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Liver Function Blood Test Interpreter

Cholestasis is seen in: Gallstones; Malignancy (pancreatic, cholangiocarcinoma); Primary Biliary Cholangitis (PBC); Primary Sclerosing Cholangitis (PSC), often associated with IBD;

Drugs associated with cholestasis: Amoxicillin-clavulanate; macrolides (erythromycin); trimethoprim-sulfamethoxazole; anabolic steroids; combined oral contraceptives; chlorpromazine.

A hepatocellular pattern is seen in: Fatty liver (NAFLD, ALD); Viral Hepatitis or other viral infections; Autoimmune hepatitis; ischemic “shock” liver; Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency; Toxin exposure; Budd-Chiari syndrome

Drugs associated with hepatocellular pattern: Acetaminophen (paracetamol); statins; certain antibiotics (e.g., isoniazid, nitrofurantoin); antiepileptics (e.g., valproate, phenytoin); NSAIDs (e.g., diclofenac); methotrexate; amiodarone; herbal/dietary supplements.

Pre-hepatic pattern - mostly unconjugated bilirubin. The liver is conjugating normally; excess comes from over-production.

Pre-hepatic pattern is most commonly seen in hemolytic processes (e.g., autoimmune hemolytic anemia, transfusion reactions) and benign unconjugated syndromes (Gilbert's syndrome).

Hepatocellular injury pattern - both conjugation and canalicular export partly impaired.

Hepatocellular pattern is mostly seen in acute viral hepatitis or toxin/alcohol-related hepatocellular damage.

Cholestatic / obstructive pattern - predominantly conjugated bilirubin. Bilirubin is conjugated but can’t reach the gut.

Cholestatic pattern is most commonly seen in extra-hepatic biliary obstruction, like in choledocholithiasis; malignancy or less frequently intra-hepatic cholestasis.

Low AST levels are usually not concerning. However, they may indicate Vitamin B6 Deficiency, End-Stage Liver Disease (Cirrhosis), uremia, diabetic ketoacidosis, and pregnancy.

Elevated AST levels are seen in muscle injury (e.g., strenuous exercise, seizures, myopathies, myocardial infarction or heart failure), tissue damage (severe burns, surgery), liver injury (fatty liver, viral or other infections, malignancy), anorexia or rapid weight change (e.g., >5 kg/week), pancreatitis, gallbladder attack and hemolysis (e.g., hemolytic anemia, splenomegaly).

Several drugs can increase AST including: chronic alcohol, NSAIDs, acetaminophen, oral contraceptives, statins, certain antibiotics, corticosteroids, toxins like lead, mercury, and pesticides.

Low ALT levels are associated with low muscle mass (e.g., elderly, frail), Vitamin B6 Deficiency, Chronic Kidney Disease, CVD and cancer mortality in the elderly.

ALT is highly specific to liver injury (Fatty liver, Viral hepatitis, Autoimmune hepatitis, Liver cancer, Alcohol liver damage, Mononucleosis, Hemochromatosis).

Muscle damage – strenuous exercise, trauma, myocardial infarction, congestive heart failure.

Gallstones; Biliary disease; pancreatitis; both obesity and anorexia; rapid weight change; celiac disease; hemolysis.

Many toxins and drugs can increase ALT, but most notable are: Paracetamol, NSAIDs, statins, phenytoin, allopurinol, and antibiotics, especially amoxicillin.

ALP is seen decreased in Malnutrition (insufficient calories or very low protein diet), Magnesium or Zinc Deficiency, advanced liver disease, Hypothyroidism, severe anemia, excess cortisol levels and more.

Medication that can decrease ALP levels: mega-dosing vitamins D or B, Hormone replacement therapy, oxalates, nitrofurantoin, Cinacalcet and more.

Cholestatic liver injury – biliary obstruction, acute cholecystitis, cholangitis, cirrhosis, hepatic tumors.

Bone/osteoblastic activity – Paget’s disease, osteomalacia/rickets, fracture healing, growth spurts, hyperparathyroidism, bone metastases.

Gut/intestinal mucosa issues – IBS, celiac disease, intestinal ischemia; kidney disease; various malignancies; vitamin D deficiency; hyperthyroidism; rheumatoid arthritis; sickle cell crises.

Medications – birth control pills, allopurinol, colchicine, antibiotics, fluorides, verapamil, nicotinic acid, vigorous exercise.

Low GGT levels are usually not concerning. However, they may indicate Acute intrahepatic cholestasis, Hypothyroidism, magnesium deficiency or vitamin B6 deficiency, bone disease (low bone mass density).

Drugs that can cause low GGT: Fibrate Drugs (Clofibrate, Fenofibrate), Estrogen-Containing Medications,milk thistle, antioxidants.

Major serum GGT contributors: Liver (both hepatocytes and cholestasis), gallbladder, pancreas and kidneys. Also increased in insulin resistance, toxin exposure, oxidative stress and increased antioxidants (glutathione) need etc.

Drugs that can increase GGT: Alcohol, anti-seizure medications and more.

Low total bilirubin is associated with systemic inflammation, oxidative stress, stroke, increased carotid intima-media thickness, arterial stiffness, diabetic peripheral neuropathy, metabolic syndrome, and Chronic Kidney Disease.

Drugs that can decrease bilirubin levels: smoking, caffeine, barbiturates, penicillin, and large doses of salicylates.

High total bilirubin is associated with liver dysfunction, hepatitis, Gilbert’s Syndrome, Strenuous Exercise, Gallstones and Gallbladder Disease, Pancreatitis, Appendicitis, obstruction of extrahepatic ducts, RBC hemolysis.

Low albumin is primarily a consequence of illness rather than a cause, and it serves as a late-stage indicator of inflammation. It is frequently observed in chronic or persistent inflammatory states.

Low albumin is also associated with liver disease, kidney disease, diabetes, heart failure, fluid overload, advanced malnutrition (particularly from protein deficiency or malabsorption), severe burns, and occasionally cancer.

Elevated albumin levels occur with dehydration (commonly due to vomiting or diarrhea) and insulin resistance.