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Advanced Liver Package

Liver

68 parameters

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Report in 24Hrs

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At Home

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Fasting Required

Details

Complete Liver Profile

₹3,599₹4,599

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Parameters

  • List of Tests
    • Aspartic Acid
    • beta-Alanine
    • Glutamine
    • Albumin
    • Alkaline Phospatase
    • Bilirubin Direct
    • Bilirubin Total
    • AST or SGOT
    • ALT or SGPT
    • Total Protein
    • A/G Ratio
    • Gamma GT
    • Globulin

Advanced Liver Package

  • Why is it done?
    • Comprehensive assessment of hepatic synthetic function through measurement of albumin, total protein, and A/G ratio to evaluate liver's ability to produce essential proteins
    • Detection of hepatocellular injury via liver enzymes (AST, ALT, and Gamma GT) to identify acute or chronic liver damage from various etiologies including viral hepatitis, alcoholic liver disease, cirrhosis, and fatty liver disease
    • Assessment of hepatic cholestasis and biliary obstruction through alkaline phosphatase and bilirubin (total and direct) measurements
    • Evaluation of amino acid metabolism including aspartic acid, beta-alanine, and glutamine levels to assess hepatic metabolic capacity and urea cycle function
    • Diagnosis and monitoring of liver cirrhosis, portal hypertension, and hepatic encephalopathy through combined enzyme and protein marker evaluation
    • Screening for autoimmune hepatitis, primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC) using alkaline phosphatase and enzyme patterns
    • Monitoring of medication hepatotoxicity and assessment of drug-induced liver injury (DILI) in patients on hepatotoxic medications
    • Evaluation of jaundice etiology and differentiation between conjugated and unconjugated hyperbilirubinemia
    • Assessment of nutritional status and albumin levels to evaluate liver synthetic reserve and prognostic indicators in chronic liver disease
    • Post-transplantation monitoring in liver transplant recipients to detect rejection, recurrent disease, or medication toxicity
  • Normal Range
    • Aspartic Acid (ASP): 10-47 μmol/L or 1.3-6.3 mg/dL - Essential amino acid involved in amino acid metabolism and aspartate aminotransferase function
    • Beta-Alanine: 15-45 μmol/L or 1.3-4.0 mg/dL - Non-essential amino acid important for carnosine synthesis and hepatic amino acid balance
    • Glutamine: 495-765 μmol/L or 72-112 mg/dL - Most abundant free amino acid; critical for nitrogen metabolism and ammonia detoxification
    • Albumin: 3.5-5.0 g/dL or 35-50 g/L - Primary serum protein produced by liver; normal indicates adequate hepatic synthetic function
    • Alkaline Phosphatase (ALP): 30-120 IU/L or 0.5-2.0 μkat/L - Enzyme released from bile ducts; values vary by age and sex
    • Bilirubin Total: 0.1-1.2 mg/dL or 1.7-20.5 μmol/L - Sum of conjugated and unconjugated bilirubin; normal indicates efficient bilirubin processing
    • Bilirubin Direct (Conjugated): 0.0-0.3 mg/dL or 0-5.1 μmol/L - Conjugated bilirubin; elevation indicates biliary obstruction or hepatic excretion impairment
    • AST (Aspartate Aminotransferase/SGOT): 10-40 IU/L or 0.17-0.67 μkat/L - Hepatocellular enzyme; present in liver, heart, and muscle
    • ALT (Alanine Aminotransferase/SGPT): 7-56 IU/L or 0.12-0.94 μkat/L - Hepatocellular enzyme; more specific to liver than AST
    • Total Protein: 6.0-8.3 g/dL or 60-83 g/L - Sum of albumin and globulins; reflects hepatic protein synthesis and immune function
    • A/G Ratio (Albumin/Globulin Ratio): 1.0-2.5 - Ratio indicating albumin-to-globulin proportion; normal range favors albumin
    • Gamma GT (Gamma-Glutamyl Transferase): 8-61 IU/L or 0.13-1.02 μkat/L - Biliary enzyme; sensitive indicator of cholestasis and hepatobiliary disease
    • Globulin: 2.0-3.5 g/dL or 20-35 g/L - Calculated as total protein minus albumin; represents immunoglobulins and other plasma proteins
  • Interpretation
