What are liver function tests. How do blood tests assess liver health. Which enzymes and proteins indicate liver function. Why are liver function tests important for diagnosing liver conditions. What do abnormal liver test results mean.

The Importance of Liver Function Tests in Assessing Hepatic Health

Liver function tests are crucial diagnostic tools used by healthcare professionals to evaluate the overall health and performance of the liver. These tests typically involve a series of blood analyses that measure various enzymes, proteins, and other substances produced or processed by the liver. By examining these markers, doctors can gain valuable insights into liver inflammation, injury, and functionality.

Understanding liver function tests is essential for both patients and healthcare providers. These tests can help detect liver problems early, monitor existing liver conditions, and guide treatment decisions. Let’s delve deeper into the most common liver function tests and what they reveal about hepatic health.

Key Liver Function Tests: Bilirubin, Albumin, and Clotting Factors

Serum Bilirubin Test

What does the serum bilirubin test measure? This test quantifies the levels of bilirubin in the blood. Bilirubin is a yellowish pigment produced during the normal breakdown of red blood cells. The liver is responsible for processing bilirubin and excreting it through bile.

Why is the bilirubin test important? Elevated bilirubin levels may indicate:

• Obstruction in bile flow
• Issues with the liver’s ability to process bile
• Certain types of liver diseases or conditions affecting the biliary system

Serum Albumin Test

What is the purpose of the serum albumin test? This test measures the level of albumin, a protein synthesized by the liver, in the blood. Albumin plays a crucial role in maintaining fluid balance in the body and transporting various substances through the bloodstream.

How do albumin levels relate to liver function? Low levels of albumin may indicate:

• Impaired liver function
• Chronic liver disease
• Malnutrition or other conditions affecting protein production

International Normalized Ratio (INR) Test

What does the INR test evaluate? Formerly known as the prothrombin time (PT) test, the INR measures how long it takes for blood to clot. This test is crucial because the liver produces several proteins essential for blood clotting, including vitamin K-dependent factors.

Why is the INR test significant for liver function assessment? Prolonged clotting times may suggest:

• Liver disease affecting the production of clotting factors
• Vitamin K deficiency
• The need for anticoagulant therapy monitoring

Liver Enzyme Tests: Indicators of Hepatocellular Damage and Cholestasis

Serum Alkaline Phosphatase (ALP) Test

What information does the ALP test provide? This test measures the level of alkaline phosphatase, an enzyme found in various tissues, with the highest concentrations in the liver, biliary tract, and bone.

When is the ALP test particularly useful? Elevated ALP levels may indicate:

• Liver dysfunction
• Biliary obstruction (e.g., tumors or abscesses)
• Bone disorders

Alanine Transaminase (ALT) Test

What is the significance of the ALT test? ALT is an enzyme predominantly found in liver cells. When these cells are damaged, ALT is released into the bloodstream, making it a sensitive marker for liver injury.

How do healthcare providers interpret ALT results? Elevated ALT levels may suggest:

• Acute liver cell damage
• Chronic liver diseases such as hepatitis
• The need for monitoring treatment effectiveness in liver conditions

Aspartate Transaminase (AST) Test

What does the AST test measure? AST is an enzyme found in various tissues, including the liver, heart, and muscles. Like ALT, elevated AST levels can indicate liver cell damage.

Why is the AST test often performed alongside ALT? Comparing AST and ALT levels can help:

• Differentiate between liver and muscle damage
• Assess the severity and progression of liver disease
• Identify potential causes of liver injury

Specialized Liver Function Tests: Gamma-GT, LDH, and 5′-Nucleotidase

Gamma-Glutamyl Transpeptidase (GGT) Test

What is unique about the GGT test? GGT is an enzyme produced in the liver, pancreas, and biliary tract. It is particularly sensitive to alcohol consumption and certain medications that affect the liver.

