected in 10-15% of the population, and in women 2-3 times more often than in men, which is associated with the influence of female sex hormones. The risk of developing cholelithiasis also increases during pregnancy, especially with repeated, as well as against the background of hormone replacement therapy during menopause ² .

Cholelithiasis can be asymptomatic for a long time, however, with obstruction of the biliary tract with a stone or the development of inflammation, the disease makes itself felt. Classic exacerbation symptoms (biliary / hepatic colic) are pain, bloating, vomiting.They may be accompanied by jaundice, and the bilirubin index is moderately increased (total, usually less than 85.5 μmol / l, direct less than 5 mg / dl) ² .

Gilbert’s syndrome – congenital genetic disease in which the exchange of bilirubin is impaired.
It occurs in 5-7% of young people around the world. Approximately 30% of all jaundice is caused by Gilbert’s syndrome.
Usually, the disease is asymptomatic and is detected by chance during a biochemical blood test, when an increase in the level of bilirubin ³ is detected.

Impaired liver function – one of the common reasons for an increase in the level of bilirubin in the blood in
women and men. Liver damage can be caused by a number of conditions, including:

• liver cirrhosis ⁴ ;
• Autoimmune diseases, eg autoimmune hepatitis ⁵ ;
• viral hepatitis 6 ^6.7.8 .

Hemolytic anemia – a disease caused by increased destruction of red blood cells.Can be hereditary and acquired. With an exacerbation of the disease (the so-called hemolytic prize), general weakness, fever, headache, loss of appetite, nausea, sometimes vomiting, abdominal pain or a feeling of heaviness in the left hypochondrium may be observed. The urine sometimes darkens to a dark brown or even black color, the feces become discolored, the mucous membranes and skin turn yellow. When conducting a biochemical blood test, an increase in the indirect fraction of bilirubin ⁷ is revealed.

Increased bilirubin levels during pregnancy

Jaundice and increased bilirubin levels in women during pregnancy can be caused by a number of diseases.

Intrahepatic cholestasis – is the second most common cause of high bilirubin levels in women during pregnancy, but it is worth talking about first. The cause of jaundice during pregnancy is intrahepatic cholestasis in ¼ cases. This disease is also called cholestatic hepatosis of pregnant women, benign recurrent cholestasis of pregnant women, itching of pregnant women.It is still not known exactly why the disease occurs. It is believed that the disease develops in women with a genetic predisposition to an unusual cholestatic reaction to hormones produced during pregnancy ⁸ .

The disease usually manifests itself in the third trimester of pregnancy and stops spontaneously after childbirth. Symptoms of cholestasis in pregnant women ⁸ :

• itchy skin, one of the first and main signs;
• jaundice, usually mild, accompanied by darkening of urine and clarification of feces.however, in some cases, jaundice may not be observed.

Biochemical analysis of blood in women with cholestasis of pregnant women reveals an increase in the level of bilirubin in the blood, as a rule, no more than 5 times compared with the norm8. ⁸ .

Jaundice in pregnant women with some diseases may be accompanied by prolonged repeated vomiting.

Acute fatty degeneration of the liver of pregnant women.

Previously, the name “acute fatty hepatosis of pregnant women” was used – a rare complication of pregnancy occurring with a frequency of 1 case per 13,000 births.The reason has not been established; usually observed in young primiparas in the third trimester of pregnancy ⁸ .

Acute viral hepatitis – the main cause of jaundice in expectant mothers: they account for up to half of cases of increased bilirubin in women who are expecting a baby. The disease can develop at any stage of pregnancy, and its symptoms are very diverse.
⁸ .

Bilirubin and its fractions (total, direct, indirect)

Analysis, during which the content of bile pigments and their fractions in the blood is determined.They are metabolites of the breakdown of hemoglobin, and their level increases with increased destruction of red blood cells, impaired liver function and biliary tract.

Research results are issued with a free doctor’s commentary.

Research method

Colorimetric photometric method.

