Liver tests measure different substances produced by our liver, including proteins, enzymes and bilirubin. High or low levels of different substances can indicate different diseases.

The liver is located in the upper right portion of the abdominal cavity just beneath the rib cage. The liver has many functions that are vital to life. Briefly, some of the important functions of the human liver are:

• Detoxification of blood.
• Production of important clotting factors, albumin, and many other important proteins.
• Metabolizing (processing) medications and nutrients.
• Processing of waste products of hemoglobin and other cells.
• Storing vitamins, fat, cholesterol, and bile.
• Production of glucose (gluconeogenesis or glucose synthesis/release during starvation).

Five primary liver tests

The most common liver tests include:

• Liver enzymes test. Your liver enzymes include alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT). These are elevated when there’s liver injury.
• Total protein test. A total protein test measures levels of protein in your blood. Your liver makes protein, and low protein levels may indicate that your liver isn’t functioning optimally.
• Bilirubin test. Bilirubin is a waste product that your liver deposits in bile.
• LDH test. Lactate dehydrogenase (LDH) is an enzyme found in many of your body’s tissues, including your liver.
• Prothrombin Time (PT) test. This test measures how long it takes for a sample of your blood to clot, a process that involves proteins that your liver produces.

These tests are all part of a routine blood panel called a comprehensive metabolic panel.

What are the aminotransferase enzymes (ALT, AST)?

Aminotransferase enzymes catalyze chemical reactions in which an amino group from one amino acid (amino acids are building blocks of proteins) is transferred from a donor molecule to a recipient molecule, hence, the name “aminotransferases.”

Medical terms can sometimes be confusing, as is the case with these enzymes because they have interchangeable names that commonly appear in both medical and non-medical articles. For example:

• Another name for aminotransferase is transaminase.
• The enzyme aspartate aminotransferase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT).
• Alanine aminotransferase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT).

To put matters briefly, AST = SGOT and ALT = SGPT; are enzymes produced by the liver and other types of cells.

Common liver tests

Liver blood tests can be used to assess liver functions or liver injury. An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes mostly reside within the cells of the liver. But when the liver is injured for any reason, these enzymes are spilled into the bloodstream.

Enzymes are proteins that are present throughout the body, each with a unique function. Enzymes help to speed up (catalyze) routine and vital chemical reactions in the body.

Among the most sensitive and widely used liver enzymes are aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are normally predominantly contained within liver cells and to a lesser degree in muscle cells. If the liver is injured or damaged, the liver cells spill these enzymes into the blood, raising the AST and ALT enzyme blood levels and signaling liver disease.

Other blood tests pertaining to the liver are measurements of some of the other enzymes found in the liver. In addition to AST and ALT, alkaline phosphatase, 5′ nucleotides, and gamma-glutamyl transpeptidase (GGT) are a few of the other enzymes located in the liver.

Normally, where are AST (SGOT) and ALT (aminotransferase enzymes)?

AST (SGOT) is normally found in a variety of tissues including the liver, heart, muscle, kidney, and brain. It is released into the serum when any one of these tissues is damaged. For example, the AST level in serum is elevated in heart attacks or with a muscle injury. It is, therefore, not a highly specific indicator of liver injury as its elevation can occur as a result of other injured tissues.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in the liver, but that is where it is most concentrated. It is released into the bloodstream as the result of liver injury. Thus, it serves as a fairly specific indicator of liver status.

Normal levels of AST (SGOT) and ALT (SGPT)

However, the ranges of AST and ALT numbers may differ slightly depending on the technique and protocols used by different laboratories worldwide. However, normal reference ranges are routinely provided by each laboratory and printed with each patient’s individual report.

High AST and ALT

AST (SGOT) and ALT (SGPT) are reasonably sensitive indicators of liver damage or injury from different types of diseases or conditions, and collectively they are termed liver tests or liver blood tests. However, it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems, or they may not. For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT results depends upon the entire clinical evaluation of an individual.

Moreover, the precise levels of these liver enzyme tests do not correlate well with the extent of liver problems or the prognosis. Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future prognosis for liver function. For example, individuals with acute viral hepatitis A may develop very high AST and ALT levels (sometimes in the thousands of units/liter range), but most people with acute viral hepatitis A recover fully without residual liver disease. Conversely, people with chronic hepatitis C infection typically have only a little elevation in their AST and ALT levels while having a substantial liver injury and even advanced scarring of the liver (cirrhosis) from ongoing minor inflammation of the liver.

Do AST and ALT test results indicate liver function?

It is important to clarify that ALT and AST levels do not reflect the function of the liver, even though in the allopathic medical community and in allopathic medical publications they commonly, and incorrectly, are referred to as liver function tests. Even in conditions when AST and ALT are very elevated, the liver still may function properly.

Liver Tests to detect function

The blood tests that truly reflect liver function are the following: normal values listed are for adult men – women and children have similar but slightly different ranges of normal test values.

