What Test Shows Liver Function

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What Is Being Tested

What your Liver Function Test results can show

Liver function tests are blood tests that can provide information about how the liver is working. They test 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.

The liver is a large organ in the upper right of the abdomen and is necessary for many different functions. For example, it processes drugs and alcohol, filters toxic chemicals, stores vitamins and minerals, and makes bile, proteins and enzymes.

LFTs examine proteins, enzymes, and other substances that indicate how well the liver is working. They can show if there is damage to liver cells or a blockage to blood flow through the liver.

What Does The Test Measure

As a panel test, the liver panel involves multiple measurements. When the test is ordered, doctors can modify exactly which measurements to take.

For this reason, there is not a universal standard for what is measured on a liver panel. Nevertheless, some components of the test are more common. In most cases, a liver panel includes the following measurements:

  • Aspartate aminotransferase : This is a type of protein called an enzyme that is found in the liver as well as many muscles and organs.
  • Alanine aminotransferase : This is an enzyme found primarily in the liver.
  • Alkaline phosphatase : This is an enzyme found in the liver, bones, and other tissues in the body.
  • Bilirubin: Bilirubin is a yellow-colored waste product that is the result of the normal breakdown of red blood cells. The liver works to remove bilirubin from the body.
  • Albumin: Albumin is the most abundant protein in the blood and is made by the liver which prevents fluids from leaking out of the bloodstream.

Additional measurements may be added to a liver panel if the doctor believes they can provide more information to evaluate your situation. These measures may be tested on an initial liver panel, or included in repeat testing after an abnormal result on a previous test.

What Can Cause Your Liver Function Tests To Be Abnormal

Your liver function tests can be abnormal because:

  • Your liver is inflamed .
  • Your liver cells have been damaged .
  • Your liver is having to work harder to process medicines or toxic substances .
  • The bile drainage from your liver is blocked – for example, by a gallstone.
  • There is a swelling inside your liver .
  • You have an underlying condition that affects the liver’s production and storage abilities . In these cases the abnormality of your liver tests will be a feature of your condition, and may be normal for you.
  • Your liver is physically injured .
  • You fall just outside the normal limits .

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An Isolated Rise In Conjugated Bilirubin

Increased conjugated bilirubin suggests that the liver is conjugating the bilirubin properly but not excreting it properly via the bile ducts. Causes include:

  • Reactions to some medicines, including common ones such as blood pressure tablets, hormones , antibiotics , tricyclic antidepressants and anabolic steroids.
  • Some autoimmune diseases that affect bile excretion.
  • Blockage of the bile ducts – for example, by a gallstone.
  • Dubin-Johnson syndrome and Rotor’s syndrome.
  • In babies a rise in conjugated bilirubin can signify rare but serious problems with the development of the bile drainage system in the liver, such as biliary atresia.

Liver Function Tests Explained:

Liver Function Test in Type 2 Diabetes Mellitus

Its important to note that every child will have their own normal and whilst these levels are a guide, it doesnt necessarily mean a result outside of these ranges is dangerous. Always talk to your childs medical team if you have any worries about test results. LFTs show the amount of inflammation in the liver, whether the bile ducts are affected and how well the liver is functioning.

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What Tests And Procedures Diagnose The Causes Of Abnormal Levels Of Liver Enzymes

The most important step in evaluating patients with abnormal liver enzyme levels is to take a thorough medical history and perform a complete medical examination. All the patient’s medications, including over-the-counter drugs (OTC, and herbal remedies.

  • Any history of blood transfusion , history of intravenous or intranasal drug use or needle sharing, tattoos, sexual contact with someone with possible viral hepatitis, alcohol consumption, foreign travel, and possible consumption of contaminated food need to be questioned.
  • Moreover, in addition to the liver tests , other tests to screen the liver functions, such as a blood coagulation panel, albumin level, and total bilirubin level as well as a complete blood count need to be measured.
  • Screening for viral hepatitis is also routinely done to detect any possible active infections of the liver or to determine immunity against these viruses either through prior infections or vaccination.

In many instances, a doctor may also order an ultrasound of the liver to assess the structure of the liver and the biliary tree as well to look for any gallstones that may be causing the liver disease.

