// LiverFunctionTests

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LiverFunctionTests

Alsoknownas:LiverProfileLiverFunctionTestsLFTs
Formalname:HepaticFunctionPanel
Relatedtests:ALT,ALP,AST,Bilirubin,Albumin,TotalProtein,GGT,ProthrombinTimeandInternationalNormalizedRatio,LD,ComprehensiveMetabolic
Panel,HepatitisATesting,HepatitisBTesting,HepatitisCTesting,EmergencyandOverdoseDrugTesting,Ethanol,ANA,SmoothMuscleAntibody,AntiLKM
1,DrugsofAbuseTesting,Copper,Ceruloplasmin,DCP,AFPTumorMarkers,Alpha1Antitrypsin,Acetaminophen,Ammonia

AtaGlance
WhyGetTested?

Toscreenfor,detect,evaluate,andmonitoracuteandchronicliverinflammation(hepatitis),liverinfection,liverdiseaseand/oranddamage

WhentoGetTested?

Periodicallytoevaluateliverfunctionwheneveryouareatriskforliverinjurywhenyouaretakingmedicationsthatmayaffectyourliverwhenyouhavealiverdiseasewhen
youhavesymptomsassociatedwithliverdamage,suchasjaundice

SampleRequired?

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// LiverFunctionTests
Abloodsampledrawnfromaveininyourarmforinfants,bloodmaybedrawnbypuncturingtheheelwithalancet.

TestPreparationNeeded?

Youmaybeinstructedtofastovernightwithonlywaterpermitted.Followanyinstructionsyouaregiven.Informthehealthcarepractitioneraboutallprescriptionandoverthe
countermedications,herbalmedications,vitaminsandsupplementsyouaretaking.

TheTestSample
Whatisbeingtested?

Aliverpanelisagroupofteststhatareperformedtogethertodetect,evaluate,andmonitorliverdiseaseordamage.Theliverisoneofthelargestorgansinthebodyandis
locatedintheupperrighthandpartoftheabdomenandbehindthelowerribs.Thelivermetabolizesanddetoxifiesdrugsandsubstancesthatareharmfultothebody.It
producesbloodclottingfactors,proteins,andenzymes,helpsmaintainhormonebalances,andstoresvitaminsandminerals.Bile,afluidproducedbytheliver,istransported
throughductsdirectlytothesmallintestinetohelpdigestfatsortothegallbladdertobestoredandconcentratedforlateruse.

Avarietyofdiseasesandinfectionscancauseacuteorchronicdamagetotheliver,causinginflammation(hepatitis),scarring(cirrhosis),bileductobstructions,livertumors,
andliverdysfunction.Alcohol,drugs,someherbalsupplements,andtoxinscanalsoposeathreat.Asignificantamountofliverdamagemaybepresentbeforesymptoms
suchasjaundice,darkurine,lightcoloredstools,itching(pruritus),nausea,fatigue,diarrhea,andunexplainedweightlossorgainemerge.Earlydetectionisessentialin
ordertominimizedamageandpreserveliverfunction.

Theliverpanelmeasuresenzymes,proteins,andsubstancesthatareproduced,processedoreliminatedbytheliverandareaffectedbyliverinjury.Somearereleasedby
damagedlivercellsandsomereflectadecreaseintheliver'sabilitytoperformoneormoreofitsfunctions.Whenperformedtogether,thesetestsgiveahealthcare
practitionerasnapshotofthehealthofaperson'sliver,anindicationofthepotentialseverityofanyliverinjury,changeinliverstatusovertime,andastartingplaceforfurther
diagnostictesting.

Howisthesamplecollectedfortesting?

Abloodsampleisobtainedbyinsertinganeedleintoaveininthearm.Forinfants,bloodmaybedrawnbypuncturingtheheelwithalancet.

Isanytestpreparationneededtoensurethequalityofthesample?

Someoftheteststhatmaybeincludedinthepanelmayrequirefastingovernightwithonlywaterpermitted.Followanyinstructionsprovided.Informthehealthcarepractitioner
aboutallprescriptionandoverthecountermedications,herbalmedications,vitaminsandsupplementsbeingtaken.

TheTest
Howisitused?
Whenisitordered?
Whatdoesthetestresultmean?
IsthereanythingelseIshouldknow?

Howisitused?

Aliverpanelmaybeusedtoscreenforliverdamage,especiallyifsomeonehasaconditionoristakingadrugthatmayaffecttheliver.Acomprehensivemetabolicpanel
(CMP),whichisoftenperformedaspartofageneralhealthcheckup,maybeorderedinsteadofaliverpanelforroutinescreening.Thisgroupoftestsincludesmostofthe
liverpanelaswellasadditionalteststhatevaluateotherorgansandsystemswithinthebody.