• Coagulation panel (prothrombin time or PT, and international normalized ratio or INR): These tests measure blood’s ability for normal clotting and prevention of bleeding and bruising. This is the function of certain proteins called clotting factors that normally are produced in the liver. Normal values are about 9.5 to 13.8 seconds.
• Albumin level (hypoalbuminemia): Albumin is a very common protein found in the blood with a variety of functions. It also is produced only in the liver, and if its levels are lower than normal it can be suggestive of chronic liver disease or liver cirrhosis. Of note, many conditions other than liver disease also may cause low albumin levels. Normal values are about 3.5 to 5 g/dL.
• Bilirubin: This molecule is a byproduct of the routine destruction of red blood cells occurring in the liver. It is normally released as bile in the feces. Elevation of the bilirubin can suggest liver dysfunction. However, other conditions with increased destruction of red blood cells also can cause elevated bilirubin levels despite normal liver function. Normal values are about 0.1 to 1.0 mg/dL.

  

• Platelet count: Low platelet count (thrombocytopenia) has many causes, one of which can be advanced liver disease. Normal platelet counts are about 150,000 to 400,000 per (µL).
• Glucose: Glucose level is maintained in the body by a variety of mechanisms. The liver can release glucose in the blood for nourishment of other cells in case of starvation with insufficient oral intake of glucose. This process, called gluconeogenesis, is another major function of the liver. In advanced liver disease, this function of the liver can be compromised leading to unusually low glucose levels in the absence of adequate oral intake. Conversely, a large number of people with liver cirrhosis become glucose intolerant and develop diabetes.
• GGT (Gamma-glutamyl transpeptidase): This enzyme is thought to indicate possible liver damage; the higher the abnormal level, the more likely there is liver damage. Normal levels of GGT are about 9 to 48 U/L.
• ALP (alkaline phosphatase): The liver synthesizes the highest amounts of this enzyme so high levels in the blood may suggest liver injury among other causes. Normal levels of ALP are about 45 to 115 U/L.
• LD or LDH (Lactate dehydrogenase): This enzyme may be elevated in many types of diseases, including liver disease. Normal levels are about 122 to 222U/L.

Note that many hospitals and doctor’s offices list a liver function panel as part of a lab workup. These panels vary and may consist of AST, ALT, and some or all of the tests listed above. In addition, the normal panel values may vary somewhat, especially between adult men, women, and children so viewing the “normal” ranges of test values is always recommended, and a thorough discussion with the physician is necessary.

In addition, some clinicians recommend other tests such as serum ammonia and serum lactate levels in their panels. There are other tests such as serum ammonia and serum lactate levels in their panels.

Some common causes for abnormal liver tests

Abnormal liver tests may be detected in the blood in a variety of liver conditions for example:

• Mild to moderate elevations of liver enzymes are common. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT readings in such cases are usually between twice the upper limits of normal and several hundred units/liter.
  • One of the most common causes of mild to moderate elevations of these liver tests is a condition referred to as fatty liver (steatohepatitis or hepatic steatosis). The most frequent cause of fatty liver disease is alcohol use.
  • Other causes of fatty liver include diabetes mellitus and obesity. Fatty liver tests are composed of several tests including blood tests, CT and/or MRI tests, and in some individuals, a liver biopsy.
• Chronic hepatitis B and hepatitis C are other causes of chronic mild to moderate liver enzyme elevation. In these conditions, ALT and AST may be only slightly high and the degree of abnormality in liver function tests can indicate the degree of injury.
• Chronic and acute alcohol use can also commonly cause abnormal liver blood tests.

In alcoholic hepatitis, the range of liver tests can vary greatly.

• • In chronic alcohol liver disease or alcoholic cirrhosis, a slight elevation of ALT and AST may be observed.
  • In acute alcoholic hepatitis, high liver enzyme numbers are often seen.
• Many allopathic medicines can be responsible for a mild to moderate increase in liver enzyme tests.

Allopathic medications that cause increased AST and ALT

A variety of medications can cause abnormal liver enzyme levels in some individuals. Examples of some of the common medications with potential liver toxicity include:

Pain relief medications such as:

• Aspirin,
• Acetaminophen,
• Ibuprofen,
• Naproxen,
• Diclofenac, and
• Phenylbutazone etc.

Anti-seizure medications such as:

• Phenytoin,
• Valproic acid,
• Carbamazepine,
• Phenobarbital etc.

Antibiotics such as:

• Tetracyclines,
• Sulfonamides,
• Isoniazid
• Sulfamethoxazole,
• Trimethoprim
• Nitrofurantoin,
• Fluconazole
• Almost all allopathic anti-fungal, etc.

Cholesterol-lowering drugs such as statins:

• Lovastatin,
• Pravastatin,
• Atorvastatin,
• Fluvastatin,
• Simvastatin,
• Rosuvastatin,
• Niacin etc.

Cardiovascular drugs such as:

• Amiodarone,
• Hydralazine
• Quinidine, etc.
• Antidepressant drugs of the tricyclic type etc.

With drug-induced liver enzyme abnormalities, the enzymes usually normalize weeks to months after stopping those specific medications.

What diseases can cause very high AST or ALT levels?

