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

Indications: - evaluation of liver disease Clinical significance: 1) elevations in serum transaminases (serum AST & serum ALT) a) increases in serum transaminases > 5X upper limit of normal indicate hepatic dysfunction b) serum gamma-glutamyltransferase (GGT) will also be elevated with hepatic dysfunction, but is also elevated with cholestasis c) AST/ALT ratio < 1 with most elevations of serum transaminases secondary to hepatic dysfunction - ALT is a more liver-specific enzyme than AST d) non-alcoholic fatty liver is the most common cause [3] - morbid obesity may cause steatohepatitis e) alcohol-induced hepatitis: - AST/ALT ratio generally > 2 f) viral hepatitis g) toxin-induced hepatitis h) drug-induced hepatitis i) hemochromatosis: - transaminases generally moderately elevated - ferritin levels are very high j) autoimmune hepatitis - primarily affects women 20-40 years of age - transaminases generally quite elevated k) Wilson's disease - patients < 40 years of age - eye findings: Kayser-Fleischer ring - neurologic symptoms may be present l) alpha-1 antitrypsin deficiency - may have associated COPD 2) elevations in serum alkaline phosphatase (ALP) a) ALP > 3X upper limit of normal suggests cholestasis or biliary tract disease b) serum AST & serum ALT are generally < 3X upper limit of normal in the absence of hepatic dysfunction c) serum gamma-glutamyl transferase (GGT) is also elevated with cholestasis or biliary tract disease d) kidney, bone & placenta are other sources of alkaline phosphatase e) biliary tract obstruction - choledocholithiasis - biliary stricture - pancreatic carcinoma - neoplasm in region of ampulla of Vater - pancreatitis - biliary atresia f) drug-induced cholestasis g) right-sided heart failure h) cholestasis of pregnancy i) hemolytic anemias j) disorders of ineffective erythropoiesis - thalassemia k) hepatobiliary neoplasms - primary benign & malignant tumors - metastatic tumors l) primary biliary cirrhosis - middle-aged women - very elevated alkaline phosphatase m) 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: a) viral hepatitis b) hemochromatosis [3] c) Wilson's disease (young patients) Notes: - recommend inclusion of serum cholesterol (marker of hepatic synthetic capacity)

Related

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)

Specific

alanine aminotransferase (ALT) in serum/plasma (SGPT) alkaline phosphatase (ALP) in serum/plasma 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)

General

chemistry panel

References

  1. Prescriber's Letter 11(9): 2004 Detail-Document#: 200903 (subscription needed) http://www.prescribersletter.com
  2. Prescriber's Letter 12(12): 2005 Liver function test scheduling Detail-Document#: 211210 (subscription needed) http://www.prescribersletter.com
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, 17. American College of Physicians, Philadelphia 2009, 2015
  4. Prescriber's Letter 17(17): 2010 Liver function test scheduling Detail-Document#: 260704 (subscription needed) http://www.prescribersletter.com
  5. Henry's Clinical Diagnosis & Management by Laboratory Methods, 21st edition, McPherson RA & Pincus MR (es), W.B. Saunders Co., Philadelphia, PA. 2007
  6. Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology. 2002 Oct;123(4):1367-84. PMID: 12360498
  7. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000 Apr 27; 342:1266 PMID: 10781624 https://www.nejm.org/doi/full/10.1056/NEJM200004273421707
  8. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112:18-35. PMID: 27995906

Components

alanine aminotransferase (ALT) in serum/plasma (SGPT) alkaline phosphatase (ALP) in serum/plasma aspartate aminotransferase (AST) in serum (SGOT) bilirubin (total) in serum/plasma (TBIL) bilirubin conjugated in serum gamma-glutamyltransferase (GGT) in serum protein (total) in serum prothrombin time (PT)