Aliverpaneloroneormoreofitscomponenttestsmaybeusedtohelpdiagnoseliverdiseaseifapersonhassignsandsymptomsthatindicatepossibleliverdysfunction.Ifa
personhasaknownconditionorliverdisease,testingmaybeperformedatintervalstomonitorthehealthoftheliverandtoevaluatetheeffectivenessofanytreatments.A
seriesofbilirubintests,forinstance,maybeorderedtoevaluateandmonitorajaundicednewborn.

Abnormaltestsonaliverpanelmaypromptarepeatanalysisofoneormoretests,orofthewholepanel,toseeiftheelevationsordecreasespersistand/ormayindicatethe
needforadditionaltestingtodeterminethecauseoftheliverdysfunction.

Thepanelusuallyconsistsofseveralteststhatarerunatthesametimeonabloodsample.Thesetypicallyinclude:

Alanineaminotransferase(ALT)anenzymemainlyfoundintheliverthebesttestfordetectinghepatitis

Alkalinephosphatase(ALP)anenzymerelatedtothebileductsbutalsoproducedbythebones,intestines,andduringpregnancybytheplacenta(afterbirth)often
increasedwhenbileductsareblocked.

Aspartateaminotransferase(AST)anenzymefoundintheliverandafewotherorgans,particularlytheheartandothermusclesinthebody

Bilirubintwodifferenttestsofbilirubinoftenusedtogether(especiallyifapersonhasjaundice):totalbilirubinmeasuresallthebilirubinintheblooddirectbilirubin
measuresaformthatisconjugated(combinedwithanothercompound)intheliver.

Albuminmeasuresthemainproteinmadebytheliverthelevelcanbeaffectedbyliverandkidneyfunctionandbydecreasedproductionorincreasedloss.

Totalprotein(TP)measuresalbuminandallotherproteinsinblood,includingantibodiesmadetohelpfightoffinfections

Dependingonthehealthcareproviderandthelaboratory,otherteststhatmaybeincludedinaliverpanelare:

Gammaglutamyltransferase(GGT)anotherenzymefoundmainlyinlivercells

Lactatedehydrogenase(LD)anenzymereleasedwithcelldamagefoundincellsthroughoutthebody

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// LiverFunctionTests
Prothrombintime(PT)theliverproducesproteinsinvolvedintheclotting(coagulation)ofbloodthePTmeasuresclottingfunctionand,ifabnormal,mayindicateliver
damage.

Alphafetoprotein(AFP)associatedwithregenerationorproliferationoflivercell

Autoimmuneantibodies(e.g.,ANA,SMA,antiLKM1)associatedwithautoimmunehepatitis

Whenisitordered?

Aliverpanel,oroneormoreofitscomponents,maybeorderedwhensomeoneisatriskforliverdysfunction.Someexamplesinclude:

Peoplewhotakemedicationsthatmaypotentiallydamagetheliver

Thosewhoarealcoholicsorheavydrinkers

Thosewhohaveahistoryofknownorpossibleexposuretohepatitisviruses

Individualswhosefamilieshaveahistoryofliverdisease

Peoplewhoareoverweight,especiallyiftheyhavediabetesand/orhighbloodpressure

Aliverpanelmaybeorderedwhenapersonhassignsandsymptomsofliverdiseasehowever,mostpeoplewhohaveliverdiseasedonothaveanyofthesesymptomsuntil
thediseasehasbeenpresentformanyyearsorisverysevere.Someoftheseinclude:

Weakness,fatigue

Lossofappetite

Nausea,vomiting

Abdominalswellingand/orpain

Jaundice(yellowingofeyesorskin)

Darkurine,lightcoloredstool

Itching(pruritus)

Diarrhea

Usuallynoonesinglesetoflivertestsisusedtomakeadiagnosis.Often,severalliverpanelswillbeorderedoverafewdaysorweekstohelpdeterminethecauseofthe
liverdisorderandevaluateitsseverity.

Whenliverdiseaseisdetected,itmaybemonitoredonaregularbasisovertimewiththeliverpanelorwithoneormoreofitscomponents.Aliverpanelmayalsobeordered
regularlytomonitortheeffectivenessoftreatmentfortheliverdisorder.

Whatdoesthetestresultmean?