AST and ALT serum levels in some liver conditions can range anywhere from ten times the upper limits of normal to thousands of units/litters. The highest levels of AST and ALT are found with disorders that cause the rapid death of numerous liver cells (extensive hepatic necrosis). Although this degree of liver enzymes elevation is not common, it can occur in such conditions as:

• Acute viral hepatitis A or B.
• Profound liver damage inflicted by toxins from an overdose of acetaminophen (brand-name Tylenol), poisons, chemicals and/or mushroom poisoning.
• The prolonged collapse of the circulatory system (shock) when the liver is deprived of fresh blood providing oxygen and nutrients.
• Also, very high AST and ALT levels can be a result of severe muscle diseases.

Less common diseases can cause of elevated liver blood tests

Less common causes of abnormal liver enzymes include hemochromatosis (iron overload), Wilson’s disease, alpha-1-antitrypsin deficiency, celiac disease, Crohn’s disease, ulcerative colitis, and autoimmune hepatitis. Though not as common as hepatitis C, hepatitis B can cause chronic liver disease with persistently abnormal liver enzymes.

• Hemochromatosis is a genetic (inherited) disorder in which there is excessive absorption of dietary iron leading to the accumulation of iron in the liver with resultant inflammation and scarring of the liver. If undiagnosed or untreated, hemochromatosis can progress to cirrhosis and liver failure.
• Wilson’s disease is an inherited disorder with excessive accumulation of copper in diverse tissues including the liver and the brain. Excess copper in the liver can lead to chronic liver inflammation, while copper in the brain can cause psychiatric and motor disturbances.
• Alpha-1-antitrypsin deficiency is an inherited disorder in which the lack of a glycoprotein (carbohydrate-protein complex) called alpha-1-antitrypsin leads to chronic lung disease (emphysema) and chronic liver disease.
• Autoimmune hepatitis results from liver injury brought about by the body’s own antibodies and defense systems attacking the liver.
• Celiac disease (celiac sprue) is a disease of the small intestine where a person has an allergy to gluten and develops gas, bloating, diarrhea, and in advanced cases malnutrition. Patients with celiac disease can also develop mildly abnormal ALT and AST levels.
• Crohn’s disease and ulcerative colitis are diseases with chronic inflammation of the intestines (collectively referred to as inflammatory bowel diseases). In these individuals’ inflammation of the liver (hepatitis) or bile ducts (primary sclerosing cholangitis) also can occur, causing abnormal liver tests.
• Viral infections other than common hepatitis viruses (A, B, C) can sometimes cause an elevation of liver enzymes as they can result in generalized body infection and liver inflammation.
• Non-viral infections of the liver are rare, but they can cause liver damage. Bacterial and amebic (parasitic) hepatic (liver) abscesses typically present as focal infection and inflammation of the liver as opposed to viral hepatitis where generalized liver inflammation occurs. Liver enzyme elevation is usually seen in the setting of these infections.
• Rarely, abnormal liver enzymes can be a sign of liver cancer. Cancer arising from liver cells is called hepatocellular carcinoma or hepatoma. Cancers spreading to the liver from other organs (such as the colon, pancreas, stomach, and others) are called metastatic malignancies (to the liver).
• Liver hemangiomas (masses of abnormal and atypical blood vessels within the liver) are the most common tumors in the liver. However, hepatic hemangiomas are benign and in general, do not cause elevation of liver tests.
• Another rare condition that causes elevation of liver tests is called the Budd-Chiari Syndrome. In this condition, obstruction of blood flow in the liver by a blood clot can damage the liver by limiting blood flow leading to injury of liver cells. As a result of this insult, liver enzymes may rise indicating hepatic inflammation.
• Glycogen storage disorders are genetic conditions seen in the pediatric population (detected at birth in severe types or later in childhood in less severe types). They impair the ability of the liver to store and metabolize glycogen, a complex sugar necessary for the production of nutrients and energy in the body. Glycogen storage disorders cause varying degrees of liver enzyme abnormalities.

It is important to note that the above list is not comprehensive and other less common conditions can also cause elevated liver blood tests.

Liver Tests for other enzymes cause medical problems

Aside from AST and ALT, there are other enzymes including alkaline phosphatase, 5′-nucleotidase (“5 prime” nucleotides), lactate dehydrogenase (LDH), and gamma-glutamyl transpeptidase (GGT) that are often used to detect liver disease.

• LDH is not specific to the liver and can be elevated in many diseases with inflammation in other tissues.
• Alkaline phosphatase is another liver enzyme that is frequently measured. This enzyme is usually found in the walls of the bile ducts (tube-like structures within the liver that connect liver cells together). Elevation of alkaline phosphatase may indicate an injury to the biliary cells.
  • Common causes of biliary injury or biliary obstruction (cholestasis) are gallstones and certain medications, although, some of the conditions listed previously can also raise the levels of this enzyme.
• Alkaline phosphate is also found in the bone and can be elevated in bone diseases.
• GGT and 5′ nucleotides levels can be elevated in biliary conditions (disease of the gallbladder and bile ducts) along with alkaline phosphatase.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

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