How does the GGT test complement other liver function tests? GGT levels can:

• Help detect alcohol abuse or recent alcohol consumption
• Provide additional information about liver diseases
• Assist in differentiating between liver and bone sources of elevated ALP

Lactic Dehydrogenase (LDH) Test

What role does the LDH test play in liver function assessment? LDH is an enzyme involved in the body’s metabolic processes and is found in various tissues. While it is a non-specific marker, elevated LDH levels can indicate tissue damage, including liver damage.

When might healthcare providers use the LDH test? LDH testing may be helpful in:

• Detecting general tissue damage
• Supporting the diagnosis of liver disease when combined with other tests
• Monitoring the progression of certain medical conditions

5′-Nucleotidase Test

What makes the 5′-nucleotidase test unique? This test measures levels of 5′-nucleotidase, an enzyme specific to the liver. It is particularly useful in diagnosing conditions associated with cholestasis.

When might elevated 5′-nucleotidase levels be significant? Increased levels may indicate:

• Liver diseases, especially those involving bile flow obstruction
• Primary biliary cirrhosis
• Certain types of liver tumors

Additional Diagnostic Tests for Liver-Related Conditions

Alpha-Fetoprotein (AFP) Test

What is the purpose of the AFP test? Alpha-fetoprotein is a protein produced by fetal tissue and certain tumors. In adults, elevated AFP levels can be a marker for liver cancer or other liver abnormalities.

How is the AFP test used in liver health assessment? AFP testing may be performed to:

• Screen for primary liver cancer (hepatocellular carcinoma)
• Monitor the effectiveness of liver cancer treatment
• Assess the risk of liver cancer in patients with chronic liver diseases

Mitochondrial Antibodies Test

What do mitochondrial antibodies indicate? The presence of these antibodies in the blood can be associated with certain autoimmune liver disorders.

Which liver conditions might be detected through mitochondrial antibody testing? This test can help identify:

• Primary biliary cirrhosis
• Chronic active hepatitis
• Other autoimmune disorders affecting the liver

Serum Alpha-1 Antitrypsin (A1AT) Test

What is the significance of the A1AT test? Alpha-1 antitrypsin is a protein produced by the liver that helps protect tissues from damage caused by certain enzymes. Deficiency in A1AT can lead to liver and lung problems.

Why might healthcare providers order an A1AT test? This test is performed to:

• Identify a rare form of emphysema in adults
• Diagnose a specific type of liver cirrhosis in children and adults
• Screen for A1AT deficiency in individuals with unexplained liver disease

Interpreting Liver Function Test Results: What Do Abnormal Values Mean?

Interpreting liver function test results requires careful consideration of various factors, including the patient’s overall health, medical history, and other diagnostic findings. Abnormal test results don’t always indicate liver disease, but they can provide valuable clues for further investigation.

What might elevated liver enzyme levels suggest? Increased levels of enzymes like ALT, AST, and ALP can indicate:

• Acute liver injury from toxins, medications, or infections
• Chronic liver diseases such as hepatitis or cirrhosis
• Biliary tract obstruction or inflammation
• Alcohol-related liver damage

How do healthcare providers interpret abnormal protein levels? Changes in albumin or clotting factor levels may indicate:

• Chronic liver disease affecting protein synthesis
• Malnutrition or other conditions impacting protein production
• Advanced liver dysfunction in severe cases

What do abnormal bilirubin levels signify? Elevated bilirubin can suggest:

• Liver cell damage or dysfunction
• Biliary tract obstruction
• Certain genetic conditions affecting bilirubin metabolism

The Role of Liver Function Tests in Diagnosis and Treatment Planning

Liver function tests play a crucial role in the diagnosis, monitoring, and management of various liver-related conditions. These tests help healthcare providers:

• Detect liver problems early, often before symptoms appear
• Differentiate between acute and chronic liver disorders
• Monitor the progression of liver diseases and the effectiveness of treatments
• Assess the severity of liver damage and make prognosis estimates
• Guide treatment decisions and medication dosing

How often should liver function tests be performed? The frequency of testing depends on individual circumstances, such as:

• The presence of known liver disease or risk factors
• Monitoring of medication side effects
• Routine health screenings for at-risk populations
• Follow-up after abnormal test results

Factors Affecting Liver Function Test Results: Beyond Liver Disease

While liver function tests are valuable tools for assessing hepatic health, it’s important to recognize that various factors can influence test results, potentially leading to false positives or negatives. Understanding these factors is crucial for accurate interpretation and diagnosis.