Liverpaneltestresultsarenotdiagnosticofaspecificconditiontheyindicatethattheremaybeaproblemwiththeliver.Inapersonwhodoesnothavesymptomsor
identifiableriskfactors,abnormallivertestresultsmayindicateatemporaryliverinjuryorreflectsomethingthatishappeningelsewhereinthebodysuchasintheskeletal
muscles,pancreas,orheart.Itmayalsoindicateearlyliverdiseaseandtheneedforfurthertestingand/orperiodicmonitoring.

Resultsofliverpanelsareusuallyevaluatedtogether.Severalsetsofresultsfromtestsperformedoverafewdaysorweeksareoftenassessedtogethertodetermineifa
patternispresent.Eachpersonwillhaveauniquesetoftestresultsthatwilltypicallychangeovertime.Ahealthcarepractitionerevaluatesthecombinationoflivertestresults
togaincluesabouttheunderlyingcondition.Often,furthertestingisnecessarytodeterminewhatiscausingtheliverdamageand/ordisease.

Thistableshowsexamplesofsomecombinationsofresultsthatmaybeseenincertaintypesofliverconditionsordiseases.

Typeofliverconditionor Bilirubin ALTandAST ALP Albumin PT

disease

Acuteliverdamage(due,for Normalorincreasedusually Usuallygreatlyincreased(>10 Normaloronly Normal Usually

example,toinfection,toxinsor afterALTandASTarealready times)ALTisusuallyhigherthanAST moderatelyincreased normal
drugs,etc.) increased

Chronicformsofvariousliver Normalorincreased MildlyormoderatelyincreasedALTis Normaltoslightly Normal Normal

disorders persistentlyincreased increased

AlcoholicHepatitis Normalorincreased ASTismoderatelyincreased,usually Normalormoderately Normal Normal

atleasttwicethelevelofALT increased

Cirrhosis Maybeincreasedbutthis ASTisusuallyhigherthanALTbut Normalorincreased Normalordecreased Usually

usuallyoccurslaterinthe levelsareusuallylowerthanin prolon
disease alcoholicdisease ged

Bileductobstruction, Normalorincreased Normaltomoderatelyincreased Increasedoften Usuallynormalbutifthe Usually

cholestasis increasedincomplete greaterthan4times diseaseischronic,levels normal
obstruction whatisnormal maydecrease

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// LiverFunctionTests

Cancerthathasspreadtothe Usuallynormal Normalorslightlyincreased Usuallygreatly Normal Normal

liver(metastasized) increased

Canceroriginatingintheliver Maybeincreased,especiallyif ASThigherthanALTbutlevelslower Normalorincreased Normalordecreased Usually

(hepatocellularcarcinoma, thediseasehasprogressed thanthatseeninalcoholicdisease prolon
HCC) ged

Autoimmune Normalorincreased ModeratelyincreasedALTusually Normalorslightly Usuallydecreased Normal

higherthanAST increased

Ifapersonistakingdrugsthatmayaffecttheirliver,thenabnormaltestresultsmayindicateaneedtoreevaluatethedosageorchoiceofmedication.Whenapersonwithliver
diseaseisbeingmonitored,thenthehealthcarepractitionerwillevaluatetheresultsoftheliverpaneltogethertodetermineifliverfunctionordamageisworseningor
improving.Forexample,increasinglyabnormalbilirubin,albumin,and/orPTmayindicateadeteriorationinliverfunction,whilestableorimprovingresultsofthesetestsmay
indicateliverfunctionpreservationorimprovement.

Forindividualtests:

Alanineaminotransferase(ALT)
AveryhighlevelofALTisfrequentlyseenwithacutehepatitis.Moderateincreasesmaybeseenwithchronichepatitis.Peoplewithblockedbileducts,cirrhosis,andliver
cancermayhaveALTconcentrationsthatareonlymoderatelyelevatedorclosetonormal.

Alkalinephosphatase(ALP)
ALPmaybesignificantlyincreasedwithobstructedbileducts,cirrhosis,livercancer,andalsowithbonedisease.

Aspartateaminotransferase(AST)
AveryhighlevelofASTisfrequentlyseenwithacutehepatitis.ASTmaybenormaltomoderatelyincreasedwithchronichepatitis.Inpeoplewithblockedbileducts,cirrhosis,
andlivercancer,ASTconcentrationsmaybemoderatelyincreasedorclosetonormal.Whenliverdamageisduetoalcohol,ASToftenincreasesmuchmorethanALT(thisis
apatternseenwithfewotherliverdiseases).ASTisalsoincreasedafterheartattacksandwithmuscleinjury.

