LIVER PROFILING: The Liver Function

Tests
A. The Liver
Located in the upper-right portion of
the abdominal cavity under the
diaphragm and to the right of the
stomach.
The largest glandular organ in the
body
and
performs
multiple
critical functions to keep the body
pure of toxins and harmful
substances.

Functions:
o Produce bile. (Biles salts break up
fat into smaller pieces so it can be
absorbed more easily in the small
intestine.)
o Detoxification of blood.
o Production
of
glucose
(gluconeogenesis
or
glucose
synthesis/release during starvation)
o Production of important clotting
factors, albumin, and many
other important proteins
o Processing of waste products of
hemoglobin and other cells
o Storing
of
vitamins,
fat,
cholesterol, and bile
o Metabolizing medications and
nutrients
o Destroys old red blood cells.

B. The Liver Function Tests

Liver
function
tests
help
determine the health of your liver
by
measuring
the
levels
of
proteins,
liver
enzymes,
or
bilirubin in your blood.
The blood sample for liver function
tests is usually taken from a vein in
your arm. The main risk associated
with blood tests is soreness or
bruising at the site of the blood draw.
Most people don't have serious
reactions to having blood drawn.

A liver function test is often given

in the following situations:
o To screen for liver infections
o To monitor the side effects of
certain medications known to
affect the liver.

If you already have a liver

disease, to monitor the disease
and how well a particular
treatment is working.
To measure the degree of
scarring (cirrhosis) on the liver.

1. Alanine Transaminase (ALT) Test

o Also known as serum glutamic
oxaloacetic
transaminase
(SGOT).
o Used by your body to metabolize
protein.
o Best test for detecting hepatitis.
2. Aspartate
Transaminase
(AST)
Test
o Also known as serum glutamic
oxaloacetic
transaminase
(SGOT).
o An enzyme found in the liver and a
few other organs (heart and other
muscles in the body).
o A high result might indicate a
problem
with
the
liver
or
muscles.
o A very high level is frequently
seen with acute hepatitis.
o Usually measured together with
ALT to check for liver problems.
3. Alkaline Phosphatase (ALP) Test
o Related to the bile ducts
o Also produced by the bones,
intestines, and during pregnancy by
the placenta (afterbirth)
o The liver synthesizes the highest
amounts of this enzyme so high
levels in the blood may suggest
liver injury among other causes
o Often increased when bile ducts
are blocked.
o High levels may indicate liver
damage, blockage of the bile
ducts, or a bone disease.
4. Albumin Test
o Main protein made by your liver.
(It stops fluid from leaking out of
your blood vessels, nourishes your
tissues,
transports
hormones,
vitamins, and other substances
throughout your body.)
o A low result indicates that your
liver isnt functioning properly

and can be suggestive of chronic

liver disease or liver cirrhosis.

5. Bilirubin Test
o A byproduct of the routine
destruction of red blood cells
occurring in the liver.
o A damaged liver cant properly
process bilirubin. This leads to an
abnormally high level of bilirubin in
the blood.
o It is normally released as bile in the
feces.
o Elevation of the bilirubin can
suggest liver dysfunction.
o However, other conditions with
increased destruction of red blood
cells also can cause elevated
bilirubin levels despite normal liver
function

6. Total protein (TP)

TP test measures albumin and
all other proteins in blood,
including antibodies made to
help fight off infections.
Total protein is typically normal
with liver disease.
7. Gamma-glutamyl
transferase
(GGT) Test
o May be used to help determine
the cause of an elevated ALP.
o Increased levels are also seen
with alcohol consumption and
with
conditions,
such
as
congestive heart failure.
o Thought to indicate possible
liver damage; the higher the
abnormal level, the more likely
there is liver damage.
8. Lactate dehydrogenase (LD) Test
o LD is an enzyme released with
cell damage; found in cells
throughout the body.
o This is a non-specific marker of
tissue damage.
o It is usually not elevated with most
liver diseases, but it may be
elevated with very acute liver
disease or liver tumors.
9. Prothrombin time (PT) Test

Measure
blood's
ability
for
normal clotting and prevention
of bleeding and bruising.
A prolonged or increased PT can
be seen with liver disease,
vitamin K deficiency, use of
drugs to reduce risk of clotting
(warfarin), and with coagulation
factor deficiencies.

10.
Alpha-feto protein (AFP)
o Associated with regeneration or
proliferation of liver cell.
o Often ordered to monitor people
with chronic liver diseases such
as cirrhosis, chronic hepatitis B
or hepatitis.
11.

Autoimmune antibodies
o e.g., ANA, SMA, anti-LKM1
o Associated
with
autoimmune hepatitis.