What non-liver-related factors can affect liver function test results?

• Medications: Certain drugs can alter enzyme levels or interfere with test accuracy
• Alcohol consumption: Recent alcohol intake can temporarily elevate liver enzymes
• Exercise: Intense physical activity may cause transient increases in some liver enzymes
• Diet: Fasting or specific dietary patterns can influence test results
• Obesity: Excess weight can lead to non-alcoholic fatty liver disease and affect test outcomes
• Hormonal changes: Pregnancy or hormone therapies may impact liver function markers
• Other medical conditions: Diseases affecting other organs can sometimes alter liver test results

How do healthcare providers account for these factors? To ensure accurate interpretation of liver function tests, doctors may:

• Review a patient’s complete medical history and current medications
• Consider recent lifestyle factors, such as diet and exercise habits
• Repeat tests to confirm abnormal results
• Order additional diagnostic tests or imaging studies when necessary
• Consult with specialists for complex cases or unclear results

Emerging Trends in Liver Function Testing: Beyond Traditional Markers

As medical science advances, new approaches to liver function testing are being developed and refined. These emerging trends aim to provide more accurate, comprehensive, and personalized assessments of liver health.

What are some innovative approaches to liver function testing?

• Non-invasive fibrosis assessment: Techniques like FibroScan (transient elastography) measure liver stiffness to evaluate fibrosis without a biopsy
• Metabolomics: Analyzing patterns of metabolites in blood or urine to detect liver dysfunction at an early stage
• Genetic testing: Identifying genetic variants associated with increased risk of liver diseases or drug-induced liver injury
• Liquid biopsy: Detecting circulating tumor DNA or other biomarkers in blood for early cancer detection or disease monitoring
• Artificial intelligence: Using machine learning algorithms to interpret complex patterns in liver function test results and imaging studies

How might these emerging trends impact liver health assessment in the future? These advancements could lead to:

• Earlier detection of liver diseases, potentially improving treatment outcomes
• More personalized risk assessment and treatment strategies
• Reduced need for invasive procedures like liver biopsies
• Improved monitoring of disease progression and treatment efficacy
• Better understanding of the complex interactions between genetics, environment, and liver health

As research in this field continues, it’s likely that liver function testing will become increasingly sophisticated, providing more nuanced and actionable information about liver health. However, traditional liver function tests remain invaluable tools in clinical practice and will likely continue to play a crucial role in liver health assessment for the foreseeable future.

Common Liver Tests | Johns Hopkins Medicine

Common Liver Tests | Johns Hopkins Medicine

What are some of the most common liver tests?

A series of special blood tests can often determine whether or not the liver is inflamed, injured, or functioning properly. These tests can also distinguish between acute and chronic liver disorders and between hepatitis (infection or inflammation of the liver) and cholestasis (disruption in the formation of or obstruction in the flow of bile). 

The most commonly performed blood tests include the following:

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. Elevated levels of bilirubin may indicate an obstruction of bile flow or a problem in the processing of bile by the liver.

• Serum albumin test. This test is used to measure the level of albumin (a protein in the blood) and may be useful in the diagnosis of liver disease. Low levels of albumin may indicate the liver is not functioning properly. 

• International normalized ratio (INR), formally called 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. Prolonged clotting may indicate liver disease or other deficiencies in specific clotting factors.

Liver enzymes

• Serum alkaline phosphatase test. This test is used to measure the level of alkaline phosphatase (an enzyme) in the blood. Alkaline phosphatase is found in many tissues, with the highest concentrations in the liver, biliary tract, and bone. This test may be performed to assess liver functioning and to find liver lesions that may cause biliary obstruction, 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 that is released into the bloodstream after acute liver cell damage. This test may be performed to assess liver function, and/or to evaluate 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 that is released into the bloodstream after liver or heart problems. This enzyme is released into the bloodstream after acute liver cell damage.

