Lab Results 101: Liver Function Tests
Dr. Pullen
The first thing to know is that what is commonly called liver function testing (LFTs) has little if anything to do with the function of the liver. They are really tests that are clues to liver injury or disorders, but not really liver function. Still the name is likely here to stay, so liver function testing is what you will hear discussed. In the common test ordered at your doctor’s office, called the Comprehensive Metabolic Panel(CMP), several tests are included that give information about the liver.
The first two tests are the ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) were formally called SGPT and SGOT respectively. These are enzymes that normally function inside liver cells primarily, and are present in the blood stream in small quantities. When there is something causing injury to liver cells, these enzymes leak into the bloodstream in large quantities, and elevated serum levels of these enzymes what physicians call hepatocellular injury. At the top of the list of things that can lead to elevation of these enzymes is alcohol use. Excessive alcohol intake, especially chronic overuse, leads to hepatocellular damage, and eventually liver tissue scarring called cirrhosis. Elevation of the AST and ALT is often a clue to your physician that alcohol overuse may be a concern. Interestingly a high ratio of AST to ALT is especially suggestive of alcohol toxicity. Other toxic compounds, including acetaminophen (Tylenol) overuse, can cause similar liver cell injury and transaminase enzyme elevation.
Other causes of elevation of the AST and ALT include the various viral hepatitis infections. Currently hepatitis C is the cause we think of most commonly as a concern. It’s at epidemic proportions in the US now, and can be a silent cause of progressive liver damage, liver failure, and liver cancer. Often a physician will order testing for hepatitis C, B and sometimes A when evaluating for a cause of elevation of the liver transaminases. Less common causes of hepatitis include other medications, other ingested toxins, autoimmne hepatitis, , hemochromatosis, amyloidosis, and fatty liver. Alcoholism, diabetes and obesity can be causes of fatty liver.and infiltrative diseases like cancer
Another test result on the CMP is called alkaline phosphatase, or Alk Phos. This is an enzyme found mostly in the liver’s bile ducts. These are the tubes that bile flows through to exit the liver into the gallbladder and small intestine. Anything that causes obstruction to or inflammation of the bile ducts can lead to an elevated Alk Phos level. Examples of things your physician may look for include gall stones or other causes of bile duct obstruction, cancers or other masses that can block the bile ducts, and autoimmune disorders of the bile ducts, like primary sclerosing cholangitis.
Bilirubin is a breakdown product of the hemoglobin in our red blood cells. Red blood cells are constantly breaking down and being replenished. The end product of the metabolism of hemoglobin is bilirubin, and the liver excretes bilirubin in the bile as well as changes it in a process called conjugation into a form that can be excreted by the kidney in the urine. Elevation of bilirubin can be a clue to blockage of the bile ducts, to excessive red blood cell destruction or to failure of the liver to metabolize the bilirubin properly to be excreted. Significant elevation of bilirubin is a very concerning finding most of the time, and needs to be investigated.
Other tests in the CMP that reflect on liver function include the albumin level. The liver produces albumin, the primary intravascular protein, and low albumin levels can reflect malnutrition, chronic illness, or liver disease.
There are lots of additional tests available to investigate liver function, but these are the ones commonly seen on routine office testing. As you may have noted, most reflect problems with liver inflammation, blockage of the bile ducts, or liver cell damage rather than the true function of the liver, so they should be called liver disorder tests. The term is likely here to stay, so LFTs it is.
Liver Function Tests
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.
Tests that assess liver function ,
Your doctor may do tests to measure certain chemicals produced by the liver. These tests can help your doctor check how well your liver is working. . Tests may measure:
Bilirubin
Bilirubin is a yellowish pigment found in bile, a fluid produced by the liver.
This test done to measure bilirubin in the blood. Total and direct bilirubin are usually measured to screen for or to monitor liver or gallbladder problems. Large amounts of bilirubin in the body can lead to jaundice.
A test may also be done to measure bilirubin in a urine sample
This test is useful in determining if a patient has liver disease or a blocked bile duct. Additional conditions under which the test may be performed:Hepatic encephalopathy
Factors that interfere with bilirubin testing are:
Hemolysis (breakdown) of blood will falsely increase bilirubin levels
Lipids in the blood will falsely decrease bilirubin levels
Bilirubin is light-sensitive; it breaks down in light
/
Normal Results
Direct bilirubin: 0 to 0.3 mg/dL
Total bilirubin: 0.3 to 1.9 mg/dL /
What Abnormal Results Mean,
Jaundice is a yellowing of the skin and the white part of the eye, which occurs when bilirubin builds up in the blood at a level greater than approximately 2.5 mg/dL. Jaundice occurs because red blood cells are being broken down too fast for the liver to process. This might happen due to liver disease or bile duct blockage.
