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How do you evaluate whether a liver is healthy or not? What metrics do doctors look at to determine if a patient needs intervention or if they are healthy? Liver function tests(LFTs) are a group of blood tests used to assess the health and function of the liver. These tests measure various enzymes, proteins, and substances produced by the liver. The American Gastroenterological Association states that these tests should be referred to as liver chemistries or liver tests, rather than liver function tests, as they primarily indicate liver injury rather than function.
For people with metabolic dysfunction-associated steatohepatitis (MASH), liver tests are a normal part of care! Your doctors need to understand how much damage there is, which will then inform the treatment you get and the steps you need to take to improve your health. Curious what these tests actually measure and what they say about your liver? Here is a guide from PatientsLikeMe.
What Is the Liver and Why Is It Important?
The liver is one of the most important organs in your body. It sits in the upper right side of your abdomen and does a whole host of vital functions. These include breaking down and processing food for energy, storing nutrients like vitamins and minerals, and filtering toxins out of your blood. The liver also makes proteins for blood clotting and bile for digesting fat. When a person has MASH, the liver is inflamed because of a buildup of fat. This inflammation can cause liver damage, and over time, it may cause scarring or even liver failure. Because of these risks, doctors use liver function tests to monitor the liver and find problems early.
Liver Tests
Liver tests are blood tests that measure different substances in the blood to see how well the liver is working. These tests help doctors find inflammation and damage, measure the severity of liver disease, and check if the treatments for MASH are working. Since MASH does not always cause symptoms, especially early on, these blood tests are an important way for doctors to track your liver health.
Common Liver Tests for MASH
Liver Enzyme Tests
Liver enzymes are proteins that help the liver function. These enzymes drive every chemical reaction that happens in the liver. When the liver is inflamed or damaged, these enzymes can leak into the bloodstream. That is what these tests are looking for - are the liver enzyme levels outside of normal ranges. Blood tests measure three main liver enzymes.
1. Aspartate Aminotransferase (AST)
AST is an enzyme in the liver, heart, and muscles. Elevated AST levels can mean liver damage but could also be high because of muscle or heart problems. Most people with MASH have high levels of AST.
2. Alanine Aminotransferase (ALT)
ALT is another enzyme found mainly in the liver. High ALT levels are a strong indicator of liver inflammation and are commonly elevated in people with MASH.
3. Alkaline Phosphatase (ALP)
ALP is an enzyme in the liver, bones, and bile ducts. While less commonly connected to MASH, high ALP levels could mean issues with the bile duct or liver.
Total Protein and Albumin Tests
These tests look at the total amount of protein in the blood, including albumin which is a protein made by the liver. Low levels on these tests could mean liver disease or malnutrition.
Bilirubin Test
Bilirubin is a substance your red blood cells make when they break down. Your liver is responsible for filtering bilirubin out of your blood, as it is a toxin. High bilirubin levels can mean there is damage to your liver, or problems with the flow of bile. Too much bilirubin can even leak out into your skin and eyes, turning them yellow. This condition is called jaundice.
Prothrombin Time (PT) Test
A prothrombin time test looks at how long it takes for blood to clot. Your liver is responsible for making the proteins that help with clotting. A longer time on the PT test could mean liver disease.
How Are Liver Tests Done?
A liver test is a blood test. Your doctor draws blood from a vein in your arm, which they then send to a lab for analysis. The results from this test are usually available within a few hours or days after blood is drawn. You might need to fast for a few hours before the test, depending on what your doctor recommends.
If your liver tests are abnormal, your doctor may recommend taking a few steps. Other blood tests can rule out certain infections or other liver conditions. Imaging tests like an ultrasound, MRI, or FibroScan can check for fat build up and scarring. A liver biopsy is still the gold standard for diagnosing MASH and can confirm suspicions and check the level of damage done to the liver.
If you have MASH or are at risk, you need regular liver tests to monitor your liver’s health. These tests can find problems early, helping you and your doctor take steps to prevent serious complications. If your doctor recommends a liver test, don’t skip it! Early detection and management can make a big difference in protecting your liver and overall health.
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