Liver function tests
Who should get the LFT Test done?
A Liver Function Test is recommended for people who fall into the below-mentioned categories:
- Individuals experiencing constant health symptoms such as pain in the abdomen, feeling tired, weakness, nausea, bloating, loss of appetite, etc.
- People undergoing treatment for liver diseases should also get the test done to know the effectiveness of the treatment on their body.
- Individuals having diabetes or symptoms of the same should get the test done to know the risk of liver disease in advance and treat it accordingly.
- LFT is also recommended to check the functioning of the liver and possible damage due to medications.
What is being tested?
The liver is a large organ located in the upper right-hand part of the abdomen behind the lower ribs. It takes up drugs and toxic substances from the blood and renders them harmless. It produces proteins including enzymes and blood clotting factors, helps maintain hormone balance and stores vitamins. The liver produces bile a fluid that is transported through ducts to the gallbladder to be stored and then to the small intestine to help digest fats.
Liver disease can be detected, evaluated and monitored by combinations of up to five tests measured at the same time on a blood sample. These may include:
- Alanine aminotransferase (ALT) an enzyme mainly found in the liver; the best test for detecting hepatiis
- Aspartate aminotransferase (AST) an enzyme found in the liver and a few other places, particularly the heart and other muscles in the body
- Total Bilirunin measures all the yellow bilirubin pigment in the blood
- Conjugated bilirubin measures the form made only in the liver and is often requested with total bilirubin in infants with jaundice
- Alkaline Phosphatase (ALP) an enzyme related to the bile ducts; often increased when they are blocked, either inside or outside the liver
- Albumin measures the main protein made by the liver and tells how well the liver is making this protein
- Total Protein measures albumin and all other proteins in blood, including antibodies made to help fight off infections
What does the result mean?
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It is important to note that abnormal results in the individual tests can occur in conditions that do not involve the liver or the bile ducts and that, conversely, normal results can be found in patients with serious liver disease. However, one or more abnormal liver blood test results often point to a diagnosis or to further investigations.
Raised ALT andn AST values indicate leakage from cells due to inflammation or cell death. Liver disease is more likely when the values of AST and ALT are higher, ALT rising more than AST in acute liver damage such as hepatits. When there is doubt about the source of the high enzyme levels, a raised creatinine kinase (CK) would suggest muscle damage and measurement of troponin will show whether it is the heart that is damaged.
A raised total bilirubin is usually due to liver disease or blockage of the passage of bile to the gut, for example by gall stones. Bilirubin is made water soluble (conjugated) by the liver and is then excreted in the urine, the stools becoming pale. However, a raised bilirubin can also occur in conditions where the breakdown of red blood cells produces more unconjugated bilirubin than the liver can handle, for example in newborn babies and conditions of abnormal haemoglobin like sickle cell anaemia. If this is suspected, both total and conjugated bilirubin are measured and monitored.
Liver disease and blockage of the bile ducts also increase ALP. This is believed to be due to increased bile duct pressure causing the liver to make more ALP. If there are localised lesions within the liver, for example deposits of cancer cells, then ALP may be stimulated to rise but there may be sufficient normal liver around the deposits to keep bilirubin normal. Bone disease can also increase ALP, for an example fracture or Vitamin D deficiency.
Albumin is made only in the liver and may be low when there has been extensive loss of liver tissue in long-standing disease. Other causes of a low albumin include malnutrition (which may accompany alcoholic liver disease), kidney disease, due to loss of protein in the urine, and inflammatory conditions anywhere in the body.
Total protein is usually normal in liver disease. The difference between its concentration and that of albumin, called globulin, tends to increase when albumin falls, but very high values are seen most commonly in alcoholic hepatitis and in hepatitis caused by the body producing antibodies against its own liver (autoimmune hepatitis).
Patients with liver disease often bruise easily and cuts take a long time to stop bleeding. A long prothrombin time PT suggests a deficiency of clotting factors made by the liver or a deficiency of vitamin K which is needed for the factors to work. The deficiency can be the result of severe malnutrition, for example in alcoholism, or the result of blockage of bile passage to the gut. (Bile contains bile salts that are needed for the gut to absorb fat, and vitamin K is fat soluble.) Patients with a long PT may be given an injection of vitamin K and the PT measured again in 24 hours. A quicker PT after the injection indicates a deficiency of vitamin K rather than of clotting factors.

Page created: 16 June 2025