If the bile ducts are blocked, direct bilirubin will build up, escape from the liver, and end up in the blood. If the levels are high enough, some of it will appear in the urine. Only direct bilirubin appears in the urine. Increased direct bilirubin usually means that the biliary (liver secretion) ducts are obstructed. Increased direct bilirubin may indicate:
Bile duct obstruction
Cirrhosis
Hepatitis
Intrahepatic cholestasis (buildup of bile in the liver) due to any cause Other Conditions
.
Albumin
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 This test can help determine if a patient has liver disease or kidney disease, or if the body is not absorbing enough protein.
Albumin helps move many small molecules through the blood, including bilirubin, calcium, progesterone, and medications. It plays an important role in keeping the fluid from the blood from leaking out into the tissues.
Because albumin is made by the liver, decreased serum albumin may be a sign of liver disease. It can also result from kidney disease, which allows albumin to escape into the urine. Decreased albumin may also be explained by malnutrition or a low protein diet. Considerations
If you are receiving large amounts of intravenous fluids, the results of this test may be inaccurate.
Albumin will be decreased during pregnancy. .
Normal Results
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.
The normal range is 3.4 - 5.4 grams per deciliter (g/dL).
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
. What Abnormal Results Mean
Lower-than-normal levels of albumin may indicate: Liver disease (for example, hepatitis, cirrhosis, malnutrition Ascites , Glomerulonephritis or hepatocellular necrosis) . Other Conditions.
.. If you have increased levels of the following, your liver may be damaged:
Alanine aminotransferase (ALT or SGPT)
Aspartate aminotransferase (AST or SGOT)
LiverEnzymes
AST (aspartate aminotransferase), which was previously called SGOT, can also be elevated in heart and muscle diseases and is not liver specific. AST is an enzyme found in high amounts in heart muscle and liver and skeletal muscle cells. It is also found in lesser amounts in other tissues. Diseases that affect liver cells increase the levels of AST. However, increased levels of AST alone do not specifically indicate liver disease. An increase in AST levels may indicate: Acute hemolytic anemiaAcute renal failure
Cirrhosis , Hepatitis , Hereditary hemochromatosis
Infectious mononucleosis , Lack of blood flow to the liver (liver ischemia)
Liver necrosis , Liver tumor, Use of drugs that are poisonous to the liver and other conditions
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. Normal range can vary according to a number of factors, including age and gender / An increase in ALT levels may be due to:
Acute pancreatitis , Celiac disease , Cirrhosis
Death of liver tissue ( liver necrosis) , Hepatitis (viral, autoimmune)
Hereditary hemochromatosis , Infectious mononucleosis Lack of blood flow to the liver ( liver ischemia)
liverdisease, liver tumor
Use of drugs that are poisonous to the liver Risks m
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. ALP is a protein found in all body tissues. Tissues with particularly high amounts of ALP include the liver bile ducts, and bone. An increased level of alkaline phosphatase (AP) may indicate blockage of bile ducts. Many drugs affect the level of alkaline phosphatase in the blood. Your heatlh care provider may tell you to stop taking certain drugs before the test. Never stop taking any medicine without first talking to your doctor. ,
Drug List:
Allopurinol , Antibiotics , Anti-inflammatory medicines
Birth control pills , Certain arthritis drugs, Certain diabetes medicines
Chlorpromazine , Cortisone , Male hormones , Methyldopa
Narcotic pain medicines, Propranolol, Tranquilizers , Tricyclic and antidepressants ,. Higher-than-normal ALP levels may be due to:Higher-than-normal ALP levels may be due to:
Anemia, Biliary obstruction, Hepatitis , Hyperparathyroidism , liver disease or other conditions .
Lower-than-normal ALP levels (hypophosphatasemia) may be due to:
Malnutrition , Protein deficiency . 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. This test is used to detect diseases of the liver or bile ducts. It is also done along with other tests, such as the ALP test, to tell the difference between liver or bile duct disorders and bone disease.
Alkaline phosphatase (ALP) is increased in liver and bile duct disease as well as in bone disease. GGT is only increased in liver and bile duct disease, but not in bone disease. So, a patient with an elevated ALP and a normal
GGT probably has bone disease, not liver or bile ducts disease. .
