Raised liver tests are a clue, not a diagnosis.
Liver function tests (LFT) are a group of blood tests. A raised result is very common and often mild, but it is the liver asking for attention. What matters is why it is raised, because the cause, not the number, decides what to do.
In plain words.
Reading the report: SGPT (ALT) and SGOT (AST) are enzymes inside liver cells; they rise when the cells are irritated or damaged. ALP and GGT rise when the flow of bile is slowed, as with a stone, and GGT often with alcohol; ALP also comes from bone, and is normally higher in growing children and in pregnancy. Bilirubin rises in jaundice. Albumin and the clotting test (INR) show how well the liver is making things, the truest measure of how it is working.
The commonest causes of a raised SGPT or SGOT are fatty liver, alcohol, viral hepatitis (A and E pass in weeks; B and C can last for years), and medicines, such as TB medicines, some antibiotics, too much paracetamol, and herbal, ayurvedic or body-building products. Less often it is the thyroid, coeliac disease, heavy exercise or a muscle injury (SGOT also comes from muscle), or rarer liver diseases.
A mild rise, less than about three times the top of the range, is common; it is usually checked for the cause and repeated after some weeks. A reading many times above normal, or with yellow eyes, needs a doctor promptly. The direction over time tells more than one number.
A normal LFT does not always mean a healthy liver: a scarred liver can have normal enzymes. A FibroScan or a simple blood score (FIB-4) checks for scarring when there is a reason to.
Liver cells that spill their enzymes
Liver cells hold enzymes such as SGPT (ALT) and SGOT (AST). Only a little leaks into the blood as old cells are replaced, so the reading stays within the normal range.
When liver cells are irritated, by fat, alcohol, a virus or a medicine, they swell and spill their enzymes into the blood. The reading climbs above the normal range.
Once the cause is found and dealt with (weight loss, no alcohol, a medicine changed, a virus treated), the cells settle and the reading usually comes back down over weeks to months.
Go to hospital now if
- Yellow eyes or skin with drowsiness, confusion or unusual behaviour: go to hospital now.
- Vomiting blood, or black, tarry stools: go to hospital now; call 112 if you feel faint.
- Yellow eyes or skin during pregnancy: go to hospital now.
- Severe tummy pain with fever or yellow eyes: go to hospital now.
- Raised liver tests in pregnancy with headache, high BP, upper tummy pain or vomiting: go to hospital now.
- You have taken more paracetamol than the pack allows, even if you feel well: go to hospital now, because treatment works best early.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
Speak to your doctor the same day if
- You are on TB medicines, or a new medicine, and get nausea, vomiting, tummy pain or a poor appetite: ask before the next dose. If your eyes turn yellow, do not take the next dose until a doctor has seen you and checked your LFT
- Your eyes or urine turn yellow, or your stools turn pale
- Your report shows SGPT or SGOT many times above normal, or a raised bilirubin
- Your tummy or legs are swelling
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Repeat LFT | Confirms the result, shows the pattern, and whether it is settling. |
| Hepatitis B (HBsAg) and hepatitis C (anti-HCV) | Common, silent and treatable causes that every raised LFT should be checked for. |
| Ultrasound of the abdomen | Shows fatty liver, gallstones, blocked bile ducts, and the size and texture of the liver. |
| HbA1c, cholesterol and waist size | The companions of fatty liver. |
| Blood count, albumin and INR | How well the liver is working. |
| FibroScan or FIB-4 score | Checks for scarring in the liver. |
| Further tests when needed | Hepatitis A and E after a recent illness, thyroid, a muscle test (CK), and tests for rarer liver diseases. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Many liver problems cause no symptoms until late, so a raised test is worth following up even when you feel well. "Liver tonics" and herbal cleanses are not proven to help a raised LFT, and some cause liver damage themselves.
A video call can
- Read the pattern of your LFT and what it points to
- Arrange the tests that find the cause
- Go through your medicines and supplements for anything harming the liver
- Follow the trend, with a plan for fatty liver, and refer to a liver specialist when needed
Needs a visit in person
- Blood tests, ultrasound and FibroScan
- Endoscopy, or a liver biopsy when a specialist needs one
- Hospital care for liver failure or bleeding
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759