Liver Disease

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Testing

Laboratory Tests
The goals with testing for liver disease are to screen for and detect liver injury, to evaluate its severity, diagnose the cause, and to monitor liver status over time. Screening and early detection are important since significant liver damage may occur with few or no symptoms. Diagnosing the cause helps health practitioners understand what type of liver disease someone has and how to treat it. The liver is often capable of repairing injuries and resolving inflammation, but conditions that cause obstruction of the bile ducts and/or lead to cirrhosis can cause permanent, progressive liver damage. Monitoring the status of a person's liver over time allows steps to be taken to preserve liver function.

Screening, detection, and monitoring
Several liver tests are performed routinely as part of general health screening in a comprehensive metabolic panel (CMP). Essentially the same liver tests may be ordered as a liver panel when someone has symptoms that may be due to liver injury or is at risk for developing liver disease. These tests measure the levels of specific enzymes, bilirubin, and protein that are abnormal when liver injury is present. Tests such as bilirubin may also be ordered individually to monitor a person with a liver disease. If any of the liver tests are abnormal, then they indicate the need for additional evaluation. A health practitioner will order diagnostic testing for whatever liver condition(s) a patient is suspected to have. Screening and detection tests include:

  • Alanine aminotransferase (ALT) – an enzyme found mainly in the liver; best test to detect hepatitis
  • Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased if ducts are blocked
  • Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places, particularly the heart and other muscles
  • Gamma-glutamyl transferase (GGT) – an enzyme found mainly in the liver; very sensitive to changes in liver function
  • Total bilirubin – measures all of the bilirubin in the blood; levels are increased with many liver diseases
  • Direct bilirubin – measures a form of bilirubin that is conjugated (combined with another compound) in the liver
  • Albumin – measures albumin, the main protein made by the liver, and tells how well the liver is making it
  • Total protein – measures albumin and all other proteins in blood, including antibodies present to help fight off infections (antibodies are not made in the liver)

Diagnosis and monitoring
Other tests may be ordered to help diagnose the cause of liver dysfunction. Some are used to monitor disease status and/or effectiveness of treatment. These may include:

For more information on laboratory tests used for specific types of liver diseases, see the table on the Types page.

Non-Laboratory Tests

  • Ultrasound
  • CT (computed tomography) scan
  • MRI (magnetic resonance imaging)
  • MRCP (magnetic resonance cholangiopancreatography)
  • PTC (percutaneous transhepatic cholangiogram)
  • ERCP (endoscopic retrograde cholangiopancreatography)

For more information on these imaging procedures, see RadiologyInfo.org.

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