Liver Tests

Medical Specialities
Liver Care
Liver Tests

Liver Tests
Comprehensive Evaluation of Liver Health
Liver Tests (LFTs), commonly referred to as Liver Function Tests, are blood investigations that assess how well the liver and bile ducts are functioning. They help detect liver inflammation, infection, or damage at an early stage. These tests measure enzyme and protein levels in the blood, offering valuable insights into liver performance and identifying diseases that may affect it.
A liver function test is often performed along with clinical evaluation and physical examination. Together, they help doctors diagnose and monitor liver diseases such as fatty liver, hepatitis, alcoholic liver disease, and liver cirrhosis.

Common Liver Tests

1. Serum Bilirubin Test

Measures total, direct, and indirect bilirubin to determine jaundice and its type. Elevated levels indicate liver dysfunction or bile duct obstruction.

2. Liver Enzyme Tests (ALT, AST, ALP, GGT)

Alanine Aminotransferase (ALT) - previously known as SGPT, this enzyme helps convert proteins into energy. Elevated ALT levels are a key parameter in the liver function test ALT used to detect liver cell injury.
Aspartate Aminotransferase (AST) - formerly called SGOT, used to assess liver and heart health.
Alkaline Phosphatase (ALP) - indicates bile duct or bone disorders.
Gamma Glutamyl Transferase (GGT) - used to identify bile duct and alcohol-related liver conditions.

3. Proteins and Albumin Test

Measures the liver’s ability to produce essential proteins. Low albumin may suggest chronic liver disease or malnutrition.

4. Prothrombin Time and INR (PT/INR)

Evaluates the liver’s role in blood clotting. Prolonged PT or INR can indicate advanced liver disease or vitamin K deficiency.

Tests to Identify Underlying Liver Causes

Viral Etiology

These tests detect infections that can lead to liver damage:

Hepatitis A (HEP A IgM)
Hepatitis B (HBsAg / ABV / DNA / PCR)
Hepatitis C (HCV / RNA)
Cytomegalovirus (CMV) - CMV IgG, CMV IgM
Epstein Barr Virus (EBV) - IgG, IgM
HIV testing when clinically indicated.

Autoimmune Markers

Antinuclear Antibody Test (ANA)
Liver Kidney Microsomal Antibody (LKMA)
Anti-Smooth Muscle Antibody (ASMA)

These tests help identify autoimmune hepatitis or other immune-mediated liver disorders.

Liver Cancer and Tumor Markers
To screen for or monitor liver cancer, the following are commonly performed:

Alpha-Fetoprotein (AFP)
Carcinoembryonic Antigen (CEA)
Prothrombin Induced by Vitamin K Absence (PIVKA)
PET CT Scan for staging and spread assessment.

Advanced Diagnostic Assessments

1. FibroScan Liver Test

A FibroScan or liver elastography is a non-invasive scan that is a painless imaging technique that evaluates liver stiffness (fibrosis), a key marker of fibrosis (scarring) and liver fat content (steatosis using a CAP score).
Using Vibration Controlled Transient Elastography (VCTE), FibroScan provides accurate measurements within minutes, eliminating the need for a biopsy in many cases.
Benefits include:

Detects liver damage early
Assess fatty liver severity
Evaluate fibrosis or cirrhosis
Monitor disease progression or improvement
Quantitative measurement of liver stiffness and fat
Early detection of fibrosis and cirrhosis
High reproducibility with minimal operator variability

FibroScan is now a preferred liver fibrosis test for monitoring chronic liver disease progression. It is especially helpful for chronic liver diseases like NAFLD, NASH, Hepatitis B/C, alcohol-related liver disease, and metabolic syndrome.
Who should get a FibroScan?
Patients with:

Fatty Liver (Alcoholic or Non-Alcoholic): To grade fat and measure fibrosis
Diabetes or Obesity: They are at a high metabolic risk that can silently damage the liver
Hepatitis B or Hepatitis C: To monitor fibrosis without repeated biopsies
Abnormal Liver Blood Tests (LFT): Elevated SGPT/SGOT needs evaluation
Family History of Liver Disease: Especially cirrhosis or liver cancer
Alcohol Use: FibroScan detects early alcohol-related liver injury

2. MR Elastography

It is an advanced, non-invasive imaging technique used to measure liver stiffness, helping detect and stage liver fibrosis with exceptional accuracy.
It works by visualizing the movement of mechanical waves through the liver, providing a quantitative map of tissue stiffness.
It is considered a gold-standard treatment as it:

