Question

There are many individual lab tests that encompass “liver function tests” or LFTs.  So for this week’s pearl:

1. List out the tests that make up a liver panel
2. Explain how they can be grouped together

Answer

1. A typical liver panel is made of the following individual lab tests:
   1. Total bilirubin
      1. Indirect bilirubin + direct bilirubin
   2. Aspartate aminotransminase (AST)
   3. Alanine aminotransferase (ALT)
   4. Alkaline phosphatase (ALP)
   5. Gamma-glutamyl transpeptidase (GGT)
   6. Lactate dehydrogenase (LDH)
   7. Albumin
   8. Total protein
2. The easiest way to quickly interpret LFTs is group these tests into two broad categories:
   1. Hepatocellular (damage to the hepatocytes)
      1. AST
      2. ALT
      3. LDH
   2. Cholestatic (decreased post-hepatic drainage)
      1. Bilirubin
      2. GGT
      3. ALP

Now let me make this clear, there is MUCH MORE that goes into interpreting LFTs, but this is good, quick start when you get abnormal LFTs back on your patient.

References

1. Giannini EG, Tesa R, Savarino V.  Liver enzyme alteration: a guide for clinicians.  CMAJ. 2005;172(3):367-379