To screen for, detect, evaluate, and monitor acute and chronic liver inflammation (hepatitis), liver infection, liver disease and/or and damage; to monitor side effects of certain medicines
Periodically to evaluate liver function; whenever you are at risk for liver injury; when you are taking medications that may affect your liver; when you have a liver disease; when you have symptoms associated with liver damage, such as jaundice
A blood sample drawn from a vein in your arm; for infants, a blood sample is often collected by pricking the heel and collecting a few drops of blood in a small tube (heelstick).
You may be instructed to fast overnight with only water permitted. Follow any instructions you are given. Inform the healthcare practitioner about all prescription and over-the-counter medications, herbal medications, vitamins and supplements you are taking as some medications/supplements affect the test results.
A liver panel is a group of tests that are performed together to detect, evaluate, and monitor liver disease or damage. The liver is a vital organ located in the upper right-hand part of the abdomen and behind the lower ribs. It takes up most of the space under the ribs and some space in the left upper abdomen as well.
The liver is responsible for several essential body functions, such as:
In addition, liver cells convert ammonia (end product of amino acids) to a less harmful substance called urea, which the body can get rid of through the urine.
A variety of diseases and infections can cause acute or chronic damage to the liver, causing inflammation (hepatitis), scarring (cirrhosis), bile duct obstructions, liver tumors, and liver dysfunction. Alcohol, drugs, some herbal supplements, and toxins can also inure the liver. A significant amount of liver damage may occur before symptoms such as jaundice, dark urine, light-colored stools, itching (pruritus), nausea, fatigue, diarrhea, and unexplained weight loss or gain appear. Early detection of liver injury is essential in order to minimize damage and preserve liver function.
The liver panel typically consists of several tests that measure the following:
Depending on your healthcare provider and the laboratory performing the testing, additional tests may be included in a liver panel. Examples include:
A liver panel may be used to:
One or more components of the liver panel may be used for monitoring. A series of bilirubin tests, for instance, may be ordered to evaluate and monitor a jaundiced newborn or a person with hemolytic anemia.
Abnormal results on a liver panel may prompt repeat testing of one or more of the tests, or of the whole panel, to see if the abnormal results persist. Additional testing may be needed to determine the cause of the liver dysfunction.
A liver panel, or one or more of its components, may be ordered when you have increased risk for liver disease and/or dysfunction. You may be at increased risk if you:
A liver panel may be ordered when you have signs and symptoms of liver disease. However, most people who have liver disease do not have any of these symptoms until the disease has been present for many years or is very severe. Signs and symptoms may include:
Often, a series of liver panels are ordered over a few days or weeks to help determine the cause of the liver disorder and evaluate its severity.
When liver disease is detected, it may be monitored on a regular basis over time with the liver panel or with one or more of its components. A liver panel may also be ordered regularly to monitor the effectiveness of treatment for the liver disorder.
Liver panel test results are not diagnostic of a specific condition. They indicate that there may be a problem with the liver. If you have no symptoms or identifiable risk factors, abnormal liver test results may indicate a temporary liver injury or reflect something that is happening elsewhere in the body – such as in the skeletal muscles, pancreas, or heart. It may also indicate early liver disease and the need for further testing and/or periodic monitoring.
Results of liver panels are usually evaluated together. Several sets of results from tests performed over a few days or weeks are often assessed together to determine if there is a pattern. Your healthcare practitioner will evaluate the combination of liver test results to gain clues about the underlying condition. Often, further testing is necessary to determine the cause of the liver damage and/or disease.
The following table summarizes some combinations of results that may be seen in certain types of liver conditions or diseases.
