I. Introduction

Many conditions can cause abnormal results on a liver panel, but hepatitis and liver cancer are two of the most common. In 2016, approximately 30,000 cases of hepatitis A were reported in the United States, according to the U.S. Department of Health and Human Services. The World Health Organization reports that hepatitis B and C affect more than 500 million people worldwide. According to the American Cancer Society, about 42,810 new cases of primary liver cancer will be diagnosed in 2020.

This guide explains how the liver panel is used to diagnose and monitor these conditions. It also provides an overview of hepatitis and liver cancer, including what they are and how they’re treated.

II. Overview of the Liver Panel

Why should I get tested?

The purpose of the liver function panel is to determine if the liver is functioning normally. This test can be useful for diagnosing liver diseases in people who have unexplained abdominal pain or other symptoms that could be caused by a liver problem. It’s also useful for monitoring the health of people who have alcohol use disorder, and people who have certain risk factors for liver diseases. These risk factors include a family history of liver problems, taking medications that may damage the liver, and possible exposure to the hepatitis virus.

When should I get tested?

According to MedlinePlus, the liver function panel should be ordered when an individual has symptoms that might be caused by a liver problem. These symptoms include abdominal pain, nausea, vomiting, and jaundice, which causes the skin and whites of the eyes to take on a yellowish appearance.

What is required for the test?

All that’s needed for the liver function test is a small blood sample.

What do I need to do to prepare for the test?

Foods and beverages can affect the results of certain blood tests, so it may be necessary to fast for 10 to 12 hours before having blood drawn. Before having this test, it’s also a good idea to ask the ordering physician if it’s necessary to stop taking any prescription medications, over-the-counter medications, vitamins, minerals, or herbal supplements.

III. The Basics of Hepatitis and Liver Cancer

Hepatitis

Hepatitis is an inflammatory condition that’s usually caused by a viral infection. Several strains of this virus exist, but hepatitis A, B, and C are the most common. Although each strain causes similar symptoms, they’re transmitted in different ways. The A and E strains of the hepatitis virus are usually spread via contaminated water and food. Ingesting the virus can cause an individual to develop hepatitis. The B, C, and D strains are usually spread via contact with body fluids; for example, an individual can contract hepatitis by sharing a needle with an infected person or having sexual contact with someone who has hepatitis.

Certain factors increase the risk of contracting hepatitis. For hepatitis A, some of the risk factors include living in an area with contaminated water or poor sanitation, using recreational drugs, living with someone who has hepatitis A, and having sexual contact with someone who has this condition. Traveling to an area with a high prevalence of hepatitis A without getting immunized against it can also increase an individual’s risk. The most common risk factor for hepatitis B is the use of injectable drugs, according to the U.S. Department of Health and Human Services. Other risk factors for hepatitis B include living with a person who has hepatitis B, receiving a blood transfusion, and having surgery.

Risk factors for hepatitis C include being born between 1945 and 1965, getting a piercing or a tattoo with an instrument that has not been sterilized, having HIV, receiving hemodialysis treatment for kidney disease, and using injectable drugs. People who received blood products before July 1992, and people who received clotting factor concentrates before 1987, which are used to treat hemophilia, also have a higher risk of getting hepatitis C, according to the CDC.

Not all people with hepatitis develop symptoms. In those who do, common symptoms include fatigue, abdominal pain, nausea and vomiting, pale stool, jaundice, dark urine, fever, and loss of appetite.

Liver Cancer

All cancers begin when something interferes with the body’s natural ability to control cell growth. When this happens, damaged cells do not die like they should, which affects the normal cells. Primary liver cancer, which is any cancer that starts in the liver, develops when certain cells in the liver start growing out of control. Liver cancer can develop in the hepatocytes (liver cells), or it can develop in cells found in the liver’s bile ducts or blood vessels.

The most common type of liver cancer in adults is hepatocellular carcinoma. This type of cancer involves the hepatocytes. Some people with this type of cancer develop a single large tumor, while others develop several cancerous nodules throughout the liver. Bile duct cancer makes up 10% to 20% of primary liver cancer cases. This type of cancer originates in the cells that line the bile ducts within the liver. Hemangiosarcoma and angiosarcoma are much rarer than hepatocellular carcinoma and bile duct cancer. Both of these forms of liver cancer originate in the cells that line the blood vessels that supply the liver with blood. Finally, hepatoblastoma is a very rare form of primary liver cancer that usually develops in children under the age of four.

Liver cancer causes many of the same symptoms as hepatitis. These symptoms include loss of appetite, abdominal pain, nausea, vomiting, and jaundice. Liver cancer may also cause unintended weight loss, enlarged spleen, enlarged liver, itching, and abdominal swelling.

IV. How a Liver Panel Works

The liver function panel measures the following:

  • Alkaline phosphatase
  • Aspartate aminotransferase
  • Alanine aminotransferase
  • Total protein
  • Total bilirubin
  • Direct bilirubin
  • Albumin

ALP, AST, and ALT are liver enzymes. An abnormally high result for one of these enzymes can indicate that the liver has been damaged. Total protein is a measurement of all the protein carried in the blood. Bilirubin is a substance produced when the liver destroys old red blood cells. The direct form of bilirubin dissolves in water, while indirect bilirubin does not. Total bilirubin is the sum of a person’s direct and indirect bilirubin levels. Albumin is a group of proteins that is produced in the liver and used to keep the blood inside the blood vessels.