Greater-than-normal levels of GGT may indicate: Congestive heart failure ,
Cholestasis (congestion of the bile ducts), Cirrhosis, Hepatitis
liver ischemia (blood flow deficiency), liver necrosis , liver tumor
Use of hepatotoxic drugs (drugs toxic to liver) , The normal range of GGT is 0-45 U/L
Blood Proteins.
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 .
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. .
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. . .
Why It Is Done .
liver tests are done when a medical history or physical exam suggests that something may be wrong with your liverThese tests can also help diagnose long-term (chronic) infection. Hepatitis C infection is considered chronic when liver enzymes remain elevated for longer than 6 months.
If you are being treated with antiviral therapy, you may have liver tests from time to time to see whether treatment is working.
Results .
Findings of liver function tests may include the following:
Normal .
All levels are within the normal range.
. Abnormal .
One or more levels are outside the normal range. Abnormal liver function tests may indicate that your liver is inflamed or is not working normally. This can be a sign that you have a viral infection.
.
What To Think About
Elevated liver enzymes can be caused by many things other than hepatitis C, such as obesity, hepatitis B, autoimmune hepatitis, certain medicines, or long-term alcohol use. So you will need other tests (such as a hepatitis C antibody blood test or a liver biopsy) to confirm a diagnosis of hepatitis C. .
People with chronic hepatitis C have abnormal liver enzyme levels most of the time. But the levels can fluctuate between normal and abnormal throughout the course of the disease.
liver tests can be used to help you and your doctor develop a treatment plan. Signs that you might need treatment include:
.
liver enzyme levels that remain above normal for longer than 6 months, which is evidence of chronic infection. .
Detectable levels of hepatitis C virus in your blood (positive hepatitis C RNA test). This is a sign of an active infection. .
If you have HCV talk to your health care team about the options that are available to treat this disease. Above all educated yourself about the lifestyle changes that may help protect your liver from dangerous toxins, alcohol being the number one .
Helpful Links: Hepatitis C Choices, 4th EditionFAQ Hepatitis C ( Great Help ) English (PDF) 881 KB ,,
If You Have Been Dianosed With NASH
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. ,,
Continuing tests in patients with fatty liver disease
, 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.If despite your best efforts to heal yourl 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. .
Liver Terms and Explanations
Enzyme = any of various proteins, such as the liver enzyme ALT. An enzyme is made by living cells and is capable of producing certain chemical changes in organic substances by catalytic action. Enzymes are used to digest food in the gut and to breakdown toxins in the liver cells.
Bile = a greenish to yellow colour fluid produced by the liver cells which flows out of the liver into the small intestine via the bile ducts. The bile can be stored in the gallbladder to be used to digest fat contained in a meal. Bile is needed to dissolve fats in the intestine so that they can be absorbed into the circulation.
Hepatocyte = liver cell
Proteins manufactured by the liver = albumin and globulin and clotting factors
Hepatitis = liver inflammation which can be caused by multiple and various factors
Acute hepatitis = sudden and short lived, often severe inflammation of the liver cells
Chronic hepatitis = prolonged and sustained inflammation of the liver which may be mild, moderate or severe
Chronic active hepatitis = more active prolonged inflammation of the liver cells from various and/or multiple causes
Hepatitis A, B, C = liver inflammation caused by hepatitis viruses A, B and C
Hepatocellular disease = liver cell disease causing liver cell damage which can be caused by multiple and various factors
Induction= to induce or increase
liver enzyme induction = liver enzyme increase
Steatosis = fatty changes
NASH = non-alcoholic steatorrhoeic hepatosis = severe fatty liver
Steatohepatitis = severe fatty liver disease causing liver inflammation
Hyper-triglyceridemia = high triglyceride levels in the blood
Triglycerides = a type of fat found in the blood stream and the liver. Triglyceride fat is made from dietary carbohydrates and alcohol.
Cholestatic = slow flow of bile or even worse, blocked flow of bile
Cholestatic liver disease = liver disease associated with slow or blocked flow of bile
Extrahepatic obstruction = blockage of bile ducts outside the liver
Intrahepatic obstruction = blockage of bile ducts inside the liver
Space occupying lesion = a lesion which occupies space in or near the liver = a mass in the liver or a mass near the liver – this could be a benign tumour, a cancer, an abscess, or cyst
Cirrhosis = scarred liver
Dr. Pullen
The first thing to know is that what is commonly called liver function testing (LFTs) has little if anything to do with the function of the liver. They are really tests that are clues to liver injury or disorders, but not really liver function. Still the name is likely here to stay, so liver function testing is what you will hear discussed. In the common test ordered at your doctor’s office, called the Comprehensive Metabolic Panel(CMP), several tests are included that give information about the liver.