|Type of liver condition or disease||Bilirubin||ALT and AST||ALP||Albumin||PT|
|Acute liver damage (due, for example, to infection, toxins or drugs, etc.)||Normal or increased usually after ALT and AST are already increased||Usually greatly increased (8-50 times the upper reference limit); ALT is usually higher than AST||Normal or only moderately increased (less than 3 times the upper limit)||Normal||Usually normal|
|Chronic forms of various liver disorders||Normal or increased||Mildly or moderately increased; ALT is persistently increased||Normal to slightly increased||Normal||Normal|
|Alcoholic Hepatitis||Normal or increased||AST is moderately increased (less than 8 times the upper limit), usually at least twice the level of ALT||Normal or moderately increased||Normal||Normal|
|Cirrhosis||May be increased but this usually occurs later in the disease||AST is usually higher than ALT but levels are usually lower than in alcoholic disease||Normal or increased||Normal or decreased||Usually prolonged|
|Bile duct obstruction, cholestasis||Normal or increased; increased in complete obstruction||Normal to moderately increased||Increased; often greater than 4 times what is normal||Usually normal but if the disease is chronic, levels may decrease||Usually normal|
|Cancer that has spread to the liver (metastasized)||Usually normal||Normal or slightly increased||Usually greatly increased||Normal||Normal|
|Cancer originating in the liver (hepatocellular carcinoma, HCC)||May be increased, especially if the disease has progressed||AST higher than ALT but levels lower than that seen in alcoholic disease||Normal or increased||Normal or decreased||Usually prolonged|
|Autoimmune||Normal or increased||Moderately increased; ALT usually higher than AST||Normal or slightly increased||Usually decreased||Normal|
If you take medications that may affect your liver, then abnormal test results may indicate a need to reevaluate the dose or choice of medication. When your liver disease is being monitored over time, then your healthcare practitioner will evaluate the results of the liver panel together to determine if liver function or damage is worsening or improving. For example, increasingly abnormal bilirubin, albumin, and/or PT may indicate a deterioration in liver function, while stable or improving results of these tests may indicate that liver function is stable or improving.
For individual tests:
Alanine aminotransferase (ALT)
A very high level of ALT is frequently seen with acute hepatitis. Moderate increases may be seen with 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)
ALP may be significantly increased with obstructed bile ducts, cirrhosis, liver cancer, and also with bone disease.
Aspartate aminotransferase (AST)
A very high level of AST is frequently seen with acute hepatitis. AST may be normal to moderately increased with chronic hepatitis. In people 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.
Bilirubin is increased in the blood when too much is being produced, less is being removed, due to bile duct obstructions, or to problems with bilirubin processing. It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old.
Albumin is often normal in liver disease but may be low due to decreased production, especially in liver cirrhosis.
Total protein (TP)
Total protein is typically normal with liver disease.
Gamma-glutamyl transferase (GGT)
A GGT test may be used 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.
Lactate dehydrogenase (LD)
This is a non-specific marker of tissue damage. It is usually not elevated with most liver diseases, but it may be elevated with very acute liver disease or liver tumors. It is also elevated with a number of other conditions that do not affect the liver.
Prothrombin time (PT)
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.
In order to diagnose a liver disease, a healthcare practitioner will evaluate your liver panel test results and consider other factors such as signs, symptoms and clinical and family history. Depending on the results of the liver panel, a healthcare practitioner may suspect a particular cause of liver disorder and order follow-up lab tests and may order a liver biopsy and/or imaging scans to help confirm a diagnosis and determine the extent of liver damage.
Some examples additional lab tests include:
|Suspected type of liver disorder||Other or follow-up tests|
|Viral hepatitis||Acute viral hepatitis panel, hepatitis A testing, hepatitis B testing, hepatitis C testing|
|Alcohol abuse/hepatitis||GGT, Ethanol, carbohydrate-deficient transferrin|
|Toxic or drug-induced||Tests for toxins, drugs including drugs of abuse, acetaminophen|
|Wilson disease||Copper, Cerulosplasmin, eye exam, liver biopsy|
|Alpha-1 antitrypsin deficiency||Alpha-1 antitrypsin|
|Autoimmune||ANA, SMA, anti-LKM-1|
|Liver cancer||AFP, DCP|
No. Each of these tests may be ordered individually. However, if your healthcare practitioner is interested in following two or more individual liver tests, your practitioner may order the entire liver panel because it offers more information. Alternatively, a healthcare provider may order individual tests when monitoring specific conditions.
Your healthcare provider will want to evaluate everything you are taking as a whole. Many over-the-counter drugs and herbal or dietary supplements have the potential to affect the liver. Excessive amounts of a drug, and/or a decreased ability to metabolize a drug, and/or a combination of drugs (including over-the-counter drugs and supplements) may injure the liver. For instance, taking too much acetaminophen and/or the combination taking acetaminophen and alcohol or other drugs (e.g., isoniazid and phenobarbital) can cause severe liver damage.
Yes, early acute liver disease and chronic liver disease often cause no symptoms or mild nonspecific symptoms, such as fatigue and nausea.
Yes, many temporary conditions, such as shock, burns, severe infections, muscle trauma, dehydration, pancreatitis, hemolysis, and pregnancy, can cause one or more of the liver function tests to be abnormal.
Some liver conditions, such as hemochromatosis, alpha 1- antitrypsin deficiency and Wilson disease, may be inherited and can progressively damage the liver. Early detection of these conditions allows them to be treated and managed appropriately.
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