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This sheet describes tests that may be done for liver problems. Your health care provider will tell you which tests you need.
A small amount of blood may be taken and tested for one or more of the following:
AFP (alpha fetoprotein). This is a protein made by the liver. A high level of AFP in the blood can be a sign of liver cancer, or liver injury and regeneration in adults.
Albumin. This is a liver function test. It measures a protein made by the liver. When a person has liver disease, the level of albumin in the blood (serum albumin) is often low.
Alk phos (alkaline phosphatase). This is an enzyme that is mostly made in the liver and bones. It’s measured with a blood test. A high level may suggest a problem with the bile ducts in the liver.
ALT (alanine aminotransferase, formerly called SGOT). ALT is an enzyme produced by the liver. When the liver is damaged, ALT leaks into the blood. If a blood test finds a high level of ALT, this can be a sign of liver problems such as inflammation, scarring, or a tumor.
Ammonia. This is a liver function test that shows when a harmful substance is left in the blood after digestion. Normally, the liver removes ammonia from the blood and turns it into urea, which leaves the body with urine. If a blood test shows that the ammonia level is too high, this process isn’t happening as it should. This test is very inaccurate for liver function and should rarely be used.
AST (aspartate aminotransferase, formerly called SOGT). AST is another enzyme made by the liver. It is also measured with a blood test. High levels of AST may be a sign of liver injury, especially if the ALT level is also high.
Bilirubin. This is a liver function test. It measures the yellow substance made when the body breaks down red blood cells. Bilirubin is collected by the liver and is sent out of the body with stool. When something is wrong with the liver or bile ducts, bilirubin can build up in the body. This causes jaundice (yellowing of the skin and the whites of the eyes). Two measurements may be taken from this test: total bilirubin and direct bilirubin. A high total bilirubin level means the liver isn’t breaking down bilirubin. A high direct bilirubin level suggests a blockage in the bile ducts. A high indirect bilirubin can indicate a condition called Gilbert syndrome. Only a small percentage of people have Gilbert syndrome. Gilbert syndrome is not a sign of disease. A high indirect bilirubin can also be a sign of rapid red cell breakdown. This is why a bilirubin test is not a good way to test liver function.
CBC (complete blood count). This is a test that measures all the parts of the blood (red blood cells, white blood cells, and platelets). Problems with these counts can mean infection or illness. They can also be a sign of a problem with the spleen. (The spleen is an organ close to the liver that can be affected by liver disease.) A low platelet count is common with advanced fibrosis of the liver. It also happens when the spleen becomes enlarged and begins to absorb platelets.
GGT (gamma-glutamyl transpeptidase). This is a liver enzyme that’s often measured along with other enzymes to check for liver problems. GGT is measured with a blood test. When alk phos and GGT are both higher than normal, it may be a sign that the bile ducts in the liver may be diseased or blocked. It can also be a sign of a fatty liver of alcohol damage.
Glucose. This is a sugar in the blood and the body’s most important source of energy. A healthy liver helps the body maintain a normal glucose level. If a blood test reveals that glucose is low, this may mean the liver is not working properly.
Infectious hepatitis. This is a disease that can be found with antibody and antigen tests for hepatitis A, B, C, and E.
INR (international normalized ratio). Prothrombin time (PT) tests check the ability of the blood to form clots. The liver makes a protein that helps with clotting. Problems with clotting can be a sign of liver disease and show low levels of vitamin K.
5’-Nucleotidase (5NT). This is an enzyme that is made is several organs, but only released into the blood by the liver. A high or low level may be a sign of liver disease.
Serum bile acid (SBA). This test measures the amount of bile acid in the blood. A high level may mean that bile ducts are blocked. This test is rarely done.
Vitamins A, D, E, and K. These are vitamins that are stored in the liver and fat and released over time (fat-soluble). They are absorbed by the liver with help from bile. If a blood test shows that levels of these vitamins are low, this could mean the liver is not absorbing them properly.
Zinc. This is a nutrient that is absorbed by the liver. If a blood test shows a low zinc level, this could mean the intestine isn’t absorbing zinc properly. This can worsen conditions brought on by high levels of ammonia.
Several other lab tests may be done to check for specific liver problems once liver damage is found. These include autoimmune antibodies, ceruloplasmin (Wilson’s disease), an iron panel (hemochromatosis), alpha-s-antitrypsin (alpha-s-antitrypsin deficiency), and others.
A number of procedures may be done to check the condition or function of the liver or connected organs, such as the gallbladder or bile ducts.
Liver biopsy. This is a test to look for damage in the liver tissue. A needle is used to take a small amount of tissue from the liver. The tissue is sent to a lab where it is checked for signs of inflammation, scarring, or other problems.
CT (Computed tomography) scan. A CT scan is a series of X-rays that make a 3D picture of the liver and gallbladder. This can show gallstones, abscesses, abnormal blood vessels, or tumors.
ERCP (endoscopic retrograde cholangiopnacreatography). This is a procedure that can show is the bile ducts are blocked or narrowed. It can also take pictures of the gallbladder. During this procedure, a small flexible tube called and endoscope is inserted into the mouth. The tube is moved down the esophagus and stomach to the top of the small intestine to where it meets the bile ducts. Dye is released through the scope to make the bile ducts show up on an X-ray. The doctor may also use small tools to take tiny samples of tissue or fluid. These are sent to a lab to be studied.
HIDA scan. This test checks gallbladder and liver function. A small amount of radioactive fluid is put into the body. This fluid will be seen on a scan as it travels through the liver to the gallbladder and into the intestine. It can show if bile ducts are missing or blocked and if the gallbladder is working properly. It can also show other problems in the biliary tree, or bile ducts.
MRI (magnetic resonance imaging). This test uses magnets, radio waves, and a computer to create an image ofthe organs and tissues in your body. MRCP (magnetic resonance cholangiopnacreatography) is a more detailed test. It can show abnormal or narrow bile ducts, tumors, and/or gallstones.
Sonogram (ultrasound). This test uses sound waves and a computer to create a picture of the liver, gallbladder, and bile ducts. It can show gallstones, tumors, or fat in the liver. It is also used to check the condition of the blood vessels and look for bile collections (where bile may leak out of the liver).
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