Abnormal liver function tests
Liver function tests may be requested if you have signs and symptoms of liver disease.
- Weakness, fatigue
- Loss of appetite
- Nausea and vomiting
- Abdominal swelling and/or pain
- Dark urine, light coloured stool
A liver panel is a group of tests that are performed together to detect, evaluate, and monitor liver disease or damage. The liver is one of the largest organs in the body and metabolises and detoxifies drugs and substances that are harmful to the body. It makes blood clotting factors, proteins, and enzymes, helps maintain hormone balances, and stores vitamins and minerals. Bile is transported through ducts directly or via the gall bladder to the small intestine to help digest fats.
The liver can be subject to a variety of diseases and infections causing acute or chronic damage, inflammation, scarring, bile duct obstructions, clotting abnormalities, and liver dysfunction. A significant amount of liver damage may be present before symptoms such as jaundice, dark urine, light-coloured stools, nausea, fatigue, diarrhoea, and unexplained weight loss or gain emerge. Early detection is essential in order to minimise damage and preserve liver function.
The basic Liver Function Test Profile measures enzymes, proteins, and substances that are produced or excreted by the liver and are affected by liver injury. Some are released by damaged liver cells and some reflect a decrease in the liver’s ability to perform one or more of its functions. When performed together, these tests give a snapshot of the health of the liver, an indication of the potential severity of any liver injury, change in liver status over time, and a starting place for further diagnostic testing.
The panel consists of several tests that are run at the same time on a blood sample.
- Total Protein – includes albumin and all other proteins in blood, including antibodies made to help fight off infections. Total protein is typically normal with liver disease
- Albumin – the main protein made by the liver indicates whether the liver is making an adequate amount of this protein. Often normal in liver disease but can be low due to decreased production
- Bilirubin – is a product of normal red blood cell breakdown. Bilirubin is increased when too much is being produced or less is being removed, due to bile duct obstructions, or impaired bilirubin processing
- Aspartate aminotransferase (AST) – an enzyme found in the liver, the heart and other muscles in the body. A very high level of AST is frequently seen with acute Hepatitis and may be normal to moderately increased with chronic Hepatitis. In those with blocked bile ducts, cirrhosis, and liver cancer, AST concentrations may be moderately increased or close to normal. When liver damage is due to alcohol, AST often increases much more than ALT (this is a pattern seen with few other liver diseases). AST is also increased after heart attacks and with muscle injury
- Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best test for detecting Hepatitis. Very high levels of ALT are frequently seen with acute Hepatitis with moderate increases in chronic Hepatitis. People with blocked bile ducts, cirrhosis, and liver cancer may have ALT concentrations that are only moderately elevated or close to normal
- Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked when ALP may be significantly increased. Also raised in, liver cancer, and bone disease
- Gamma-glutamyl transferase (GGT) – another enzyme found mainly in liver cells and is useful to help determine the cause of an elevated ALP. Both ALP and GGT are elevated in bile duct and liver disease, but only ALP will be elevated in bone disease. Increased GGT levels are also seen with alcohol consumption and with conditions, such as congestive heart failure
- Coagulation Screen (INR & APTT) – the liver produces proteins involved in the clotting (coagulation) of blood and, if abnormal, may indicate liver damage. Prolonged or increased coagulation can be seen with liver disease, vitamin K deficiency, and with coagulation factor deficiencies
A liver panel may be used to screen a person for liver damage, especially someone who has a condition, or who is taking a drug that may affect the liver. A Liver Investigation Profile and Full Liver Screen includes the liver panel as well as additional tests that relate to liver metabolism and function or have toxic effects on the liver. e.g. Alpha-Antitrypsin, Caeruloplasmin, Ferritin, CRP, Viral Hepatitis, Auto antibodies, vitamin D and Thyroid test.
Source: Nuffield Health Pathology Test Profiles published August 2012
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