Detection range

• Total bilirubin: 2.5 – 550 μmol / l.
• Direct bilirubin: 1.5 – 291 μmol / L.

Units

Mcmol / L (micromole per liter).

Which biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for the study?

• Do not eat within 12 hours prior to examination.
• Eliminate physical and emotional stress 30 minutes before the study.
• Do not smoke within 30 minutes prior to examination.

General information about the study

Bilirubin is a yellow pigment that is a component of bile and is formed in the spleen and bone marrow during the breakdown of red blood cells. Normally, red blood cells are destroyed 110-120 days after leaving the bone marrow. In this case, the metalloprotein hemoglobin is released from the dead cells, consisting of an iron-containing part – heme and a protein component – globin. Iron is split off from heme, which is reused as a necessary component of enzymes and other protein structures, and heme proteins are converted into bilirubin.Indirect (unconjugated) bilirubin with the help of albumin is delivered to the liver by the blood, where, thanks to the enzyme glucuronyl transferase, it combines with glucuronic acid and forms direct (conjugated) bilirubin. The process of converting water-insoluble bilirubin into water-soluble bilirubin is called conjugation. The associated pigment fraction practically does not enter the bloodstream and is normally excreted in the bile. Bilirubin in the intestinal lumen is metabolized by intestinal bacteria and excreted in the feces, giving it a dark color.

Direct bilirubin is named so in connection with the method of laboratory research. This water-soluble pigment interacts directly with reagents (Ehrlich diazo reagent) added to the blood sample. Unconjugated (indirect, free) bilirubin is insoluble in water, and additional reagents are required for its determination.

Normally, the human body produces 250-350 mg of bilirubin per day. The production of more than 30-35 μmol / l is manifested by yellowness of the skin and sclera.According to the mechanism of development of jaundice and the predominance of bilirubin fractions in the blood, suprahepatic (hemolytic), hepatic (parenchymal) or subhepatic (mechanical, obstructive) jaundice is isolated.

With increased destruction of erythrocytes (hemolysis) or impaired liver uptake of bile pigment, the bilirubin content increases due to the unconjugated fraction without an increase in the level of associated pigment (suprahepatic jaundice). This clinical situation is observed in some congenital conditions associated with impaired bilirubin conjugation, for example, in Gilbert’s syndrome.

In the presence of an obstacle on the way out of bile into the duodenum or disorders of bile secretion in the blood, direct bilirubin rises, which is often a sign of obstructive (mechanical) jaundice. With obstruction of the biliary tract, direct bilirubin enters the bloodstream, and then into the urine. It is the only fraction of bilirubin that can be excreted by the kidneys and stain urine dark.

An increase in bilirubin due to direct and indirect fractions indicates liver disease with impaired capture and secretion of bile pigments.

An increase in indirect bilirubin is often observed in newborns in the first 3 days of life. Physiological jaundice is associated with increased breakdown of red blood cells with fetal hemoglobin and insufficient maturity of the liver enzyme systems. With prolonged jaundice in newborns, it is necessary to exclude hemolytic disease and congenital pathology of the liver and biliary tract. With a conflict between the blood groups of the mother and the child, an increased breakdown of the baby’s erythrocytes occurs, which leads to an increase in indirect bilirubin.Unconjugated bilirubin has a toxic effect on the cells of the nervous system and can lead to brain damage in the newborn. Hemolytic disease of the newborn requires immediate treatment.

In 1 out of 10 thousand infants, atresia of the biliary tract is detected. This life-threatening pathology is accompanied by an increase in bilirubin due to the direct fraction and requires urgent surgical intervention and, in some cases, liver transplantation. Newborns are also likely to have hepatitis with an increase in both direct and indirect bilirubin.

Changes in the level of bilirubin fractions in the blood, taking into account the clinical picture, make it possible to assess the possible causes of jaundice and determine the further tactics of examination and treatment.

What is the research used for?

