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Liver Function Tests

Routine Profile

  • Bilirubin
  • ALT
  • Alkaline phosphatase
  • Albumin

Note: only 1% of patients with abnormal LFTs detected by indiscriminant screening have liver disease.

Common Diagnostic Patterns

Early acute hepatitis Established acute hepatitis Obstructive jaundice Cirrhosis Primary Biliary cirrhosis
Albumin N Albumin N Albumin N Albumin - / N Albumin - / N
Bilirubin N Bilirubin ^ Bilirubin ^ Bilirubin N Bilirubin N / ^
ALT   ^ ALT   ^ ALT N ALT  - / N ALT   N / ^
Alk Phos N Alk Phos  ­^ Alk Phos  ^ Alk Phos N Alk Phos  ^

Isolated Increase in Bilirubin

Gilbert's disease
  • Repeated episodes of elevated unconjugated bilirubin typically in the range 20-50 umol/L.
  • No evidence of haemolysis (normal FBC, reticulocyte count, blood film, Coomb's test, haptoglobin and LDH).
  • Fasting for 24 hours is typically followed by a rise in bilirubin to approx. 80 umol/L.

if Hepatitis consider: if Cirrhosis consider: if Obstruction consider:
Acute hepatitis

Viral hepatitis
Infectious mononucleosis

Autoimmune liver disease Gallstones or cancer (liver ultrasound)
Drug induced cholestasis
Tumour markers
Chronic hepatitis

Autoimmune liver disease

Ethanol induced liver disease
Alpha 1 Antitrypsin deficiency
Wilson's disease (Caeruloplasmin and copper)
Haemochromatosis (ferritin for diagnosis)

Obstructive jaundice

In chronic obstructive jaundice consider investigations for osteomalacia &
clotting studies
If gallstones consider sickle cell disease

Other Abnormalities in Chronic Liver Disease

Prothombin time This tests the hepatic ability to synthesise proteins and is probably the most sensitive indicator of an alteration in functional capacity of the liver.
increased RBC mean cell volume  (see Haematology section)

Gamma glutamyl transferase

gGT is a very sensitive chemical test for the presence of hepatobiliary disease. However, it should be noted that  elevations also seen with:

  • enzyme inducing agents eg alcohol, drugs
  • fatty liver due to: diabetes or obesity
  • heart failure
  • prostatic disease
  • pancreatic disease (acute & chronic pancreatitis, cancer)
  • kidney damage (ARF, nephrotic syndrome, rejection)

Page updated: 20/04/10 | Updated by: Dr. Julian Barth