Liver Function Tests

Overview :

The liver is one of the most important organs in the body. As the body's chemical factory, it regulates the levels of most of the main blood chemicals and acts with the kidneys to clear the blood of drugs and toxic substances. The liver metabolizes these products, alters their chemical structure, makes them water soluble, and excretes them in bile.

Liver function tests are used to determine if the liver has been damaged or its function impaired. Elevations of certain liver tests in relation to others aids in that determination. For example, aminotransferases (which include ALT and AST) are notably elevated in liver damage caused by liver cell disease (hepatocellular disease). However, in intrahepatic obstructive disease'which may be caused by some drugs or biliary cirrhosis'the alkaline phosphatases are most abnormal.

Alanine aminotransferase

Alanine aminotransferase (ALT), formerly called serum glutamate pyruvate transaminase, or SGPT, is an enzyme necessary for energy production. It is present in a number of tissues, including the liver, heart, and skeletal muscles, but is found in the highest concentration in the liver. Because of this, it is used in conjunction with other liver enzymes to detect liver disease, especially hepatitis or cirrhosis without jaundice. Additionally, in conjunction with the aspartate aminotransferase test (AST), it helps to distinguish between heart damage and liver tissue damage.

Aspartate aminotransferase

Aspartate aminotransferase (AST), formerly called serum glutamic-oxaloacetic transaminase, or SGOT, is another enzyme necessary for energy production. It, too, may be elevated in liver and heart disease. In liver disease, the AST increase is usually less than the ALT increase. However, in liver disease caused by alcohol use, the AST increase may be two or three times greater than the ALT increase.

Alkaline phosphatase

Alkaline phosphatase (ALP) levels usually include two similar enzymes (isoenzymes) that mainly come from the liver and bone and from the placenta in pregnant women. In some cases, doctors may order a test to differentiate between the alkaline phosphatase that originates in the liver and the alkaline phosphatase originating in bone. If a person has elevated ALP, does not have bone disease and is not pregnant, he or she may have a problem with the biliary tract, the system that makes and stores bile. (Bile is made in the liver, then passes through ducts to the gall bladder, where it is stored.)

Gamma-glutamyl transferase

Gamma-glutamyl transferase (GGT), sometimes called gamma-glutamyl transpeptidase (GGPT), is an enzyme that is compared with ALP levels to distinguish between skeletal disease and liver disease. Because GGT is not increased in bone disorders, as is ALP, a normal GGT with an elevated ALP would indicate bone disease. Conversely, because the GGT is more specifically related to the liver, an elevated GGT with an elevated ALP would strengthen the diagnosis of liver or bile-duct disease. The GGT has also been used as an indicator of heavy and chronic alcohol use, but its value in these situations has been questioned recently. It is also commonly elevated in patients with infectious mononucleosis.

Bilirubin

Bilirubin, a breakdown product of hemoglobin, is the predominant pigment in a substance produced by the liver called bile. Excess bilirubin causes yellowing of body tissues (jaundice). There are two tests for bilirubin: direct-reacting (conjugated) and indirect-reacting (unconjugated). Differentiating between the two is important diagnostically, as elevated levels of indirect bilirubin are usually caused by liver cell dysfunction (e.g. hepatitis), while elevations of direct bilirubin typically result from obstruction either within the liver (intrahepatic) or a source outside the liver (e.g. gallstones or a tumor blocking the bile ducts). Bilirubin measurements are especially valuable in newborns, as extremely elevated levels of unconjugated bilirubin can accumulate in the brain, causing irreparable damage.

Ammonia

Analysis of blood ammonia aids in the diagnosis of severe liver diseases and helps to monitor the course of these diseases. Together with the AST and the ALT, ammonia levels are used to confirm a diagnosis of Reye's syndrome (a rare disorder usually seen in children and associated with aspirin intake), which is characterized by brain and liver damage following an upper respiratory tract infection, chickenpox, or influenza. Ammonia levels are also helpful in the diagnosis and treatment of hepatic encephalopathy, a serious brain condition caused by the accumulated toxins that result from liver disease and liver failure.