• For differential diagnosis of conditions accompanied by yellowness of the skin and sclera.
• To assess the degree of hyperbilirubinemia.
• For differential diagnosis of neonatal jaundice and identification of the risk of developing bilirubin encephalopathy.
• For the diagnosis of hemolytic anemia.
• For the study of the functional state of the liver.
• For the diagnosis of disorders of the outflow of bile.
• For monitoring a patient taking drugs with hepatotoxic and / or hemolytic properties.
• For dynamic monitoring of patients with hemolytic anemia or pathology of the liver and biliary tract.

When is assigned Analysis ?

• With clinical signs of liver and biliary tract pathology (jaundice, dark urine, discoloration of stools, itching of the skin, heaviness and pain in the right hypochondrium).
• When examining newborns with severe and prolonged jaundice.
• If hemolytic anemia is suspected.
• When examining patients who regularly consume alcohol.
• When using drugs with probable hepatotoxic and / or hemolytic side effects.
• When infected with hepatitis viruses.
• In the presence of chronic liver diseases (cirrhosis, hepatitis, cholecystitis, cholelithiasis).
• With a comprehensive prophylactic examination of the patient.

What do the results mean?

Reference values ​​

• Total bilirubin

• Direct bilirubin: ≤ 5 μmol / L.
• Indirect bilirubin is a calculated indicator.

Reasons for an increase in the level of total bilirubin

1. Mainly due to indirect bilirubin (indirect hyperbilirubinemia associated with excessive hemolysis or impaired capture and binding of free bilirubin by the liver)

• Autoimmune hemolysis.
• Hemolytic anemia.
• Pernicious anemia.
• Sickle cell anemia.
• Congenital microspherocytosis.
• Thalassemia.
• Embryonic type of hematopoiesis.
• Gilbert’s syndrome.
• Crigler-Nayyar Syndrome.
• Posthemotransfusion reaction.
• Transfusion of incompatible blood groups.
• Malaria.
• Myocardial infarction.
• Sepsis.
• Hemorrhagic pulmonary infarction.
• Tissue hemorrhage.

2. Mainly due to direct bilirubin (direct hyperbilirubinemia associated with biliary obstruction or impaired excretion of bound bilirubin by the liver)

• Choledocholithiasis.
• Gallstone disease.
• Viral hepatitis.
• Sclerosing cholangitis.
• Biliary cirrhosis of the liver.
• Cancer of the head of the pancreas.
• Dabin-Johnson syndrome.
• Rotor Syndrome.
• Atresia of the biliary tract.
• Alcoholic liver disease.
• Pregnancy.

3. Due to direct and indirect bilirubin (parenchymal jaundice with impaired capture of bilirubin and bile secretion)

• Viral hepatitis.
• Alcoholic liver disease.
• Cirrhosis.
• Infectious mononucleosis.
• Toxic hepatitis.
• Echinococcosis of the liver.
• Liver abscesses.
• Metastases or massive tumors of the liver.

What can influence the result?

• Intravenous administration of a contrast agent 24 hours before the study distorts the result.
• Prolonged fasting and intense physical activity increase the level of bilirubin.
• Nicotinic acid and atazanavir increase the content of indirect bilirubin.
• Drugs that increase the level of total bilirubin: allopurinol, anabolic steroids, antimalarial drugs, ascorbic acid, azathioprine, chlorpropamide, cholinergic drugs, codeine, dextran, diuretics, epinephrine, isoproterenol, levodopa, monoaminease inhibitors, methyloamine oxygenotine oral contraceptives, phenazopyridine, phenothiazides, quinidine, rifampin, streptomycin, theophylline, tyrosine, vitamin A.
• Medicines that reduce total bilirubin: amikacin, barbiturates, valproic acid, caffeine, chlorin, citrate, corticosteroids, ethanol, penicillin, protein, anticonvulsants, salicylates, sulfonamides, ursodiol, urea.

What is Alanine Aminotransferase?

Alanine aminotransferase (ALT) is an enzyme found primarily in the liver. It is also found in smaller amounts in other organs such as the kidneys, heart, muscles, and pancreas. Formerly referred to as serum glutamate pyruvic transaminase, ALT is now sometimes interchangeably referred to as alanine transaminase. ALT is usually monitored by doctors on blood chemistry panels, and is especially useful in liver function tests.

