What do liver tests reveal? What do elevated values indicate?

Do you have elevated liver tests, GMT, ALT, AST or other parameters?

Liver disease is the sixth most common cause of death in Europe. Surprisingly, it is viral hepatitis that is very common. It is the number one cause of liver disease in general, and therefore the most common cause of liver failure and death.

Right after viral liver diseases come metabolic damage, toxic damage (mostly toxic liver damage from alcohol and drugs) and finally cancer.

All of these diseases can be detected very quickly, during a preventive check-up by a general practitioner. Basic blood parameters, including liver enzymes, are examined as standard. Elevated values do not always indicate serious disease, but should never be underestimated.

Tip: Viral hepatitis A and poor hygiene

Elevated liver tests and their significance

Elevated liver tests occur quite frequently in patients. They may not immediately indicate a serious condition, but further differential diagnosis is needed in a hepatology or gastroenterology outpatient clinic.

It is important to perform follow-up blood tests. If the liver enzymes are elevated for a long time, this is a sign of chronic liver damage. Chronic liver diseases include, for example, steatosis (fatty liver) or cirrhosis. Acute causes include, for example, liver abscess, metastasis or viral hepatitis.

In chronic liver disease, these tests are performed regularly and are an indicator of the course of the disease. Their frequency is determined by the doctor based on the patient's condition.

They inform us about the regression or progression of the condition and indicate the effectiveness of the existing treatment. Other manifestations of liver disease are equally important.

Liver test values reflect the degree of liver damage

Liver tests are performed by taking venous blood. Patients usually come in fasting, but this is not a requirement. Venous blood is taken in a tube and then sent to a biochemistry laboratory.

Interesting:
Any blood test can be requested by the patient. This test is usually not covered by health insurance.
This is also true of liver tests.

Liver tests and their values always reflect the degree of damage to the liver tissue and indicate the severity of the condition. They allow the disease to be caught in its early stages and thus facilitate treatment.

The most serious prognosis is for the relatively common liver cirrhosis caused by alcohol or drugs, but also for the less common hepatocellular carcinoma.

Interesting:
Almost all medications taken increase liver test values.
However, the most common are non-steroidal antiphlogistic drugs, antibiotics, antiepileptics and others.
It has also been found that the liver is often burdened by herbal extracts, especially Chinese teas. Therefore, even with homeopathic remedies, caution should be exercised.

Normal values of basic liver parameters:

The values given in the table may vary slightly depending on the specific laboratory and the age of the patient.

Additional liver tests

In addition to the basic liver tests that reveal the above AST, ALT, ALP, GMT and bilirubin values, specific liver tests are performed. These are additional tests that are performed when the basic liver tests are elevated or when a serious liver diagnosis is suspected.

Specific liver tests:

1. tests measuring synthetic liver activity (albumin, prealbumin, CHE, prothrombin factors).
2. tests measuring the liver's capacity and ability to transport organic substances into the circulation and to remove bile fluid and bilirubin
3. tests measuring the liver's capacity and ability to metabolise endogenous and xenogenic substances (ammonia)
4. other non-specific and complementary tests (antibody levels, serological testing for hepatitis)

Increases in AST and ALT are a sign of liver cell damage

AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are liver enzymes whose elevated values tell us about liver damage at the cellular level, i.e. hepatocellular damage.

What are the most common causes of elevated aminotransferases?

Elevated aminotransferases usually occur in chronic diseases when these values are elevated for a long time, i.e. more than 6 months.

The most important thing is to rule out viral hepatitis at the outset, the prognosis of which is serious if untreated. This is done by serological testing for evidence of antibodies in the serum (anti-HBs, anti-HBc, anti-HBe, HBV DNA, anti-HCV, HCV RNA).

They are also elevated in, for example, liver steatosis, cirrhosis, drug-induced liver damage or haemochromatosis (serum iron concentration is determined on differential dagnostic).

The most common cause of long-term elevated aminotransferases tends to be alcohol-induced liver damage, with AST being up to twice as high as ALT. There is also a concomitant elevation or increase in GMT. A targeted history of alcohol abuse is also important, which is difficult to admit to. However, physical examination can reveal other features of chronic alcoholism.

Elevated ALP and GMT values reveal bile duct disorders

ALT (alkaline phosphatase) and GMT (gamma-glutamyltransferase) are liver enzymes whose elevated values tell us about liver damage at the level of the bile duct, called cholestatic liver damage.

What diseases should be thought of when ALP and GMT are elevated?

Isolated elevation of ALT tells us that the damage is at the level of the bile duct, such as obstruction of the bile ducts by a stone. This is the direction of the diagnosis even when ALT and GMT are elevated at the same time. With isolated elevation of GMT and normal ALP values, there is usually no serious disease.

A hepatocellular origin such as cirrhosis, steatosis, hepatocellular carcinoma should be thought of, with AST and ALT also being elevated.

Blood tests when ALP and GMT are elevated should be supplemented with other investigations such as USG, X-ray, CT, MRI and ERCP. These investigations are done for accurate diagnosis and proper treatment.

Bile dye bilirubin indicates the problem at 3 levels

Elevated biliary dye values and the subsequent yellow colouration of the skin and mucous membranes indicate a problem at the level of the hematopoietic system, liver and biliary tract. Hyperbilirubinemia and icterus alone do not tell us anything closer, so additional investigations are always necessary (serological tests, oncomarkers, sonography, ERCP...).

Yellow discoloration of the skin, mucous membranes and sclerae may not only be a sign of the diseases we are familiar with. It may also be due to various foreign infections that ultimately lead to liver failure and death.

Tip: Vaccination, its importance before travelling abroad - foreign diseases

Type of icterus according to the site of damage:

1. Prehepatic icterus (⇑ n-Bil., norm. k-Bil.) occurs at the level of blood cells. There is an increased breakdown of red blood cells (erythrocyte hemolysis) and an increased concentration of conjugated bilirubin. It occurs mostly in newborns. It is called hemolytic icterus. It can also occur in an adult from various disease causes (hemolytic fever).
2. Hepatic icterus (⇑ n-Bil., ⇑ k-Bil.) arises directly in the liver from damage to the liver cells - hepatocytes. The cause is usually cirrhosis of the liver, all types of viral hepatitis (A, B, C) and other diseases. Laboratory evidence shows an increased concentration of conjugated and unconjugated bilirubin.
3. Posthepatic icterus (norm. n-Bil., ⇑ k-Bil.) arises at the level of the bile ducts. They are dilated due to obstruction. The obstruction may be formed, for example, by a gallbladder stone or a pressure-generating tumor.

Interesting:
Travelers beware!
Trips to exotic countries can cost you your liver.
As well as a tanned body, you may also take away a yellow colour from your holiday.
This can happen if you are infected with viral hepatitis or even yellow fever.

Albumin has little diagnostic value

Albumin is a plasma protein that makes up almost 60% of all proteins in the body. Elevated albumin levels have little diagnostic significance, which is why they are not often reported in articles about the liver or liver tests.

However, albumin binds bilirubin and is important in dissolving it. It also binds various toxic substances (heavy metals, drugs).

Its reduced values indicate some liver diseases, also kidney diseases, other digestive tract diseases, metabolic disorders, but also tissue damage (injuries, burns).

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Liver tests at home?

Home tests to check liver function can also be bought at the pharmacy and on the internet. But remember that no quick test is equal to a professional examination.