• Gamma-glutamyl transpeptidase 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 performed to assess liver function, to provide information about liver diseases, and to detect alcohol ingestion.

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

• 5′-nucleotidase test. This test measures the levels of 5′- nucleotidase (an enzyme specific to the liver). The 5′- nucleotidase level is elevated in persons with liver diseases, especially those diseases associated with cholestasis. This is disruption in the formation of, or obstruction in the flow of bile.

Additional diagnostic tests

• Alpha-fetoprotein test. Alpha-fetoprotein (a specific blood protein) is 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 monitor the effectiveness of therapy in certain cancers, such as hepatomas (a type of liver cancer).

• Mitochondrial antibodies test. The presence of these antibodies can indicate primary biliary cirrhosis, chronic active hepatitis, and certain other autoimmune disorders.

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

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Liver Function Tests: Purpose, Procedure, and Results

Liver function tests are blood tests that can be used to monitor the health of your liver. Ask the doctor what you need to do to prepare. In some cases you may need to avoid food or certain medications before the test.

Liver function tests, also known as liver chemistries, help determine the health of your liver by measuring the levels of proteins, liver enzymes, and bilirubin in your blood. They can also monitor the progression or treatment of an existing disease.

Depending on the test, either higher- or lower-than-typical levels of these enzymes or proteins can indicate a problem with your liver.

Some of the reasons liver function tests may be performed include screening for diseases such as hepatitis, monitoring the side effects of your medications, and examining the severity of liver disease.

In this article, we take a look at when you might need a liver function test, the different types of tests used, and how to interpret results.

A liver function test is often recommended in the following situations:

• to check for damage from liver infections, such as hepatitis B and hepatitis C, especially if it’s suspected you were exposed to a virus that causes hepatitis
• to monitor the side effects of certain medications because some medications are known to affect the liver, including:
  • NSAIDs
  • statins
  • antibiotics
  • antiseizure medications
  • tuberculosis drugs
• if you already have liver disease, to monitor the disease and how well a particular treatment is working
• if you’re experiencing the symptoms of a liver disorder or have a family history of a liver disease, such as fatty liver disease
• if you have certain medical conditions, such as:
  • high triglycerides
  • diabetes
  • high blood pressure
  • anemia
• if you drink alcohol frequently
• if you have gallbladder disease

Certain tests can reflect different aspects of liver function. For example, elevated alanine transaminase and aspartate transaminase disproportional to bilirubin and alkaline phosphatase levels often indicates liver disease.

Liver function tests are used to measure specific enzymes and proteins in your blood.

Having atypical results on any of these liver tests usually requires a follow-up to determine the cause of the atypical characteristics. Even mildly elevated results can be associated with liver disease.

Common liver function tests include:

Alanine transaminase (ALT) test

Alanine transaminase (ALT) is used by your body to metabolize protein. If the liver is damaged or not functioning properly, ALT can be released into the blood. This causes ALT levels to increase. A higher result than what’s typical on this test can be a sign of liver damage.

It’s estimated that about 10 percent of people in the United States have elevated ALT levels.

Aspartate aminotransferase (AST) test

Aspartate aminotransferase (AST) is an enzyme found in several parts of your body, including your:

• heart
• brain
• pancreas
• liver
• muscles

When the liver is damaged, AST can be released into the bloodstream. A high result on an AST test might indicate a problem with the liver or muscles.

Since AST levels aren’t as specific of a marker for liver damage as ALT, it’s usually measured together with ALT to check for liver problems. For example, a high AST:ALT ratio may indicate alcoholic liver disease.

Alkaline phosphatase (ALP) test

Alkaline phosphatase (ALP) is an enzyme found in your bones, bile ducts, and liver. An ALP test is typically ordered in combination with several other tests. An ALP test can be used to evaluate the bile duct system of the liver.