The first two tests are the ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) were formally called SGPT and SGOT respectively. These are enzymes that normally function inside liver cells primarily, and are present in the blood stream in small quantities. When there is something causing injury to liver cells, these enzymes leak into the bloodstream in large quantities, and elevated serum levels of these enzymes what physicians call hepatocellular injury. At the top of the list of things that can lead to elevation of these enzymes is alcohol use. Excessive alcohol intake, especially chronic overuse, leads to hepatocellular damage, and eventually liver tissue scarring called cirrhosis. Elevation of the AST and ALT is often a clue to your physician that alcohol overuse may be a concern. Interestingly a high ratio of AST to ALT is especially suggestive of alcohol toxicity. Other toxic compounds, including acetaminophen (Tylenol) overuse, can cause similar liver cell injury and transaminase enzyme elevation.
Other causes of elevation of the AST and ALT include the various viral hepatitis infections. Currently hepatitis C is the cause we think of most commonly as a concern. It’s at epidemic proportions in the US now, and can be a silent cause of progressive liver damage, liver failure, and liver cancer. Often a physician will order testing for hepatitis C, B and sometimes A when evaluating for a cause of elevation of the liver transaminases. Less common causes of hepatitis include other medications, other ingested toxins, autoimmne hepatitis, , hemochromatosis, amyloidosis, and fatty liver. Alcoholism, diabetes and obesity can be causes of fatty liver.and infiltrative diseases like cancer
Another test result on the CMP is called alkaline phosphatase, or Alk Phos. This is an enzyme found mostly in the liver’s bile ducts. These are the tubes that bile flows through to exit the liver into the gallbladder and small intestine. Anything that causes obstruction to or inflammation of the bile ducts can lead to an elevated Alk Phos level. Examples of things your physician may look for include gall stones or other causes of bile duct obstruction, cancers or other masses that can block the bile ducts, and autoimmune disorders of the bile ducts, like primary sclerosing cholangitis.
Bilirubin is a breakdown product of the hemoglobin in our red blood cells. Red blood cells are constantly breaking down and being replenished. The end product of the metabolism of hemoglobin is bilirubin, and the liver excretes bilirubin in the bile as well as changes it in a process called conjugation into a form that can be excreted by the kidney in the urine. Elevation of bilirubin can be a clue to blockage of the bile ducts, to excessive red blood cell destruction or to failure of the liver to metabolize the bilirubin properly to be excreted. Significant elevation of bilirubin is a very concerning finding most of the time, and needs to be investigated.
Other tests in the CMP that reflect on liver function include the albumin level. The liver produces albumin, the primary intravascular protein, and low albumin levels can reflect malnutrition, chronic illness, or liver disease.
There are lots of additional tests available to investigate liver function, but these are the ones commonly seen on routine office testing. As you may have noted, most reflect problems with liver inflammation, blockage of the bile ducts, or liver cell damage rather than the true function of the liver, so they should be called liver disorder tests. The term is likely here to stay, so LFTs it is.
Liver Function Tests
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.
Tests that assess liver function ,
Your doctor may do tests to measure certain chemicals produced by the liver. These tests can help your doctor check how well your liver is working. . Tests may measure:
Bilirubin
Bilirubin is a yellowish pigment found in bile, a fluid produced by the liver.
This test done to measure bilirubin in the blood. Total and direct bilirubin are usually measured to screen for or to monitor liver or gallbladder problems. Large amounts of bilirubin in the body can lead to jaundice.
A test may also be done to measure bilirubin in a urine sample
This test is useful in determining if a patient has liver disease or a blocked bile duct. Additional conditions under which the test may be performed:Hepatic encephalopathy
Factors that interfere with bilirubin testing are:
Hemolysis (breakdown) of blood will falsely increase bilirubin levels
Lipids in the blood will falsely decrease bilirubin levels
Bilirubin is light-sensitive; it breaks down in light
/
Normal Results
Direct bilirubin: 0 to 0.3 mg/dL
Total bilirubin: 0.3 to 1.9 mg/dL /
What Abnormal Results Mean,
Jaundice is a yellowing of the skin and the white part of the eye, which occurs when bilirubin builds up in the blood at a level greater than approximately 2.5 mg/dL. Jaundice occurs because red blood cells are being broken down too fast for the liver to process. This might happen due to liver disease or bile duct blockage.