The enzyme alanine aminotransferase is involved in the alanine cycle in cells. As an enzyme, it is a protein made by the body to speed up a chemical reaction. The specific function of ALT is to catalyze a reversible reaction that transfers an amino group from alanine to alpha-ketoglutarate, forming pyruvate and glutamate. ALT activity is highest in hepatocytes, or liver cells, and striated cells of skeletal and cardiac muscles. Due to its role in the glucose-alanine cycle, ALT promotes effective muscle contraction by using muscle protein to produce glucose and waste waste through the liver.

Both humans and veterinarians routinely measure ALT on blood chemistry panels. Elevated blood ALT levels are a sign of hepatocellular damage or liver cell damage. When liver cells are damaged, ALT effectively leaks out of these cells, causing it to appear in higher concentrations on the blood panels. Thus, ALT is known as a leakage enzyme. It is often measured in combination with aspartate transaminase (AST), alkaline phosphatase, and bilirubin to evaluate liver disease.

Some common causes of elevated alanine aminotransferase include liver disease such as cirrhosis of the liver, viral hepatitis, liver tumors and ischemia, or lack of blood flow to the liver. Additional causes of elevated ALT levels include drugs that affect the liver, such as statins, certain antibiotics, chemotherapy, aspirin, drugs, and barbituates.

ALT may also be elevated in other conditions such as pancreatitis, mononucleosis, or celiac disease.Sometimes ALT levels rise due to recent cardiac catheterization or surgery. Individuals on long-term medications, or those with risk factors for liver disease, are often monitored regularly for high ALT levels.

The normal ALT range for an adult alanine aminotransferase test is 0-40 units / liter. However, ranges can vary based on gender and even animal species. Test results can also differ from one testing laboratory to another.

Alanine aminotransferase test results can also be distorted by cigarette smoking, medication or pregnancy. Sometimes exercising just before the test can skew the results. Certain herbs, such as echinacea or valerian, can also raise blood ALT levels.

OTHER LANGUAGES

Resuscitation equipment: LiMON module for PulsioFlex

Description

LiMON technology is used for non-invasive measurement of liver function based on the analysis of the rate of elimination of the diagnostic fluorescent dye indocyanine green (ICG) from the vascular bed.Absorption and emission spectrum ICG – 810-830 nm. The measurement is performed non-invasively using a finger probe. Due to the fact that ICG is excreted exclusively by the liver, the rate of its excretion is a significant indicator of the filtering function of the liver. The diagnostic importance of the rate of ICG elimination as an indicator of liver function has been confirmed in numerous scientific publications for more than 30 years.

Advantages

• Early detection of liver dysfunction
• Reflects the current state of liver function
• Non-invasive measurement method
• Use in general ward

Applications

Intensive care.Multiple organ failure.

• LiMON immediately detects liver hypoperfusion
• Reliably predicts survival
• If ICG clearance rate is less than 16% / min, intervention is required
• Optimized infusion therapy when combined with LiMON and PiCCO
• Indication of local blood flow quality

Liver transplant

• Perioperative assessment of graft quality and function to reduce the likelihood of re-transplantation
• Provide a reliable indicator of early graft survival after surgery
• Promotes early diagnosis of complications

Liver resection

• LiMON technology provides data critical to assessing operational risks
• Low rates of indocyanine clearance exclude the possibility of performing extensive liver resection
• Allows early identification of postoperative liver dysfunction
• Probability of prediction is significantly higher than with traditional markers

Cardiac surgery

• Pre-, peri-, and early postoperative ICG clearance rate (PDR ICG) measurements can predict the length of time a patient is in intensive care
• An improvement-oriented patient management strategy (PDR ICG) can increase patient survival after cardiac surgery

Hepatology

• The use of LiMON technology is an important predictor of liver cirrhosis
• LiMON Technology Predicts Patient Survival With Progressive Liver Diseases
• Evaluates the active cell mass of the liver

Measured parameters

PDR – multidrug resistance (in this case to ICG)

R15 – ICG perfusion coefficient after 15 minutes

SpO2 – oxygen saturation of blood

The LiMON module works using a reusable LiMON sensor.

