liver (function) tests (LFT, liver panel, hepatic function panel)
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Indications
- evaluation of liver disease
Clinical significance
- elevations in serum transaminases (serun AST & serum ALT)
- increases in serum transaminases > 5X upper limit of normal indicate hepatic dysfunction
- serum gamma-glutamyltransferase (GGT) will also be elevated with hepatic dysfunction, but is also elevated with cholestasis
- AST/ALT ratio < 1 with most elevations of serum transaminases secondary to hepatic dysfunction
- non-alcoholic fatty liver is the most common cause[3]
- morbid obesity may cause steatohepatitis
- alcohol-induced hepatitis:
- AST/ALT ratio generally > 2
- viral hepatitis
- toxin-induced hepatitis
- drug-induced hepatitis
- hemochromatosis:
- transaminases generally moderately elevated
- ferritin levels are very high
- autoimmune hepatitis
- primarily affects women 20-40 years of age
- transaminases generally quite elevated
- Wilson's disease
- patients < 40 years of age
- eye findings: Kayser-Fleischer ring
- neurologic symptoms may be present
- alpha-1 antitrypsin deficiency
- may have associated COPD
- elevations in serum alkaline phosphatase (ALP)
- ALP > 3X upper limit of normal suggests cholestasis or biliary tract disease
- serum AST & serum ALT are generally < 3X upper limit of normal in the absence of hepatic dysfunction
- serum gamma-glutamyl transferase (GGT) is also elevated with cholestasis or biliary tract disease
- kidney, bone & placenta are other sources of alkaline phosphatase
- biliary tract obstruction
- drug-induced cholestasis
- right-sided heart failure
- cholestasis of pregnancy
- hemolytic anemias
- disorders of ineffective erythropoiesis
- hepatobiliary neoplasms
- primary benign & malignant tumors
- metastatic tumors
- primary biliary cirrhosis
- middle-aged women
- very elevated alkaline phosphatase
- 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:
- viral hepatitis
- hemochromatosis[3]
- Wilson's disease (young patients)
Notes
- recommend inclusion of serum cholesterol (marker of hepatic synthetic capacity)
More general terms
More specific terms
- 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)
Additional terms
- 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)
Components
- aspartate aminotransferase (AST) in serum (SGOT)
- alanine aminotransferase (ALT) in serum/plasma (SGPT)
- alkaline phosphatase (ALP) in serum/plasma
- gamma-glutamyltransferase (GGT) in serum
- protein (total) in serum
- bilirubin (total) in serum/plasma (TBIL)
- bilirubin conjugated in serum
- prothrombin time (PT)
References
- ↑ Prescriber's Letter 11(9): 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200903&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 12(12): 2005 Liver function test scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211210&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 17. American College of Physicians, Philadelphia 2009, 2015
- ↑ Prescriber's Letter 17(17): 2010 Liver function test scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Henry's Clinical Diagnosis & Management by Laboratory Methods, 21st edition, McPherson RA & Pincus MR (es), W.B. Saunders Co., Philadelphia, PA. 2007
- ↑ Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology. 2002 Oct;123(4):1367-84. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12360498
- ↑ Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000 Apr 27; 342:1266 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10781624 https://www.nejm.org/doi/full/10.1056/NEJM200004273421707
- ↑ Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112:18-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27995906