If the bile ducts are blocked, direct bilirubin will build up, escape from the liver, and end up in the blood. If the levels are high enough, some of it will appear in the urine. Only direct bilirubin appears in the urine. Increased direct bilirubin usually means that the biliary (liver secretion) ducts are obstructed. Increased direct bilirubin may indicate:
Bile duct obstruction
Cirrhosis
Hepatitis
Intrahepatic cholestasis (buildup of bile in the liver) due to any cause Other Conditions
.
Albumin
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 This test can help determine if a patient has liver disease or kidney disease, or if the body is not absorbing enough protein.
Albumin helps move many small molecules through the blood, including bilirubin, calcium, progesterone, and medications. It plays an important role in keeping the fluid from the blood from leaking out into the tissues.
Because albumin is made by the liver, decreased serum albumin may be a sign of liver disease. It can also result from kidney disease, which allows albumin to escape into the urine. Decreased albumin may also be explained by malnutrition or a low protein diet. Considerations
If you are receiving large amounts of intravenous fluids, the results of this test may be inaccurate.
Albumin will be decreased during pregnancy. .
Normal Results
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.
The normal range is 3.4 - 5.4 grams per deciliter (g/dL).
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
. What Abnormal Results Mean
Lower-than-normal levels of albumin may indicate: Liver disease (for example, hepatitis, cirrhosis, malnutrition Ascites , Glomerulonephritis or hepatocellular necrosis) . Other Conditions.
.. If you have increased levels of the following, your liver may be damaged:
Alanine aminotransferase (ALT or SGPT)
Aspartate aminotransferase (AST or SGOT)
LiverEnzymes
AST (aspartate aminotransferase), which was previously called SGOT, can also be elevated in heart and muscle diseases and is not liver specific. AST is an enzyme found in high amounts in heart muscle and liver and skeletal muscle cells. It is also found in lesser amounts in other tissues. Diseases that affect liver cells increase the levels of AST. However, increased levels of AST alone do not specifically indicate liver disease. An increase in AST levels may indicate: Acute hemolytic anemiaAcute renal failure
Cirrhosis , Hepatitis , Hereditary hemochromatosis
Infectious mononucleosis , Lack of blood flow to the liver (liver ischemia)
Liver necrosis , Liver tumor, Use of drugs that are poisonous to the liver and other conditions
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. Normal range can vary according to a number of factors, including age and gender / An increase in ALT levels may be due to:
Acute pancreatitis , Celiac disease , Cirrhosis
Death of liver tissue ( liver necrosis) , Hepatitis (viral, autoimmune)
Hereditary hemochromatosis , Infectious mononucleosis Lack of blood flow to the liver ( liver ischemia)
liverdisease, liver tumor
Use of drugs that are poisonous to the liver Risks m
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. ALP is a protein found in all body tissues. Tissues with particularly high amounts of ALP include the liver bile ducts, and bone. An increased level of alkaline phosphatase (AP) may indicate blockage of bile ducts. Many drugs affect the level of alkaline phosphatase in the blood. Your heatlh care provider may tell you to stop taking certain drugs before the test. Never stop taking any medicine without first talking to your doctor. ,
Drug List:
Allopurinol , Antibiotics , Anti-inflammatory medicines
Birth control pills , Certain arthritis drugs, Certain diabetes medicines
Chlorpromazine , Cortisone , Male hormones , Methyldopa
Narcotic pain medicines, Propranolol, Tranquilizers , Tricyclic and antidepressants ,. Higher-than-normal ALP levels may be due to:Higher-than-normal ALP levels may be due to:
Anemia, Biliary obstruction, Hepatitis , Hyperparathyroidism , liver disease or other conditions .
Lower-than-normal ALP levels (hypophosphatasemia) may be due to:
Malnutrition , Protein deficiency . 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. This test is used to detect diseases of the liver or bile ducts. It is also done along with other tests, such as the ALP test, to tell the difference between liver or bile duct disorders and bone disease.
Alkaline phosphatase (ALP) is increased in liver and bile duct disease as well as in bone disease. GGT is only increased in liver and bile duct disease, but not in bone disease. So, a patient with an elevated ALP and a normal
GGT probably has bone disease, not liver or bile ducts disease. .
