Practical: 06

Liver Function Tests

Liver blood tests are some of the most commonly performed blood tests. These
tests can be used to assess liver functions or liver injury. An initial step in detecting liver
damage is a simple blood test to determine the level of certain liver enzymes (proteins)
in the blood. Under normal circumstances, these enzymes mostly reside within the cells
of the liver. But when the liver is injured for any reason, these enzymes are spilled into
the blood stream. Commonly used tests to check liver abnormalities include:

• Alanine aminotransferase (ALT)

• Aspartate aminotransferase (AST)
• Alkaline phosphatase (ALP)
• Gamma-glutamyl transferase (GGT)
• Bilirubin
• Total serum proteins
• 5’ Nucleopeptidase

 Alanine aminotransferase (ALT)

• This test measures the amount of this enzyme in the blood.
• ALT is found mainly in the liver, but also in smaller amounts in the kidneys, heart,
muscles, and pancreas.
• ALT was formerly called serum glutamic pyruvic transaminase.
ALT Clinical Significance
Normal Value High Low
Females : 10-35 IU/L; • hepatitis, • Poor nutrition
Males : 10-40 IU/L cirrhosis, and
obstructive jaundice
• lead
poisoning
• Alcohol
abuse
 • Liver cancer
• mononucleo
sis
• Medications
(Acetaminophen,
Aspirin etc.)

 Aspartate aminotransferase (AST)

• AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas,
and kidneys.
• AST formerly was called serum glutamic oxaloacetic transaminase (SGOT).
• Low levels of AST are normally found in the blood.
• When body tissue or an organ such as the heart or liver is diseased or damaged,
additional AST is released into the bloodstream.
• The amount of AST in the blood is directly related to the extent of the tissue
damage.
• After severe damage, AST levels rise in 6 to 10 hours and remain high for about
4 days

AST Clinical Significance

Normal Value High Low
10-40 IU/L • Liver damage from • Vitamin B6
conditions such as deficiency
hepatitis or • chronic kidney
disease
cirrhosis.
• Smoking and
• A heart attack or Alcoholism
heart failure.
• Many medicines,
such as statins,
antibiotics,
chemotherapy,
aspirin, opioids,
and barbiturates.
• Very strenuous
exercise or severe
 injury to a muscle.
• High doses of
vitamin A.
• Kidney or lung
damage.
• Cancers

 Alkaline phosphatase (ALP)

• ALP is made mostly in the liver and in bone with some made in the intestines and
kidneys. It also is made by the placenta of a pregnant woman.
• The liver makes more ALP than the other organs or the bones.

ALP Clinical Significance

Normal Value
Females : 42-98 IU/L.
Males : 53-168 IU/L
High Low
• Rapid bone growth • Zinc deficiency
(during puberty) • hypophosphatasia,
• bone disease (such • Genetic disorder of
as Paget's disease bone metabolism.
or cancer that has • Malnutrition
spread to the bones)
• Hyperparathyroidism
• vitamin D deficiency
• damaged liver cells
• Heart failure, heart
attack, kidney
cancer or sepsis
• Pregnancy (third
trimester)

 Gamma-glutamyl transferase (GGT)

• It is used to determine the cause of elevated alkaline phosphatase (ALP)
• Both ALP and GGT are elevated in bile ducts disease and in some liver
diseases but only ALP will be elevated in bone disease.
Normal Values: 9–48 units per liter (U/L)
 Bilirubin
• It is a brownish yellow substance found in bile and is produced when the liver breaks
down old red blood cells
• Bilirubin is then removed from the body through the stool (feces) and gives stool its
normal color.
• Bilirubin circulates in the bloodstream in two forms:
• Indirect (or unconjugated) bilirubin: This form of bilirubin does not dissolve in
water. Indirect bilirubin travels through the bloodstream to the liver, where it is
changed into a soluble form (direct or conjugated).
• Direct (or conjugated) bilirubin: Direct bilirubin dissolves in water and is made by
the liver from indirect bilirubin.

Bilirubin Clinical Significance

Normal Value
• Total Bilirubin: 0.0–1.4
mg/dL or 1.7–20.5
µmol/L
• Direct bilirubin: 0.0–
0.3 mg/dL or 1.7–5.1
µmol/L
• Indirect bilirubin: 0.2–
1.2 mg/dL or 3.4–20.5
µmol/L
High Low
• Infected gallbladder, or • Medicines:
cholecystitis. vitamin C,
• Gilbert's syndrome phenobarbital, and
(hereditary disease theophylline
• hepatitis, cirrhosis, or
mononucleosis
• blockage of the bile
ducts, gallstones or
pancreatic cancer
• sickle cell disease or an
allergic reaction due to
blood transfusion
• Medicines : antibiotics,
contraceptives ,
diazepam (Valium),
flurazepam,
indomethacin, and
phenytoin

 Total serum proteins

• A total serum protein test measures the total amount of protein in the blood.
• It also measures the amounts of two major groups of proteins in the blood: albumin
and globulin
• Albumin is made mainly in the liver. It helps keep the blood from leaking out of blood
vessels. Albumin also helps carry some medicines and other substances through the
blood and is important for tissue growth and healing.
• Globulin is made up of different proteins called alpha, beta, and gamma types. Some
globulins are made by the liver, while others are made by the immune system.
Certain globulins bind with hemoglobin. Other globulins transport metals, such as
iron, in the blood and help fight infection.
Clinical Significance
Normal Value High Low
Total protein: 6.4–8.3 Severe dehydration • A poor diet
g/dL or 64–83 g/L (malnutrition).
Albumin: 3.5–5.0 g/dL or • Kidney disease.
35–50 g/L • Liver disease.
• Lupus or rheumatoid
arthritis.
• Gastrointestinal
malabsorption
syndromes, such as
sprue or Crohn's
disease.
• Hodgkin's lymphoma.
• Uncontrolled diabetes.
• Hyperthyroidism.
• Heart failure.
Globulin: 2.0 to 3.5 grams • Blood diseases: multiple • liver or kidney disease
per deciliter (g/dL) or 20 to myeloma, Hodgkin's
35 grams per liter (g/L) lymphoma, leukemia,
macroglobulinemia, or
hemolytic anemia.
• Autoimmune disease:
rheumatoid arthritis, lupus,
autoimmune hepatitis, or
sarcoidosis ,Tuberculosis

 5’ Nucleopeptidase

• It is used mostly to tell if the high protein level is due to liver damage or skeletal
muscle damage.
• Normal levels: 2 to 17 units per liter