Highest accuracy among non-invasive tests
Not affected by obesity or inflammation (common limitations of FibroScan)
Ideal for NAFLD/NASH evaluation
Detects early fibrosis before symptoms appear
Tracks disease progression or regression precisely

3. Proton Density Fat Fraction (PDFF)

PDFF is the most accurate method worldwide for measuring liver fat content. It quantifies fat at the tissue level, unaffected by age, BMI, or iron overload.
Benefits include:

Detects even small changes in liver fat
Ideal for monitoring treatment response
Helps avoid invasive liver biopsy
More reliable than ultrasound or CT fat estimation

4. Liver Biopsy

In select cases, a liver biopsy is advised to confirm the diagnosis and assess the extent of scarring. A small tissue sample is examined microscopically for detailed evaluation.

5. Endoscopic Examination

Used to evaluate internal bleeding, varices, or structural changes associated with liver cirrhosis.

Associated Health Panels

Diabetes Panel: Fasting, Postprandial Blood Sugar (PPBS), HbA1c, and lipid profile to evaluate metabolic factors that affect liver health.
Liver and Kidney Function Test / Liver Kidney Test: Combined panels that check both liver and renal health, especially useful for patients with metabolic syndrome, hypertension, or chronic illness.
Liver Cirrhosis Test: A Comprehensive set of enzyme, imaging, and biopsy studies to identify the extent of liver damage.
Liver Function Test in Pregnancy: Conducted to monitor liver performance in pregnant women with conditions like intrahepatic cholestasis or preeclampsia.
Dengue Liver Function Test / Liver Function Test in Dengue Fever: Helps assess temporary liver stress or inflammation caused by dengue infection.

Zydus Hospitals offers complete Liver Protocols designed for liver-specific diseases that include:

MRE (Liver stiffness mapping)
PDFF (Liver fat quantification)
T1/T2-weighted imaging
MRCP (bile duct evaluation)
Dynamic liver contrast studies
Iron quantification (if needed)

Best suited for patients with:

Fatty liver (NAFLD/NASH)
Hepatitis B & C
Alcoholic liver disease
Early cirrhosis
Liver tumors / masses
Iron overload disorders

When to See a Liver Specialist

A detailed evaluation should always be done by a hepatologist or gastroenterologist. Liver tests are crucial not only for diagnosis but also for monitoring response to liver disease treatment. Early detection and appropriate intervention can prevent progression to irreversible liver damage.

Acute Liver Failure (ALF)
Acute Liver Failure is a sudden and rapid loss of liver function in a previously healthy liver, occurring within days to weeks.
It can cause jaundice, severe hepatic encephalopathy, cerebral edema, or multi-organ failure.
Common Causes of Acute Liver Failure include:

Viral hepatitis (A, B)
Wilson Disease (children/young adults)
Drug-induced liver injury (paracetamol toxicity, herbal medications)
Autoimmune hepatitis flare
Mushroom poisoning
Pregnancy-related liver failure (AFLP, HELLP)
Acute fatty liver of pregnancy
Heat stroke liver injury
Shock-induced ischemic hepatitis

Early identification and rapid intervention are critical for survival.

Acute-on-Chronic Liver Failure (ACLF)
ACLF is sudden deterioration in a patient with chronic liver disease, associated with persistent inflammation, or multi-organ failure. It can be triggered by sepsis/infection, binging alcohol binge, GI bleeding, acute hepatitis (A/E/B), drug-induced injury, or portal vein thrombosis.
Symptoms of ALF & ACLF include:

Rapid-onset jaundice
Altered sensorium (in cases of hepatic encephalopathy)
Severe abdominal distension
Breathing difficulty
Bleeding from mouth or nose
Low urine output
Severe fatigue
Seizures (advanced cases)

Advanced ALF/ACLF Diagnosis at Zydus Hospitals include Liver-specific investigations including LFT, coagulation profile (INR/PT), ammonia levels, arterial blood gases, serum ceruloplasmin, 24h urinary copper (for Wilson disease), viral markers, and an autoimmune profile. Imaging is done using Ultrasound Doppler or CT / MRI of the liver to help identify if there is an urgent need for transplant.
Zydus Hospitals is one of the very few centres with a dedicated Liver ICU, specialized in ACLF stabilization and transplant optimization.