LiMON module and reusable finger sensor

The module requires Indocyanine Green (ICG) diagnostic dye produced by Diagnostic Green – VERDYE trademark.

V ATTENTION! The LiMON modules for the PulsioFlex hemodynamic monitor are not compatible with PiCCO2 monitors and vice versa.

MELARENA 3MG N10 TABLE P / PLEN / SHELL

Disorders of the blood and lymphatic system Rarely: leukopenia, thrombocytopenia.

Rarely: decreased visual acuity, blurred vision, increased lacrimation. Hearing disorders and labyrinthine disorders Rarely: vertigo, positional vertigo.

Rarely: eczema, erythema, hand dermatitis, psoriasis, generalized rash, itchy rash, nail damage.

Rarely: increased activity of “hepatic” transaminases, deviation from the norm in the content of electrolytes in the blood, deviation from the norm in the results of laboratory tests.

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90,000 Tesamorelin Prevents Liver Fibrosis in People with HIV

Researchers at the US National Institutes of Health (NIH) and their colleagues at Massachusetts General Hospital (MGH) in Boston reported that tesamorelin injectable reduces liver fat and prevents fibrosis (scarring ) in people living with HIV. Scientists came to such conclusions based on an analysis conducted by the US National Institute of Allergy and Infectious Diseases (NIAID) and the National Cancer Institute. The results of the study were published October 14 in the Lancet.

“Most people living with HIV have overcome significant barriers to a better quality of life and better life expectancy, but many still suffer from liver disease,” said NIAID Director Dr. Anthony S. Fauci. “Meanwhile, we are encouraged that tesamorelin, a drug already approved for the treatment of other complications of HIV, may be effective in combating non-alcoholic fatty liver disease.”

Non-alcoholic fatty liver disease, or NAFLD, is often associated with HIV infection. In developed countries alone, it affects up to 25% of people living with HIV. However, there are currently no effective treatments for this disease, which is a risk factor for progressive liver disease and cancer.

A team led by Dr. Collin M. Hadigan, Senior Research Fellow, NIAID Immunoregulation Laboratory, and Dr. Stephen K. Grinspoon, Head of Metabolism at MGH, tested whether tesamorelin can reduce liver fat levels in men and women. living with HIV and NAFLD.

Of the enrolled participants, 43% had at least mild liver fibrosis and 33% met the diagnostic criteria for a more severe subgroup of NAFLD called non-alcoholic steatohepatitis (NASH).

31 participants were randomized to receive tesamorelin 2 mg daily, and 30 to receive placebo injections. The researchers provided all participants with nutritional counseling and training on self-administration of daily injections.The specialists then compared the indicators of liver health in both groups at the initial stage and after 12 months.

After a year of follow-up, participants who received tesamorelin had better liver health scores than those who received placebo. This was indicated by the results of the analysis of the reduction of the proportion of adipose tissue in the liver (HFF). The normal range for HFF is less than 5%. 35% of those taking tesamorelin achieved a normal HFF, while only 4% of those taking placebo achieved the same level, provided the dietary recommendations were followed.Overall, tesamorelin was well tolerated and reduced HFF by an average of 37%.

While 9 participants who received placebo made progress in fibrosis, only 2 volunteers from the tesamorelin group experienced the same.

Based on these results, the researchers proposed to expand the indications for the use of tesamorelin among people living with HIV with a diagnosis of NAFLD. Experts also recommend doing more research to determine if tesamorelin may help long-term protection against serious liver disease in people without HIV.

“We hope these results will help people living with HIV and those who are HIV-negative with impaired liver function,” commented Dr. Hadigan. “Further research could lead us to the potential long-term benefits of this approach and develop drugs that will benefit everyone with liver disease, regardless of status.