This sheet describes common tests that may be done for liver problems. Your healthcare provider will tell you which tests you need.
Procedures to Monitor the Liver
Below are procedures that may be done to monitor the condition or function of the liver or related organs (such as the gallbladder or bile ducts).
- A liver biopsy is a procedure that looks for damage in liver tissue. A needle is used to remove a small amount of tissue from the liver. This is studied in the lab for signs of inflammation, scarring, or other problems.
- A CT (computed tomography) scan shows a 3D picture of the liver and gallbladder. This can show gallstones, abscesses, abnormal blood vessels, or tumors.
- ERCP (endoscopic retrograde cholangiopancreatography) is a procedure that can reveal blockage or narrowing in the bile ducts. An endoscope (small, flexible tube) is inserted into the mouth. It’s threaded through the esophagus and stomach to the top of the small intestine. This is where the bile ducts meet the intestine. Dye is inserted through the scope to make the bile ducts show up on an x-ray. The doctor may take samples of tissue or fluid using instruments inserted into the scope. The samples are sent to the lab to be studied.
- A HIDA scan checks the function of the gallbladder or liver. A radioactive fluid (marker) is put into the body. As this marker travels through the liver to the gallbladder and into the intestine, it can be seen on a scan. The marker can show whether bile ducts are missing or blocked, and other problems.
- MRCP (magnetic resonance cholangiopancreatography) is an imaging test that uses strong magnets to create pictures of the bile ducts, pancreas, and gallbladder. It can reveal abnormal bile ducts, narrowed bile ducts, or gallstones.
- A sonogram uses sound waves to show a picture of the liver. It can show bile lakes (collections of bile leaking out of the liver) and gallstones.
Blood Tests to Monitor the Liver
A small amount of blood may be taken and tested for one or more of the following:
- AFP (alpha fetoprotein) is a protein made by the liver. In an adult, a high level in the blood can be a sign of liver cancer.
- Albumin is a protein made by the liver. It can be measured with a blood test. When a person has liver disease, the level of albumin in the blood (serum albumin) is often low.
- Alk phos (alkaline phosphatase) is an enzyme produced in the liver and bone. It’s measured with a blood test. A high level sometimes suggests a problem with the bile ducts in the liver.
- ALT (alanine aminotransferase) is an enzyme produced by the liver. When the liver is damaged, ALT leaks into the blood. If a blood test finds a high level of ALT, this can be a sign of liver problems such as inflammation, scarring, or a tumor.
- Ammonia is a harmful substance left behind in the blood after digestion. Normally, the liver removes ammonia from the blood and turns it into urea, which leaves the body with urine. If a blood test shows that the ammonia level is too high, this process isn’t happening as it should.
- AST (aspartate aminotransferase) is another enzyme made by the liver. It too is measured with a blood test. High levels suggest liver injury, especially if the ALT level is also high.
- Bilirubin is a yellow substance made when the body breaks down red blood cells. It’s collected by the liver to be sent out of the body with stool. When something is wrong with the liver or bile ducts, bilirubin may build up in the body. This causes jaundice (yellowing of the skin and the whites of the eyes). Two measurements may be taken: total bilirubin and direct bilirubin. A high total bilirubin level means the liver isn’t breaking down bilirubin. A high direct bilirubin level suggests a blockage in the bile ducts.
- A CBC (complete blood count) is a test that measures all the parts of the blood (red blood cells, white blood cells, and platelets). Problems with these counts can mean infection or illness. They can also be a sign of a problem with the spleen, an organ close to the liver that can be affected by liver disease.
- Essential fatty acids (EFAs) are nutrients in the body. EFA levels may be lower when the liver is diseased. This is because the liver can’t absorb and transport EFAs as it’s supposed to.
- GGT (gamma-glutamyl transpeptidase) is an enzyme that’s often measured along with other enzymes to gauge liver problems. GGT is measured with a blood test. If alk phos and GGT are both elevated, this is a sign that the bile ducts in the liver may be diseased or blocked.
- Glucose is sugar in the blood. A healthy liver helps the body maintain a normal glucose level. If a blood test reveals that glucose is low, this may mean the liver is not working properly.
- Prothrombin time (PT) tests the ability of the blood to clot. Since the liver makes a protein that helps with clotting, problems with clotting can be a sign of liver disease. Part of this blood test, the INR (international normalized ratio), measures vitamin A levels.
- Serum bile acid (SBA) is the amount of bile acid in the blood. A high level may mean that bile ducts are blocked.
- Vitamins A, D, E, and K are fat-soluble vitamins that are absorbed by the liver, with help from bile. If a blood test shows that levels of these vitamins are low, this could mean the liver is not absorbing them properly.
- Zinc is a nutrient that is absorbed by the liver. If a blood test shows a low zinc level, this could mean the liver isn’t absorbing zinc properly.
