LIVER FUNCTION TEST:

The liver is an important organ of the body that has many important functions like the production of bile, removal of bilirubin along with other toxic materials, removal of medicine taken by the person, and storage of vitamins and minerals.

Due to these various functions performed by the liver, it is important to keep the liver healthy and to diagnose any liver disease as early as possible to limit the damage and give proper treatment.

Various types of liver tests are available which includes various types of blood tests, imaging studies, and pathological studies by biopsy.

These tests can help to make a proper diagnosis of the disease and treat the patient accordingly.

So we will discuss the various liver function tests in this blog and we should start with :

BLOOD TEST IN LIVER FUNCTION TEST:

1) SERUM BILIRUBIN: Bilirubin is produced in the body after the breakdown of heme which results in the formation of two types of bilirubin which are known as conjugated and non-conjugated bilirubin. Conjugated bilirubin is water-soluble and excreted by the kidney whereas non-conjugated bilirubin is insoluble in water.

If the serum bilirubin test result shows only elevation of unconjugated bilirubin then it mostly points towards hemolytic disease or genetic diseases like Gilbert syndrome and other diseases.

If test results show elevation of conjugated bilirubin then it can be due to liver disease.

If both are increased then it mostly points towards liver or biliary tract disease and further investigation should be done to find the cause of increased serum bilirubin level.

2) LIVER ENZYMES: These enzymes can play an important role in liver function tests to find out if the liver cells are undergoing any damage or if the bile flow from the liver is disturbed due to any disease.

A) AMINOTRANSFERASE – This includes two types of enzymes which are called Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST). ALT is more commonly found in the liver and AST is found in the liver, brain, pancreas, heart, and some muscles of the body too. So changes in ALT level is more specific for liver cell injury.

Aminotransferase level generally increases even due to mild liver cell injury, and a very high level of aminotransferase is generally seen in a disease like viral infections of the liver or prolonged use of any medicine which causes damage to the cells of the liver.

ALT and AST ratios are beneficial in identifying if the disease is acute or chronic in nature.

If the ALT level is more or equal to the AST level then it is mostly pointing towards acute liver cell injury, and if AST and ALT are less than one, then it is mostly seen in chronic liver disease.

AST: ALT ratio of more than 2 mostly points towards liver cell injury due to excessive use of alcohol.

B) ALKALINE PHOSPHATE: This enzyme is found in the liver, bone, and placenta. So this enzyme can be elevated in young children, pregnant ladies, and cholestatic disease. If the level of alkaline phosphate is nearly four times or more then it points towards cholestatic disease and further investigation should be done to rule out liver carcinoma also.

A higher level of alkaline phosphate is seen in diabetes, congestive cardiac failure, amyloidosis, and Hodgkin’s disease.

5′-nucleotidase and GGT ( GAMMA GLUTAMYL TRANSPEPTIDASE) are also liver enzymes that can be elevated during cholestatic disease.

3) SERUM PROTHROMBIN TIME – The liver has a function of synthesis of all the clotting factors except factor VIII which is synthesized in the vascular endothelial cells. Prothrombin time is useful in determining the synthetic function of the liver.

SERUM PT INR ( PROTHROMBIN TIME – INTERNATIONAL NORMALIZED RATIO) is used to check the degree of anticoagulation in patients who are on warfarin therapy.

Serum prothrombin time can be increased in diseases like obstructive jaundice, cirrhosis of the liver, and hepatitis.

4) SERUM ALBUMIN: Albumin is produced in the liver and a low level of albumin is seen in patients with chronic liver disease.

LIVER BIOPSY :

A biopsy is a procedure in liver function tests in which liver tissue is taken by a percutaneous or transjugular approach depending on the patient’s condition.  

It is generally done in cases like prolonged hepatomegaly, and splenomegaly, to diagnose autoimmune hepatitis, staging in liver cancer, and other conditions of the liver whose causes are not clear by other investigations.

IMAGING TECHNIQUES

ULTRASOUND: It is used to diagnose if the patient is having cholestasis, gallstone, or any liver mass is present or not, and if present then it is a cystic or solid mass in origin.

Hepatic blood flow can also be checked and portal hypertension can be diagnosed.

FIBROSCAN AND MAGNETIC RESONANCE ELASTROGRAPHY (MRE) is the latest investigation procedure that is useful in the diagnosis of fibrosis of the liver.

The liver is an important organ of the body, and it is very important to find the cause of any problem of the liver so that a proper diagnosis and treatment of the patient can be done which can save the liver from further damage.

TAKE HOME MESSAGE :

Liver function can be assessed by various types of blood tests, imaging techniques, and invasive procedures. The doctor can take a proper history from the patient regarding the disease and then will advise for the test depending on the patient.

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