To perform this test, laboratory personnel need a blood sample. This sample is obtained by inserting a needle into one of the veins and allowing blood to drain into a test tube. Once the sample has been obtained, it’s sent to the laboratory to be analyzed.

V. Treatment for Hepatitis and Liver Cancer

Hepatitis

The right approach to treating hepatitis depends on which strain is causing the infection. No particular treatment is recommended for hepatitis A, so the focus is on taking preventive measures to avoid exposure to the virus. People who plan to travel to areas with high rates of hepatitis infection should be vaccinated before they leave.

In about one-fourth of people with hepatitis B, a drug called pegylated interferon-alpha can be used to kill the virus. This injectable treatment is administered once a week for six months. If pegylated interferon-alpha does not work, or if the individual isn’t a good candidate for this treatment, the hepatitis B virus can be suppressed with oral medications. Adefovir and lamivudine are two of the medicines used for this purpose.

For hepatitis C, the most effective treatment is a combination of pegylated interferon and ribavirin. How effective this treatment is depends on the genetic makeup of the hepatitis virus. Some forms of the virus respond better to pegylated interferon and ribavirin than others. Because this treatment is a form of chemotherapy, it can cause harsh side effects, including hair loss, loss of appetite, and flu-like symptoms.

Liver Cancer

The right treatment for liver cancer is based upon several factors, such as the stage of the cancer, the individual’s health history, and the type of cancer. Available treatment methods include chemotherapy, radiation therapy, immunotherapy, surgery, embolization therapy, and ablation. Chemotherapy isn’t as effective for treating liver cancer as it is for other types of cancer; however, some individuals get good results when they take more than one chemo drug at a time. Cisplatin, capecitabine, and gemcitabine are some of the chemotherapy medications used to treat liver cancer.

Radiation therapy involves aiming high-dose radiation at the liver to destroy cancerous cells. This treatment is sometimes used in people who haven’t had success with other treatments, in people with liver cancer that has spread to other parts of the body, and in people who aren’t good candidates for surgery. Immunotherapy helps the immune system do a better job fighting the cancer cells. In people receiving immunotherapy, Opdivo or Keytruda may be used to block PD-1, a substance that prevents the immune system from attacking cancer cells. Blocking PD-1 makes the immune system more effective against cancer.

According to the American Cancer Society, surgery is the best treatment option for liver cancer. A procedure known as a partial hepatectomy is used to remove the part of the liver that has the cancer; this approach is only appropriate for an individual with a single tumor. An individual who isn’t a candidate for a partial hepatectomy may receive a liver transplant. During a transplant, the surgeon takes out the individual’s liver and replaces it with a healthy liver from a donor. This approach is an especially good option for people who have multiple liver tumors.

Embolization helps kill off cancer cells by cutting off the blood supply to the tumor. This is accomplished by injecting a substance into the hepatic artery, which provides most of the blood supply to the cancerous cells. Normal liver cells receive most of their blood from the portal vein, so this procedure can kill cancer cells without causing much damage to normal cells. Embolization is sometimes recommended for people with large tumors who aren’t good candidates for surgery. Ablation destroys cancer cells with radio waves, electromagnetic waves, cold gasses, or alcohol. This procedure isn’t quite as effective as surgery, but it’s a good option for people who can’t have surgery because they’re in poor health. Ablation can also be used to treat people with several small nodules rather than one large tumor.

VI. FAQs

What is a normal ALP level?

A normal ALP level ranges from 44 to 177 international units per liter of blood.

What is a normal AST level?

A normal AST level ranges from 0 to 35 international units per liter of blood.

What is a normal ALT level?

A normal ALT level ranges from 0 to 45 international units per liter of blood.

What is a normal total protein level?

A normal total protein level ranges from 6 to 8 grams per deciliter of blood.

What is a normal albumin level?

A normal albumin level ranges from 40 to 60 grams per liter of blood.

What is a normal bilirubin level?

A normal bilirubin level ranges from 2 to 17 micromoles per liter of blood.

If my liver panel is abnormal, will I need additional tests?

The need for additional tests depends on several factors, including which components of the liver panel are abnormal, whether the individual is taking any medications that could affect liver function, and whether the individual has any medical conditions that can affect the liver. If the ordering physician believes an abnormal result is due to a decline in liver function, the individual might need an ultrasound of the abdomen. An ultrasound can help determine if the liver is enlarged or has any other structural problems. This test is also used to determine if the liver is functioning normally. Computed tomography (CT) can also be used to generate images of the liver and other abdominal organs. The images produced by a CT scan are much more detailed than the ones produced by an ultrasound, making it possible for the ordering physician to get more information about any tumors, cysts, or other abnormalities in the liver.

VII. Additional Resources

NameWebSummary
MedlinePluswww.medlineplus.govLearn more about the liver panel and other blood tests used to diagnose and manage hepatitis and liver cancer.
American Liver Foundationwww.liverfoundation.orgThe American Liver Foundation offers educational materials on liver diseases like hepatitis.
Hepatitis Foundation Internationalwww.hepatitisfoundation.orgFind out more about hepatitis.
American Cancer Societywww.cancer.orgAccess in-depth information on cancers of the liver and other organs.
National Institute of Diabetes and Digestive and Kidney Diseaseswww.niddk.nih.govThe NIDDK offers a variety of resources for patients and caregivers who want to learn more about diseases affecting the digestive system.

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