Normal blood test results for typical

liver function tests include:
Blood
Test
ALT
AST
ALP
Albumin
Total
protein
Bilirubin
GGT
LD
PT

Range

Unit

7 56
5 - 40
45
115
3.5
5.0
6.3
7.9
0.1
1.2
9 48
122
222
9.5
13.8

U/L
U/L
U/L

g/dL

d/dL

mg/d
L
U/L
U/L

secon
ds

C. Liver Diseases/Disorders
Symptoms of a liver disorder
include:
o Skin and eyes that appear
yellowish (jaundice)
o Abdominal pain and swelling
o Swelling in the legs and ankles
o Itchy skin

o
o
o
o
o
o

Dark urine color

Pale stool color, or bloody or tarcolored stool
Chronic fatigue
Nausea or vomiting
Loss of appetite
Tendency to bruise easily

Potential infectious and noninfectious causes and risk factors

for liver disease such as:
o Medications
o Alcohol use
o Sexual exposures
o History of blood transfusions
o History of injectable drug use
o Occupational exposure to blood
products
o Family history of liver disease
(for the possibility of inherited
diseases such as hemochromatosis,
Wilson's
disease,
or
alpha-1antitrypsin deficiency).

Common Liver Diseases/Disorders

Fatty Liver
o Steatohepatitis or hepatic steatosis
o One of the most common causes of
mild to moderate elevations of these
liver tests
o The most frequent cause of fatty
liver is alcohol abuse.
o Other causes of fatty liver
include diabetes mellitus and
obesity.

Hemochromatosis
A genetic (inherited) disorder in
which
there
is
excessive
absorption
of
dietary
iron
leading to accumulation of iron
in the liver with resultant
inflammation and scarring of the
liver.
o
If undiagnosed or untreated,
hemochromatosis can progress to
cirrhosis and liver failure.

Wilson's disease
An
inherited
disorder
with
excessive
accumulation
of
copper
in
diverse
tissues
including the liver and the brain.

Hepatitis
o Inflammation (swelling) of the
liver caused by a viral infection
or
exposure
to
harmful
substances such as alcohol
o Autoimmune hepatitis - Results from
liver injury brought about by the
body's own antibodies and defense
systems attacking the liver.
o Chronic hepatitis B and hepatitis C
o Other causes of chronic mild to
moderate liver enzyme elevation.
Cirrhosis
Characterized
by
the
replacement of healthy tissue
with fibrous tissue, regenerative
nodules, and liver scarring.
o The resulting hardening of the liver
interferes with blood circulation,
eventually leading to irreversible
liver damage and a complete loss of
liver function.
o

Excess copper in the liver can lead

to chronic liver inflammation, while
copper in the brain can cause
psychiatric and motor disturbances.

Cysts
A simple liver cyst is a thinwalled bubble, a fluid-filled
cavity in the liver.
Fibrosis
Characterized by the formation
of fibroids or fibrous tissue,
regenerative nodules, and liver
scarring, all of which impede
blood circulation, and lead to
progressive
loss
of
liver
function.

Hepatocellular
carcinoma
or
hepatoma
o Cancer arising from liver cells

Metastatic malignancies
o Cancers spreading to the liver
from other organs (such as
colon, pancreas, stomach, and
others)

o
o

o
o

Testing & Diagnosis

Blood tests. A group of blood tests
called liver function tests can be used
to diagnose liver disease. Other blood
tests can be done to look for specific
liver problems or genetic conditions.
Imaging tests. CT scan, MRI and
ultrasound can show liver damage.
Tissue analysis. Removing a tissue
sample (biopsy) from your liver may
help diagnose liver disease. Liver
biopsy is most often done using a long
needle inserted through the skin to
extract a tissue sample. It is then
analyzed in a laboratory.
Treatment
Lifestyle
modifications
alcohol use, losing weight)
Medications

(stopping

o
o

Surgery or liver transplant

Liver dialysisin which a machine
performs the detoxification function of
the liver.

o
o

Prevention
Drink alcohol in moderation
Use medications wisely

D. References:
http://www.healthline.com/humanbody-maps/liver#seoBlock
https://labtestsonline.org/understandin
g/analytes/liver-panel/tab/test
http://www.mayoclinic.org/testsprocedures/liver-functiontests/basics/results/prc-20012602
http://www.healthline.com/health/liverfunction-tests#Uses3
http://www.mayoclinic.org/diseasesconditions/liverproblems/basics/definition/con20025300
http://www.puristat.com/livercleansing/liver-disease-symptoms.aspx
http://www.medicinenet.com/liver_bloo
d_tests/article.htm