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What Do Elevated Liver Function Tests Mean?

Let’s say your doctor saw you, and they ran a series of blood tests on you. The bloodwork came back, and your doctor informed you that you had elevated liver function tests. What does this mean? Is there any reason to be concerned about these results?

Are Elevated Liver Function Tests any Cause for Concern: Yes. Look further.

What do elevated liver function tests (LFTs) mean?

The term “transaminases” applies to the tests of liver function. The tests (see table below) are a series of molecules that are not limited to the liver. Therefore, they are not always specific to a cause. However, the results may provide clues to what is happening in the liver and bloodstream.

Liver Function Tests

  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
  • Alkaline phosphatase (ALP)
  • Albumin and total protein
  • Bilirubin, unconjugated or conjugated
  • Gamma-glutamyltransferase (GGT)

It is helpful to look at the anatomy of the liver to understand the significance of the liver function tests. The liver consists of two major lobes, each divided into eight segments or lobules. Liver cells, blood vessels, and tiny canals known as canaliculi make up smaller components known as lobules. The common hepatic duct receives bile from these tributaries and flows into the common bile duct. The bile gets concentrated in the gallbladder and is secreted into the duodenum to help break down fats.

liver function tests can signal dysfunction in the biliary system, a "cholestatic pattern."
Bile system. Source: Wikimedia Commons

What are 3 patterns found on liver function tests?

One common finding in the liver function tests is what is known as the cholestatic pattern. This type of finding is characterized primarily by an elevation in the Alkaline phosphatase level; the AST and ALT may be elevated too. The GGT level is also elevated; the bilirubin may or may not be elevated. This pattern is common in the setting of blockages in the bile canaliculi or other part of the bile ducts. One example of this type of pattern would be a gallstone.

Another finding is termed hepatic pattern. An elevated AST, ALT, and bilirubin correspond to injury to the liver cells, or hepatocytes. These results are often significantly elevated. Common causes of elevated liver function tests in a hepatic pattern include viral or alcoholic hepatitis, fatty liver, drug-induced liver injury.

The third example is the hemolytic pattern, when red blood cells break down, a condition known as hemolysis. Problems that lead to these changes include infections like malaria or babesiosis, sickle cell anemia, or a medication toxicity.

There are changes in bilirubin levels in hemolysis. There are two type of bilirubin, conjugated and unconjugated. Bilirubin is changed and made more dissolvable in the liver; this is known as conjugated. When red cells break down suddenly, the liver is overwhelmed and is not able to change the bilirubin, leading to a high level of unconjugated bilirubin.

CholestasticHepatic / Hepatocellular injuryHemolytic
GallstonesInfectious Hepatitis (Chronic and Acute)Hemolytic anemia
Total parenteral nutrition (TPN)Non-alcoholic fatty liver disease (NAFLD)Autoimmune anemia
Medications (e.g. Rifampin)MedicationsMedications
Extra-hepatic (Bone source)AlcoholTransfusion reactions
SepsisPregnancySickle cell anemia
Common Causes of Liver Test Patterns

What is fatty liver?

The term “fatty liver” may not sound ominous, but in some people, ongoing inflammation of the liver can contribute to scarring of the liver and cirrhosis. The liver is the second-largest regenerative organ in the body next to the skin. However, a diet that is high in processed sugars can lead to insulin resistance and the accumulation of fat in liver cells.

The fat load can lead to challenges in cellular respiration, and a cascade of inflammatory events occurs that cause mitochondrial dysfunction and cellular death. Ultimately, inflammation continues and scar tissue builds up, leading to cirrhosis.

If you are overweight and found to have elevated liver tests, it is possible that you have non-alcoholic fatty liver (NAFLD). In the US population, about one in four people have NAFLD. The majority of people with this condition are overweight or obese; about 75% of people overweight have NAFLD. What’s more is that 20% of people with this condition can develop non-alcoholic steatohepatitis (NASH), a precursor for cirrhosis. Check out this article for more details.

What are some findings associated with fatty liver?

Most people who have fatty liver are asymptomatic – they have no idea they have it.

Here are other conditions that may suggest fatty liver:

  • Elevated triglycerides
  • High LDL, Low HDL
  • Diabetes mellitus
  • Metabolic syndrome signals fatty liver, because this syndrome is associated with excess adipose stores, diabetes or insulin resistance, and cholesterol dysfunction.

Additionally, your doctor may order an ultrasound of the liver which is quite sensitive and specific for fatty liver. Another test is the FibroSure test (example), which is another noninvasive test that look for various markers in the blood.

What is the best thing to do if I have fatty liver?

Fortunately, fatty liver is reversible. The most important change to improve it is the loss of fat stores. The body accumulates fat when insulin drives liver cells to convert excess glucose into triglycerides. These fatty acids circulate in the blood and enter into adipose tissue, expanding fat stores.

When the body is in a starvation state, another hormone secreted by the pancreas glucagon release the adipose stores into ketone bodies which are used by cells for energy.

The best way to reduce fatty liver is to lose weight, or “waist.” An indication of how effective weight loss is for insulin resistance is a decrease in the waist circumference related to visceral adiposity – the fat stores in the organs.

One achieves weight loss by eating less processed sugars and replacing it with a plant-based diet. Studies support that adhering to a mostly plant-based diet had a lower risk of fatty liver.

plus size woman measuring hips in gym. Waist loss is a good sign that liver function tests are likely to normalize.
Photo by Andres Ayrton on Pexels.com

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