Liver Disease

The liver function tests are also known as liver chemistries and help determine the health of your liver by measuring the levels of proteins, liver enzymes, and bilirubin in your blood.  Order yours today from Ulta Lab Tests and get your results confidentially online.    

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Acetaminophen is an analgesic agent that may be hepatotoxic when ingested in quantities exceeding 150 mg/kg.

Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving those related to nutrition and pathology particularly in the liver and kidney. Serum albumin is valuable when following response to therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may be a loss of albumin in the gastrointestinal tract, in the urine secondary to renal damage or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia

Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.

When the Total Alkaline Phosphatase activity is increased, the Isoenzymes are useful in determining the source of the increased activity.

This assay is intended for use in the assessment of risk for the development of hepatocellular carcinoma (HCC) in patients with chronic liver disease.

IMPORTANT - The specimen for this test must be collected at a patient service center that can collect, store and transport frozen samples as outlined below.  

IMPORTANT: Before ordering this lab test, check and confirm with the selected patient service center to ensure that they can collect, store and transport frozen samples as outlined below.

Preferred Specimen(s) 

2 mL frozen plasma collected in an EDTA (lavender-top) tube

Collection Instructions 

Collect blood from stasis-free vein of patient (e.g., no tourniquet). Patient should not clench fist during collection, as muscular exertion often increases venous ammonia levels. Patient should avoid smoking prior to phlebotomy since smoking increases plasma ammonia levels. Tubes should be filled completely and kept tightly stoppered at all times. Place immediately on ice. Separate plasma from cells within 20 minutes and freeze plasma immediately.

Transport Temperature 


Specimen Stability 

Room temperature: Unstable
Refrigerated: Unstable
Frozen -20° C: 72 hours
Frozen -70° C: 7 days

Reject Criteria 

Hemolysis • Lipemia • Received thawed • PPT Potassium EDTA (white-top) tube

Clinical Significance

Ammonia is one of the by-products of protein metabolism. Elevated blood ammonia levels have been associated with severe liver dysfunction such as hepatic encephalopathy, coma resulting from cirrhosis, severe hepatitis, Reye's syndrome, and drug hepatotoxicity. Also, elevated blood ammonia has been reported in cardiac failure, azotemia, and pulmonary emphysema. Correlation between plasma ammonia and the degree of encephalopathy can be erratic.

The major sources of amylase are the pancreas and the salivary glands. The most common cause of elevation of serum amylase is inflammation of the pancreas (pancreatitis). In acute pancreatitis, serum amylase begins to rise within 6-24 hours, remains elevated for a few days and returns to normal in 3-7 days. Other causes of elevated serum amylase are inflammation of salivary glands (mumps), biliary tract disease and bowel obstruction. Elevated serum amylase can also be seen with drugs (e.g., morphine) which constrict the pancreatic duct sphincter preventing excretion of amylase into the intestine.

Antinuclear antibodies are associated with rheumatic diseases including Systemic Lupus Erythematous (SLE), mixed connective tissue disease, Sjogren's syndrome, scleroderma, polymyositis, CREST syndrome, and neurologic SLE. 

Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge.

Testing for anti-neutrophil cytoplasmic antibodies (P-ANCA and/or C-ANCA and/or atypical P-ANCA) has been found to be useful in establishing the diagnosis of suspected vascular diseases, inflammatory bowel disease, as well as other autoimmune diseases.

Anion Gap Panel (Electrolyte Balance) includes the following test.

  • Anion gap 4
  • Sodium
  • Potassium
  • Chloride
  • Carbon dioxide

AST is widely distributed throughout the tissues with significant amounts being in the heart and liver. Lesser amounts are found in skeletal muscles, kidneys, pancreas, spleen, lungs, and brain. Injury to these tissues results in the release of the AST enzyme to general circulation. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peak within two days and return to normal by the fourth or fifth day post infarction. An increase in serum AST is also found with hepatitis, liver necrosis, cirrhosis, and liver metastasis.

Bile Acids, Fractionated and Total


Includes: Cholic Acid, Deoxycholic Acid, Chenodeoxycholic Acid, Total Bile Acids

Patient Preparation: Overnight fasting is preferred

Clinical Significance

Bile Acids, Fractionated and Total - Bile acids are formed in the liver, from cholesterol, stored and concentrated in the gallbladder, and excreted into the intestines in response to food. Elevated concentrations often suggest impaired hepatic clearance due to liver disease. Patients with intestinal malabsorption and metabolic disorders such as Gilbert's disease do not exhibit elevated bile acids concentrations.

An increase in serum bile acids concentration in the fasting state or postprandial is considered to be a specific indicator of liver disease. A decreased level indicates bile acid malabsorption, possibly due to ileal dysfunction.

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstructive disease

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gallbladder obstructive disease.

The BUN/Creatinine ratio is useful in the differential diagnosis of acute or chronic renal disease. Reduced renal perfusion, e.g., congestive heart failure, or recent onset of urinary tract obstruction will result in an increase in BUN/Creatinine ratio. Increased urea formation also results in an increase in the ratio, e.g., gastrointestinal bleeding, trauma, etc. When there is decreased formation of urea as seen in liver disease, there is a decrease in the BUN/Creatinine ratio. In most cases of chronic renal disease the ratio remains relatively normal.

