HEPATIC FUNCTION PANEL

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A liver panel may be used to screen a person for liver damage, especially someone who has a condition, or is taking a drug, that may affect the liver. A Comprehensive Metabolic Panel (CMP) may be ordered instead of a liver panel for routine screening. This group of tests includes most of the liver panel as well as additional tests that evaluate other organs and systems within the body.
A liver panel or one or more of its component tests may be used to help detect liver disorder if a person has symptoms that indicate possible liver dysfunction or if a person is being monitored or treated for a known condition or liver disorder. A bilirubin test, for instance, may be ordered to evaluate and monitor a jaundiced newborn.
Abnormal tests on a liver panel may prompt a repeat analysis to see if the elevation or decrease persists and/or may indicate the need for additional testing to determine the cause of the liver dysfunction.
The group of tests may also be ordered to monitor liver function and the effectiveness of treatment in someone who has a liver disorder.

A liver panel, or one or more of its components, may be ordered when someone is at risk for liver dysfunction. Some examples include:
·people who have a history of known or possible exposure to hepatitis viruses  
·those who are heavy drinkers  
·individuals whose families have a history of liver disorder  
·people who take drugs that might occasionally damage the liver  
A liver panel may be ordered when a person has signs and symptoms of liver disorder. Some of these include:
·Weakness, fatigue  
·Loss of appetite  
·Nausea, vomiting  
·Abdominal swelling and/or pain  
·Jaundice  
·Dark urine, light colored stool  
·Itching (pruritus)  
Usually no one single set of liver tests are used to make a diagnosis. Often, several liver panels will be ordered over a few days or weeks to determine if a pattern is present and to help determine the cause of the liver disease.
When liver disorder is detected, it may be monitored on a regular basis over time with the liver panel or with one or more of its components. A liver panel may also be ordered regularly to monitor the effectiveness of treatment for the liver disease.

Test results
The liver panel test results are not diagnostic of a specific condition; they indicate that there may be a problem with the liver. In a person who does not have symptoms or identifiable risk factors, abnormal liver test results may indicate a temporary liver injury or reflect something that is happening elsewhere in the body – such as in the skeletal muscles, pancreas, or heart. It may also indicate early liver disorder and the need for further testing and/or periodic monitoring.
Results of liver panels are usually evaluated together. Several sets of results from tests performed over a few days or weeks are often assessed together to determine if a pattern is present. Each person will have a unique set of test results that will typically change over time. A doctor evaluates the combination of liver test results to gain clues about the underlying condition. Often, further testing is necessary to determine what is causing the liver damage and/or disorder.
This table shows examples of some combinations of results that may be seen in certain types of liver conditions or disorders.
Type of liver condition or disorder
Bilirubin
ALT and AST
ALP
Albumin
PT

Acute liver damage (due, for example, to infection, toxins or drugs, etc.)
Normal or increased usually after ALT and AST are already increased
Usually greatly increased; ALT is usually higher than AST
Normal or only moderately increased
Normal
Usually normal

Chronic forms of various liver diseases
Normal or increased
Moderately increased
Normal to slightly increased
Normal
Normal

Alcoholic Hepatitis
Normal or increased
AST is usually at least twice the level of ALT
Normal or moderately increased
Normal
Normal

Cirrhosis
May be increased but this usually occurs later in the disorder
AST is usually higher than ALT but levels are usually lower than in alcoholic disorder
Normal or increased
Usually decreased
Usually prolonged

Bile duct obstruction, cholestasis
Normal or increased; increased in complete obstruction
Normal to moderately increased
Increased; often greater than 4 times what is normal
Usually normal but if the disorder is chronic, levels may decrease
Usually normal

Cancer that has spread to the liver (metastasized)
Usually normal
Normal or slightly increased
Usually greatly increased
Normal
Normal

Cancer originating in the liver (hepatocellular carcinoma, HCC)
May be increased, especially if the disorder has progressed
AST higher than ALT but levels lower than that seen in alcoholic disorder
Normal or increased
Usually decreased
Usually prolonged

Autoimmune
Normal or increased
Moderately increased
Normal or slightly increased
Normal or decreased
Normal


If a person is taking drugs that may affect their liver, then abnormal test results may indicate a need to re-evaluate the dosage or choice of medication. When a person with liver disorder is being monitored, then the doctor will evaluate the results of the liver panel together to determine if liver function in worsening or improving. For example, increasingly abnormal bilirubin, albumin, and/or PT may indicate a deterioration in liver function, while stable or improving results of these tests may indicate liver function preservation or improvement.
For individual tests:
Alanine aminotransferase (ALT)
A very high level of ALT is frequently seen with acute hepatitis. Moderate increases may be seen with chronic hepatitis. People with blocked bile ducts, cirrhosis, and liver cancer may have ALT concentrations that are only moderately elevated or close to normal.
Alkaline phosphatase (ALP)
ALP may be significantly increased with obstructed bile ducts, liver cancer, and also with bone disorder.
Aspartate aminotransferase (AST)
A very high level of AST is frequently seen with acute hepatitis. AST may be normal to moderately increased with chronic hepatitis. In people with blocked bile ducts, cirrhosis, and liver cancer, AST concentrations may be moderately increased or close to normal. When liver damage is due to alcohol, AST often increases much more than ALT (this is a pattern seen with few other liver disorders). AST is also increased after heart attacks and with muscle injury.
Bilirubin
Bilirubin is increased in the blood when too much is being produced, less is being removed, due to bile duct obstructions, or to problems with bilirubin processing. It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old.
Albumin
Albumin is often normal in liver disorder but may sometimes be low due to decreased production.
Total Protein
Total protein is typically normal with liver disorder.
Gamma-glutamyl transferase (GGT)
A GGT test may be used to help determine the cause of an elevated ALP. Both ALP and GGT are elevated in bile duct and liver disorder, but only ALP will be elevated in bone disorder. Increased GGT levels are also seen with alcohol consumption and with conditions, such as congestive heart failure.
Lactate Dehydrogenase (LDH)
This is a non-specific marker of tissue damage. It may be elevated with liver disorder but also with a number of other conditions.
Prothrombin Time (PT)
A prolonged or increased PT can be seen with liver disorder, vitamin K deficiency, and with coagulation factor deficiencies.

 
 
 
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All information on this page is intended for your general knowledge only and does not provide medical advice, diagnosis or treatment.