How Do I Keep My Liver Function Healthy

There is a difference between what you need to do to keep your liver healthy most of the time and what you need to do if your liver is inflamed or damaged.

  • The liver does not need a detox diet, which will not help it and will often make it work harder. The liver is a digesting, storage and detoxing organ. If you are well, the way to look after your liver is by:
    • A balanced diet with a good fibre content.
    • Regular exercise.
    • Keeping your weight within healthy limits.
    • Avoiding ‘fad’ diets .
    • Avoiding unnecessary medicines and supplements including paracetamol
    • Stopping smoking.
    • Saying within the recommended limits for alcohol .
  • If your liver is inflamed and injured or you have advanced liver disease then, depending on the severity, you may be advised to have a special diet. This involves using carbohydrates as your major source of calories, eating fat moderately and cutting down on protein. You may be advised to take vitamin supplements, and if you are retaining fluid you should reduce your salt consumption to less than 1500 milligrams per day.

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Production Of These Substances

  • Glycogen , which it makes from glucose.
  • Glucose, made and released into the blood from glycogen, proteins and fats.
  • Many essential proteins and amino acids .
  • Many of the clotting factors that help your blood to clot normally.
  • Plays a part in red blood cell production.
  • Albumin, the main protein in your blood, which bulks out your serum and enables it to carry essential substances around the body.
  • Angiotensinogen, which plays a role in blood pressure control.
  • Thrombopoietin, which regulates some of the work of your bone marrow.
  • Cholesterol, triglycerides, lipoproteins and fats – as part of the management of fat stores in your body.
  • Bile, excreted into the intestine for absorbing fats and vitamin K.
  • Hormones that help children grow and that build muscle in adults.

Low Levels Of Albumin

Liver Function Tests (LFTs), Animation

This can be due to:

  • Severe liver disease.
  • Malabsorption of protein .
  • Bowel conditions which result in leakage of protein .
  • Protein loss through kidney problems .
  • Failure of protein manufacture through severe liver inflammation.
  • Albumin levels also fall if you lose protein through your skin .
  • Albumin levels decrease during pregnancy, when your blood is more dilute.

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Abnormal Liver Function Tests

Liver function tests are a set of blood tests commonly done to check on the health of your liver. Changes in liver function tests give a clue as to whether your liver is under strain, inflamed, infected or diseased, and how badly. The pattern of the liver function tests can give a clue to the cause and can allow early detection of unsuspected problems, and monitoring of known problems.

In this article

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
  • Glycosylated hemoglobin abbreviated to GHB or HbA1c – this test shows the average level of sugar that has been present in your blood over the previous 3 months
  • Fasting blood fats 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.

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What Should I Do If My Liver Function Tests Are Abnormal

You are likely to find out that your liver function tests are abnormal from your healthcare provider, who will tell you what you need to do next. However, if you obtain your liver function test results without explanation, you should contact your healthcare provider to discuss them.

  • If the liver function tests are very mildly abnormal, only one or two tests are affected and you are perfectly well, this would not normally need an urgent consultation. However, you should speak to a health professional for advice within a few days .
  • If you have multiple abnormalities on your liver function tests, if some of the tests are very abnormal or if you are also unwell or in pain then you should seek medical advice more urgently.
  • If you have known liver disease and your liver function tests have altered significantly since the last time they were checked, you should seek medical advice the same day unless you have a standing instruction to do something different.
  • Sometimes an abnormal liver function test is normal for you. If you already know this is the case then it may be that no action is needed. A common example of this is Gilbert’s syndrome, when you have a naturally raised level of bilirubin but other liver function tests are normal and you are well. Your doctor will tell you if you have Gilbert’s syndrome.

Box : Common Causes Of Raised Transaminases

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  • Medications: non-steroidal anti-inflammatory drugs, antibiotics, HMG Co-A-reductase inhibitors, antiepileptic drugs, antituberculous drugs, herbal medications, illicit drug use.

  • Non-alcoholic steatohepatosis.

  • Endocrine disease: hypothyroidism, Addisons disease.

  • Diseases of striate muscle.

  • Glycogen storage diseases.