Bilirubin
Bilirubinisincreasedinthebloodwhentoomuchisbeingproduced,lessisbeingremoved,duetobileductobstructions,ortoproblemswithbilirubinprocessing.Itisnot
uncommontoseehighbilirubinlevelsinnewborns,typically1to3daysold.

Albumin
Albuminisoftennormalinliverdiseasebutmaybelowduetodecreasedproduction.

Totalprotein(TP)
Totalproteinistypicallynormalwithliverdisease.

Gammaglutamyltransferase(GGT)
AGGTtestmaybeusedtohelpdeterminethecauseofanelevatedALP.BothALPandGGTareelevatedinbileductandliverdisease,butonlyALPwillbeelevatedinbone
disease.IncreasedGGTlevelsarealsoseenwithalcoholconsumptionandwithconditions,suchascongestiveheartfailure.

Lactatedehydrogenase(LD)
Thisisanonspecificmarkeroftissuedamage.Itisusuallynotelevatedwithmostliverdiseases,butitmaybeelevatedwithveryacuteliverdiseaseorlivertumors.Itisalso
elevatedwithanumberofotherconditionsthatdonotaffecttheliver.

Prothrombintime(PT)
AprolongedorincreasedPTcanbeseenwithliverdisease,vitaminKdeficiency,useofdrugstoreduceriskofclotting(warfarin),andwithcoagulationfactordeficiencies.

IsthereanythingelseIshouldknow?

Inordertodiagnosealiverdisease,ahealthcarepractitionerwillevaluatetheliverpaneltestresults,orderfollowuptestssuchashepatitisvirustesting,andmayordera
liverbiopsyand/orimagingscanstohelpconfirmadiagnosisanddeterminetheextentofliverdamage.

CommonQuestions
WhydoesmydoctorwanttoknowallofthemedicationsandsupplementsIamtaking?
CanIhaveliverdiseaseifIfeelfine?
CanIhaveabnormaltestresultsandnothaveliverdisease?
Whyismyfamilyhistoryimportant?
Whattestsmaybedoneinfollowuptoanabnormalliverpaneltohelpdeterminethecauseofliverinjury?

1.WhydoesmydoctorwanttoknowallofthemedicationsandsupplementsIamtaking?

Yourhealthcareproviderwillwanttoevaluateeverythingyouaretakingasawhole.Manyoverthecounterdrugsandherbalordietarysupplementshavethepotentialto
affecttheliver.Excessiveamountsofadrug,and/oradecreasedabilitytometabolizeadrug,and/oracombinationofdrugs(includingoverthecounterdrugsand
supplements)mayinjuretheliver.Forinstance,bothexcessiveacetaminophenuseandthecombinationofacetaminophenandalcoholcancausesevereliverdamage.

2.CanIhaveliverdiseaseifIfeelfine?

Yes,earlyacuteliverdiseaseandchronicliverdiseaseoftencausenosymptomsormildnonspecificsymptoms,suchasfatigueandnausea.

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// LiverFunctionTests

3.CanIhaveabnormaltestresultsandnothaveliverdisease?

Yes,manytemporaryconditions,suchasshock,burns,severeinfections,muscletrauma,dehydration,pancreatitis,hemolysis,andpregnancy,cancauseoneormoreofthe
liverfunctionteststobeabnormal.

4.Whyismyfamilyhistoryimportant?

Someliverconditions,suchashemochromatosisandWilsondisease,maybeinheritedandcanprogressivelydamagetheliver.Earlydetectionoftheseconditionsallows
themtobetreatedandmanagedappropriately.

5.Whattestsmaybedoneinfollowuptoanabnormalliverpaneltohelpdeterminethecauseofliverinjury?

Dependingontheresultsoftheliverpanelandotherfactorssuchassigns,symptomsandclinicalandfamilyhistory,ahealthcarepractitionermaysuspectaparticularcause
ofliverdisorderandorderfollowuptests.Someexamplesinclude:

Suspectedtypeofliverdisorder Otherorfollowuptests

Viralinfection HepatitisA,B,C,orE

Alcoholabuse/hepatitis GGT,Ethanol

Toxicordruginduced Testsfortoxins,drugsincludingdrugsofabuse,acetaminophen

Wilsondisease Copper,Cerulosplasmin

Autoimmune ANA,SMA,antiLKM1

Chronic Liverbiopsy

Livercancer AFP,DCP

biochemistrysixthedition KaplanMCATBiochemistryReview TheMangaGuidetoBiochemistry EssentialsofBiochemistryFor

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