Liver Function Test

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Contents 1 More Specific Terms 2 Indications 3 Clinical-significance 4 Management 5 Notes 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• alanine aminotransferase (ALT) in serum (SGPT)
• alkaline phosphatase (ALP) in serum
• aspartate aminotransferase (AST) in serum (SGOT)
• bilirubin (conjugated/unconjugated) in serum
• cholesterol in serum/plasma
• gamma-glutamyltransferase (GGT) in serum
• hepatitis C virus (HCV) FibroSURE
• prothrombin time (PT)

Indications

• evaluation of liver disease

Clinical-significance

• elevations in serum transaminases ( AST & ALT)

• increases in transaminases > 5X upper limit of normal indicate hepatic dysfunction
• gamma-glutamyltransferase (GGT) will also be elevated with hepatic dysfunction, but is also elevated with cholestasis
• AST/ ALT ratio < 1 with most elevations of serum transaminases secondary to hepatic dysfunction
• alcohol-induced hepatitis:

• AST/ ALT ratio generally > 2

• viral hepatitis
• toxin-induced hepatitis
• drug-induced hepatitis
• morbid obesity may cause steatohepatitis
• hemochromatosis:

• transaminases generally moderately elevated
• ferritin levels are very high

• autoimmune hepatitis

• primarily affects women 20-40 years of age
• transaminases generally quite elevated

• Wilson's disease

• patients < 40 years of age
• eye findings: -Fleischer ring
• neurologic symptoms may be present

• alpha-1 antitrypsin deficiency

• may have associated COPD

• elevations in alkaline phosphatase ( ALP)

• ALP > 3X upper limit of normal suggests cholestasis or biliary tract disease
• AST & ALT are generally < 3X upper limit of normal in the absence of hepatic dysfunction
• gamma-glutamyl transferase (GGT) is also elevated with cholestasis or biliary tract disease
• kidney, bone & placenta are other sources of alkaline phosphatase
• biliary tract obstruction

• choledocholithiasis
• biliary stricture
• pancreatic carcinoma
• neoplasm in region of ampulla of Vater
• pancreatitis
• biliary atresia

• drug-induced cholestasis
• right-sided heart failure
• cholestasis of pregnancy
• hemolytic anemias
• disorders of ineffective erythropoiesis

• thalassemia

• hepatobiliary neoplasms

• primary benign & malignant tumors
• metastatic tumors

• primary biliary cirrhosis

• middle-aged women
• very elevated alkaline phosphatase

• primary sclerosing cholangitis

• most common in young to middle-aged men
• generally associated with ulcerative colitis

Management

• patients with abnormal liver function tests should be screened for:

• viral hepatitis
• hemochromatosis [3]
• Wilson's disease (young patients)

Notes

• recommend inclusion of serum cholesterol (marker of hepatic synthetic capacity)

More General Terms

• chemistry panel

Additional Terms

• cholestasis
• drugs that may affect liver function tests (LFTs)
• elevated serum transaminases; transaminitis; abnormal liver function tests
• hepatitis
• liver (function) tests (LFT, liver panel, hepatic function panel)

References

1. Prescriber's Letter 11(9): 2004 Detail-Document#: [1] (subscription needed) [2]
2. Prescriber's Letter 12(12): 2005 Liver function test scheduling Detail-Document#: [3] (subscription needed) [4]
3. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
4. Prescriber's Letter 17(17): 2010 Liver function test scheduling Detail-Document#: [5] (subscription needed) [6]
5. Henry's Clinical Diagnosis & Management by Laboratory Methods, 21st edition, McPherson RA & Pincus MR (es), W.B. Saunders Co., Philadelphia, PA. 2007

liver (function) tests (LFT, liver panel, hepatic function panel)