Increased CRP levels are found in inflammatory conditions including: bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

On the right side of the body, located on the upper side of the abdomen, is the liver. Approximately the size of a football, the liver weighs about 2 to 3 pounds and works to do a variety of functions in the body, including the following:

  • Metabolize and detox harmful substances in the body
  • Convert nutrients that are derived from food into the vital blood components
  • Regulate the body’s ability to clot blood
  • Produce proteins and enzymes
  • Maintain the hormonal balance
  • Store specific vitamins
  • Contribute to the factors that aid in fighting the immune system
  • Remove toxic bacteria from the blood
  • Create bile that is vital for digestion

Bile is a green-yellow fluid that is comprised of bile acids or salts that are created via waste products like bilirubin that are created as red blood cells break down. This then flows through the small bile ducts that are located inside of the liver. Bile moves from the smaller sized ducts into the larger ones much in the same way that streams flow into a river and eventually converge into the main ducts and then exit the liver as the streams exit into a river. Part of the bile will then flow into the duodenum; the rest of the bile will flow into a storage facility and concentrate in the gallbladder. After eating, the gallbladder will then release some of the bile into the smaller sized intestine where it will then digest fats.

Any condition that causes liver inflammation or damage is liver disease. These conditions may also affect how the liver functions. Liver disease is categorized according to the cause and effect upon the liver. Causes can include things such as infection, exposure to drugs, exposure to toxic compounds, injury to the liver, autoimmune processes, genetic defects, and other conditions that may be due to deposits and build-up of metals in the liver, including iron and copper. The residual effects of such exposure are inflammation, injury, obstruction, scarring, abnormalities in blood clotting, and eventual liver failure.

Signs And Symptoms

In the beginning, liver disease may not have any signs or symptoms. Other symptoms may be quite non-specific. Weakness, lack of energy, and other symptoms may also present.

The most typical signs of acute liver disease include the following:

  • Yellowing of skin due to issues processing the bilirubin. These include jaundice, light stools, dark urine, and loss of appetite.
  • Nausea
  • Diarrhea
  • Vomiting

In addition to the conditions mentioned above, Chronic Conditions of liver disease may also include the following:

  • Itching or pruritus
  • Abdominal swelling (ascites)
  • Unexplained weight gain or loss
  • Abdominal pain

These symptoms typically present at a later stage of the disease.

General Laboratory Tests For Liver Disease

The main goal in screening for liver disease is to detect injury to the liver, evaluate the severity of the injury, and diagnose the cause. With time, these will then be monitored to watch for changes.

Early detection and screening are vital to the severity of symptoms, and many can be controlled if caught in time. The more that healthcare professionals can determine the severity, the more they can plan a care plan for managing the symptoms. The liver is fully capable of repairing injuries and in resolving inflammation if the bile ducts aren’t blocked. Blocked bile ducts can lead to cirrhosis and be permanent conditions that will lead to progressive liver damage. It’s important to monitor the status with time to help take any steps that will preserve the function of the liver.

General tests in the laboratory will measure the enzyme levels, protein, bilirubin, and other symptoms if there is an injury present.

Taking a comprehensive metabolic panel or CMP is a series of tests that are done in conjunction with general health screening. This includes several tests that will show the liver function.

A liver panel may also be ordered if there are any abnormalities in the CMP testing process results. These are done if there is any question on liver function or if there has been a liver injury.

Whenever there are abnormal test results, these tests may be administered for further evaluation of the liver. All these tests may also be administered individually to monitor a person who has been diagnosed with a liver condition. These tests may include the following:

Alanine aminotransferase or ALT. This is an enzyme that is mainly located in the liver and can also detect hepatitis.

Alkaline phosphatase or ALP. This enzyme is located in the bile ducts and liver and will increase if they are blocked.

Aspartate aminotransferase or AST. This enzyme is in the liver and other areas of the body, including the heart.

Gamma-glutamyl transferase or GGT. This enzyme is sensitive to changes in the liver status if the bile ducts are blocked.

Total bilirubin will measure the amount of bilirubin in the blood. The levels will be higher for many liver conditions.

Direct bilirubin will measure the type of bilirubin that is combined with other compounds and increases if liver disease is present.

Albumin is the main protein that is manufactured in the liver. It will tell how the liver is doing.

Total protein will measure the amount of the protein in the liver as well as the antibodies that are present to help ward off infections.

Lactate dehydrogenase or LDH. This enzyme is released with damaged tissue and may raise if there is acute liver disease.

Select Tests

Several tests may be ordered to diagnose liver dysfunction. Some are used to monitor the condition and others to diagnose.

Liver Biopsy: Small samples of the liver tissue are taken to evaluate the liver and the cells.

Ammonia: This could be elevated in the later stages of cirrhosis and liver failure.

Viral Hepatitis tests (A, B, And C): to detect viral infections in the liver.

Alpha-fetoprotein or AFP: will elevate with liver cancer.

Des-gamma-carboxy prothrombin or DCP: will also elevate with liver cancer.

Prothrombin time or PT: will show clotting function.

Iron tests: Hemochromatosis or iron metabolism disorders

Copper and Ceruloplasmin: Wilson’s Disease is a genetic copper metabolism disorder

Alpha 1 antitrypsin: will test for deficiency.

Antimitochondrial antibody or AMA: will diagnose biliary cholangitis or PBC.

There are tests for autoantibodies that will help to diagnose autoimmune hepatitis, including antinuclear antibodies or ANA. Antismooth muscle antibodies or ASMA and the F-actin antibodies for both liver and kidney microsomes or anti-LKM1. Acetaminophen levels and other overdose drug tests or if the person is doing drugs will also show.

CBC or complete blood count will show elevated white and red blood cells as well as platelets.