Greater-than-normal levels of GGT may indicate: Congestive heart failure ,
Cholestasis (congestion of the bile ducts), Cirrhosis, Hepatitis
liver ischemia (blood flow deficiency), liver necrosis , liver tumor
Use of hepatotoxic drugs (drugs toxic to liver) , The normal range of GGT is 0-45 U/L
Blood Proteins.
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 .
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. .
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. . .
Why It Is Done .
liver tests are done when a medical history or physical exam suggests that something may be wrong with your liverThese tests can also help diagnose long-term (chronic) infection. Hepatitis C infection is considered chronic when liver enzymes remain elevated for longer than 6 months.
If you are being treated with antiviral therapy, you may have liver tests from time to time to see whether treatment is working.
Results .
Findings of liver function tests may include the following:
Normal .
All levels are within the normal range.
. Abnormal .
One or more levels are outside the normal range. Abnormal liver function tests may indicate that your liver is inflamed or is not working normally. This can be a sign that you have a viral infection.
.
What To Think About
Elevated liver enzymes can be caused by many things other than hepatitis C, such as obesity, hepatitis B, autoimmune hepatitis, certain medicines, or long-term alcohol use. So you will need other tests (such as a hepatitis C antibody blood test or a liver biopsy) to confirm a diagnosis of hepatitis C. .
People with chronic hepatitis C have abnormal liver enzyme levels most of the time. But the levels can fluctuate between normal and abnormal throughout the course of the disease.
liver tests can be used to help you and your doctor develop a treatment plan. Signs that you might need treatment include:
.
liver enzyme levels that remain above normal for longer than 6 months, which is evidence of chronic infection. .
Detectable levels of hepatitis C virus in your blood (positive hepatitis C RNA test). This is a sign of an active infection. .
If you have HCV talk to your health care team about the options that are available to treat this disease. Above all educated yourself about the lifestyle changes that may help protect your liver from dangerous toxins, alcohol being the number one .
Helpful Links: Hepatitis C Choices, 4th EditionFAQ Hepatitis C ( Great Help ) English (PDF) 881 KB ,,
If You Have Been Dianosed With NASH
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. ,,
Continuing tests in patients with fatty liver disease
, 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.If despite your best efforts to heal yourl 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. .
Liver Terms and Explanations
Enzyme = any of various proteins, such as the liver enzyme ALT. An enzyme is made by living cells and is capable of producing certain chemical changes in organic substances by catalytic action. Enzymes are used to digest food in the gut and to breakdown toxins in the liver cells.
Bile = a greenish to yellow colour fluid produced by the liver cells which flows out of the liver into the small intestine via the bile ducts. The bile can be stored in the gallbladder to be used to digest fat contained in a meal. Bile is needed to dissolve fats in the intestine so that they can be absorbed into the circulation.
Hepatocyte = liver cell
Proteins manufactured by the liver = albumin and globulin and clotting factors
Hepatitis = liver inflammation which can be caused by multiple and various factors
Acute hepatitis = sudden and short lived, often severe inflammation of the liver cells
Chronic hepatitis = prolonged and sustained inflammation of the liver which may be mild, moderate or severe
Chronic active hepatitis = more active prolonged inflammation of the liver cells from various and/or multiple causes
Hepatitis A, B, C = liver inflammation caused by hepatitis viruses A, B and C
Hepatocellular disease = liver cell disease causing liver cell damage which can be caused by multiple and various factors
Induction= to induce or increase
liver enzyme induction = liver enzyme increase
Steatosis = fatty changes
NASH = non-alcoholic steatorrhoeic hepatosis = severe fatty liver
Steatohepatitis = severe fatty liver disease causing liver inflammation
Hyper-triglyceridemia = high triglyceride levels in the blood
Triglycerides = a type of fat found in the blood stream and the liver. Triglyceride fat is made from dietary carbohydrates and alcohol.
Cholestatic = slow flow of bile or even worse, blocked flow of bile
Cholestatic liver disease = liver disease associated with slow or blocked flow of bile
Extrahepatic obstruction = blockage of bile ducts outside the liver
Intrahepatic obstruction = blockage of bile ducts inside the liver
Space occupying lesion = a lesion which occupies space in or near the liver = a mass in the liver or a mass near the liver – this could be a benign tumour, a cancer, an abscess, or cyst
Cirrhosis = scarred liver