Albumin test

Albumin is the main protein made by your liver. It performs many important bodily functions.

For example, albumin nourishes your tissues and transports hormones, vitamins, and other substances throughout your body. An albumin test measures how well your liver is making this particular protein.

Bilirubin test

Bilirubin is a waste product from the breakdown of red blood cells. It’s ordinarily processed by the liver. It passes through the liver before being excreted through your stool.

A damaged liver can’t properly process bilirubin. This leads to an atypically high level of bilirubin in the blood. Certain inherited diseases can raise bilirubin levels, even when liver function works as expected.

The following table shows what liver function tests may indicate in terms of higher or lower results than typical. Following any liver function test, you should have a discussion with your doctor about your test results and what they mean for you.

Problems with the liver can make a person very sick and can even be life threatening. Approximately 4.5 million adults in the United States have chronic liver disease.

Symptoms of a liver disorder include:

• weakness
• fatigue or loss of energy
• weight loss
• jaundice (yellow skin and eyes)
• fluid collection in the abdomen, known as ascites
• discolored bodily discharge (dark urine or light stools)
• nausea
• vomiting
• diarrhea
• abdominal pain
• atypical bruising or bleeding

Your doctor may order a liver function test if you’re experiencing symptoms of a liver disorder.

Liver function tests can also monitor the progression or treatment of a disease and test for the side effects of certain medications.

Your doctor will give you complete instructions on how to prepare for the blood sample portion of the test.

Certain medications and foods may affect levels of these enzymes and proteins in your blood. Your doctor may ask you to avoid some types of medications, or they may ask you to avoid eating anything for a period of time before the test. Be sure to continue drinking water prior to the test.

You may want to wear a shirt with sleeves that can easily be rolled up to make it easier for the medical expert to collect the blood sample.

You may have your blood drawn in a hospital or at a specialized testing facility. To administer the test:

1. The healthcare technician will clean your skin before the test to decrease the likelihood that any microorganisms on your skin will cause an infection.
2. They’ll likely wrap an elastic strap on your arm. This will help your veins become more visible. They’ll then use a needle to draw samples of blood from your arm.
3. After the draw, the technician will place some gauze and a bandage over the puncture site. Your blood sample will be sent to a laboratory for testing.

Potential risks of a liver function test

Blood draws are routine procedures and rarely cause any serious side effects. However, the risks of giving a blood sample can include:

• bleeding under the skin, or hematoma
• excessive bleeding
• fainting
• infection

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After the test, you can usually resume everyday activities. However, if you feel faint or lightheaded during the blood draw, you should rest before you leave the testing facility.

The results of these tests may not tell your doctor exactly which condition you have or the degree of liver damage, but they might help your doctor determine the next steps. Your doctor will call you with the results or discuss them with you at a follow-up appointment.

In general, if your results indicate a problem with your liver function, your doctor will review your medications and your past medical history to help determine the cause.

If you drink alcohol frequently, then you’ll need to stop drinking it. If your doctor identifies that a medication is causing the elevated liver enzymes, they’ll advise you to stop the medication.

Other diagnostic tests

Your doctor may decide to test you for hepatitis, other infections, or other diseases that can affect the liver. They may also choose to do imaging tests, like an ultrasound or CT scan.

In addition, they may recommend a liver biopsy to evaluate the liver for fibrosis, fatty liver disease, or other liver conditions.

Liver function tests are blood tests used to help determine the health of your liver. Changes in certain levels of proteins or enzymes can alert doctors of potential problems such as liver cancer, fatty liver disease, or hepatitis.

Liver function tests can also help determine if certain medications are damaging your liver or help you monitor the progression of liver disease.

After you get a liver function test, your doctor can help you interpret the results and discuss what the results mean for you. If they suspect you have liver disease, you may need to undergo other tests such as imaging or a liver biopsy.