Drug induced liver enzyme rise may present as an enzyme rise soon after starting a drug. A logical step is to stop the drug and see if the results normalise. If the drug is essential for the patient a risk benefit assessment will be required. A liver biopsy may be necessary to assess the severity of the injury or confirm a drug induced reaction.

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Why Are Liver Function Tests Done

Liver function tests may be done for many reasons. Some doctors perform these tests as part of a regular checkup. Other doctors may use liver function tests to screen patients who are at risk for liver disease. Doctors also use them to monitor a persons liver disease and to check if treatment is working.

When To Refer For A Specialist Opinion

This would normally include patients with:

Unexplained liver abnormalities more than 1.5 times normal on two occasions, a minimum of six months apart.

Unexplained liver disease with evidence of hepatic dysfunction

Known liver disease where treatment beyond the withdrawal of the implicating agent is required.

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What Can Cause Abnormal Liver Blood Test

Liver function test results that are higher than normal may not always indicate disease, and may in fact be caused by certain lifestyle factors.

Excessive alcohol consumption is a common culprit for abnormal results, as it can raise levels of ALT, AST and GGT in the bloodstream. It is recommended to limit your alcohol consumption to less than 14 units per week in order to maintain good general liver health.

Raised ALP levels can be caused by liver and bone diseases as well as things such as vitamin D deficiencies. A raised GGT levels indicates there is something wrong with the liver for example damage caused by alcohol or certain drugs.

What Do Abnormal Calcium And Corrected Calcium Levels Mean

Liver Function Tests (LFTs)

99% of the body’s calcium is stored in the bones, with the remaining 1% stored in other tissues, including the blood plasma. The calcium test measures the total calcium in the blood plasma. About half of this is tightly attached to the protein, albumin, which forms the bulk of the protein in your plasma. The calcium level that really counts is the ‘free’, or unbound, calcium that floats unattached in the plasma.

If you have low albumin levels, the total calcium in your blood will be lower. However, because the amount attached to the albumin is reduced , the actual free levels of calcium may be normal . Corrected calcium corrects the figure to give the actual, free amount of calcium.

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Why Would I Need This Test

Doctors often request these tests for people who:

  • have liver disease or damage
  • are, or might be, infected with hepatitis viruses
  • are heavy drinkers
  • have a family history of liver disease
  • take drugs that can damage the liver

Your doctor might order LFTs if you have:

  • dark urine or light-coloured bowel motion
  • weakness or tiredness

Damage Caused By Drugs Obesity And Alcohol:

  • Cirrhosis is a serious condition caused by a build-up of scars on the liver. Most of the time the condition is irreversible, but if caught early then action can be taken to prevent further damage and increase life expectancy.
  • Fatty Liver Disease occurs when fat has built up inside the liver. It is usually caused by being overweight or obese. In its early stages it usually causes no problems but it can lead to serious liver problems including cirrhosis. NAFLD increases the risk of diabetes, high blood pressure and kidney disease. According to the NHS up to one in three people in the UK may have early stages of NAFLD. If NAFLD is detected and managed early it is possible to stop it getting worse and decrease the amount of fat in the liver

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What Does An Inflamed Liver Feel Like

Most people feel it as a dull, throbbing sensation in the upper right abdomen. Liver pain can also feel like a stabbing sensation that takes your breath away. Sometimes this pain is accompanied by swelling, and occasionally people feel radiating liver pain in their back or in their right shoulder blade.

What Are Normal And Elevated Levels Of Liver Enzymes

Doctor
  • Normal levels of ALT ranges from about 7-56 units/liter of serum ,
  • Normal levels of AST is about 5-40 units/liter of serum.
  • Elevated levels of AST and ALT may signify the level of liver damage in a person. The interpretation of elevated AST and ALT results depends upon the entire clinical evaluation of an individual, and so it is best done by physicians experienced in evaluating liver disease and muscle disease.

What Diseases and Drugs Cause Elevated Liver Enzymes?

Common causes of elevated ALT and AST are

  • viral liver infections,

Common causes of abnormal AST and ALT levels are wide-ranging .

Many drugs may cause elevated blood levels of AST, and ALT and some medications can cause severe damage, for example, acetaminophen .

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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. Lets 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 200This 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 200This could mean that:

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

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

Non-alcoholic fatty liver disease

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