Blood tests to check the liver / Gastrohepatocenter EXPERT

Many patients are interested in: how to check the liver and what tests to take before consulting a hepatologist?

If you do not know where to start the examination, then the doctors of the GastroHepatoCenter EXPERT recommend that you contact a hepatologist for a free conversation, who will prescribe a list of indicators that is suitable for your case. This will help you save your resources:

• time – you pass all the necessary indicators in 1 visit to the clinic
• money – you will not hand over what is not needed at the moment.

However, for those who are being screened for prevention or suspected of having liver disease, we have prepared a list of essential blood tests that may be helpful for your doctor to see.

Indications

Comprehensive laboratory analysis of the liver condition is required:

• for symptoms : yellowness of the skin and sclera of the eyes, bitterness in the mouth, nausea, heaviness in the right hypochondrium, chronic fatigue
• with risk factors : overweight or sudden weight loss, sedentary lifestyle, regular consumption of alcohol and heavy meals (suspicion of fatty liver disease)
• if possible infection with viral hepatitis B, C, D is suspected 0013 with heredity factor and suspected genetic disorder of iron and copper metabolism
• with suspected autoimmune diseases – this also applies to other organs (thyroid gland, hematopoietic system, etc.)
• for preventive examination .

Prevention of liver diseases is of particular importance, because it has no nerve endings and does not hurt. Therefore, diseases of this organ occur without obvious symptoms.

Basic blood tests for the liver

Among the tests to check liver function, biochemical and virological indicators are key:

1. Liver enzymes – AST, ALT analysis . These enzymes are released from liver cells (hepatocytes) when they are damaged. Depending on the activity of the course of the disease, they can even exceed the norm by 50 times.
2. GGTP enzymes, alkaline phosphatase . The activity of these enzymes increases in violation of the outflow of bile and congestion (cholestasis). GGTP is also sensitive to alcohol consumption.
3. Bilirubin total, direct, indirect . Bilirubin is an intermediate product of hemoglobin processing. One of the stages of hemoglobin metabolism occurs in the liver. If the metabolic process is disturbed due to damage to hepatocytes, excess bilirubin is released into the blood. It is he who gives the icteric color to the skin, mucous membranes and sclera of the eyes.
4. Screening for viral hepatitis . Unfortunately, many people do not know that they are infected with viral hepatitis or know, but cannot even guess how the infection occurred. Therefore, an analysis for antibodies to hepatitis C and B is carried out for all patients who seek help from a hepatologist. With a positive analysis, further virological examination is carried out.
5. CBC . This is a mandatory analysis for all diseases, showing the state of the body as a whole and the presence of an inflammatory or other pathological process.

In addition, the doctor may prescribe an assessment of the level of copper and iron in the blood with genetic studies (if Wilson-Konovalov’s disease and hemochromatosis are suspected), pancreatic amylase and glucose to assess pancreatic function, screening for autoimmune disorders and others.

The cost of tests for liver diseases

Biochemistry of the liver and blood for hepatitis, the prices for which are listed below, are given strictly on an empty stomach 10-12 hours after the last meal.

In case of any liver disease, the examination should be supplemented by liver ultrasound with elastography. This will give the doctor information about the anatomical features of the organ, its size, location, stage of fibrosis / cirrhosis, and the state of the biliary tract.

To clarify the activity of the course of the disease, the doctor may prescribe fibrotest / fibromax. This is one of the most informative tests for the liver, giving additional information about the stage of fibrosis and steatosis.

Consult a hepatologist with the results of the examination.

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When choosing where to take a profile of tests “Assessment of liver function” at an affordable price in Moscow and other cities of Russia, do not forget that the cost, methods and terms of performing studies in regional medical offices may differ.

If a liver disease is suspected, for the initial laboratory assessment of its condition, biochemical blood tests for bilirubin are used (it is removed from the bloodstream by the liver, the concentration increases with its pathology or difficulty in the outflow of bile) and enzymes that are rich in hepatocytes and bile duct epithelium (their content increases when these tissues are damaged).