    • Aspartic Acid Elevation: Indicates hepatocellular necrosis with simultaneous elevation of AST (from which it derives), suggesting acute liver injury. Low levels may indicate cirrhosis with impaired amino acid metabolism
    • Beta-Alanine Abnormalities: Elevated levels suggest impaired hepatic metabolism or certain neurological conditions. Decreased levels may indicate liver synthetic dysfunction or malnutrition
    • Glutamine Elevation: Typically indicates hepatic encephalopathy or severe liver disease with impaired ammonia metabolism. Low glutamine suggests portal hypertension with portosystemic shunting. Fischer ratio (BCAA/AAA including glutamine) helps assess encephalopathy risk
    • Albumin Decreased: Indicates chronic liver disease, malnutrition, malabsorption, or nephrotic syndrome. Progressive decline suggests worsening hepatic synthetic reserve and is a poor prognostic sign in cirrhosis. Low albumin correlates with portal hypertension risk
    • Alkaline Phosphatase Elevation: May indicate biliary obstruction, cholestasis, bone disease, or infiltrative liver disease. Mild elevation (1-2x normal) with normal Gamma GT suggests bone origin. Marked elevation with elevated Gamma GT suggests hepatobiliary origin
    • Bilirubin Total Elevation: Above 2.5 mg/dL causes clinical jaundice. Values above 1.2 indicate impaired bilirubin processing. Sudden elevation suggests acute hepatitis or biliary obstruction
    • Bilirubin Direct Elevation: Direct hyperbilirubinemia (>0.3 mg/dL and >50% of total) indicates cholestasis from biliary obstruction, hepatocellular damage, or intrahepatic cholestasis. Absence of direct bilirubinemia with elevated total suggests hemolysis or Gilbert syndrome
    • AST Elevation: Indicates hepatocellular injury; marked elevation (>1000 IU/L) suggests acute hepatitis (viral, autoimmune, or drug-induced), ischemic hepatitis, or acute Budd-Chiari syndrome. Mild to moderate elevation suggests chronic liver disease
    • ALT Elevation: More hepatic-specific than AST; marked elevation (>1000 IU/L) strongly suggests acute viral hepatitis or drug-induced liver injury. ALT greater than AST favors viral or autoimmune hepatitis, while AST greater than ALT suggests alcoholic liver disease or cirrhosis
    • Total Protein Decreased: Indicates chronic liver disease with impaired synthetic function or protein malnutrition. Values below 6.0 g/dL suggest significant hepatic dysfunction
    • A/G Ratio Decreased (Below 1.0): Indicates relative globulin excess, seen in cirrhosis with elevated immunoglobulins, autoimmune hepatitis, or chronic infection. Ratio below 0.8 suggests significant liver disease
    • Gamma GT Elevation: Indicates cholestasis or hepatobiliary disease; sensitive but not specific. Marked elevation with alkaline phosphatase suggests intrahepatic or extrahepatic cholestasis. Mild elevation may occur with alcohol use or medications
    • Globulin Elevation: Suggests immune stimulation or chronic liver disease. Marked elevation indicates autoimmune hepatitis, viral hepatitis, or cirrhosis. Very high globulins (>3.5 g/dL) with low albumin indicates advanced liver disease
    • Pattern Recognition: AST/ALT elevation >5x normal suggests hepatocellular injury; ALP/Gamma GT elevation without marked transaminitis suggests cholestasis; combined elevation of all markers with low albumin indicates cirrhosis
    • Factors Affecting Results: Hemolysis, lipemia, or icterus may interfere with measurements. Muscle injury elevates AST. Bone disease or adolescence elevates alkaline phosphatase. Medications, alcohol consumption, and recent exercise affect enzyme levels
  • Associated Organs
    • Liver (Primary): All tests directly assess hepatic function. Aspartic acid, beta-alanine, and glutamine reflect hepatic amino acid metabolism capacity. Albumin, total protein, and A/G ratio indicate synthetic reserve. AST, ALT, ALP, and Gamma GT indicate hepatocellular inflammation or cholestasis
    • Biliary System: Alkaline phosphatase, Gamma GT, and bilirubin (particularly direct) indicate bile duct function and obstruction. Elevated levels with abdominal pain suggest cholangitis, choledocholithiasis, or biliary strictures
    • Pancreas: Elevated ALP and Gamma GT can indicate pancreatitis affecting biliary flow. Lipase and amylase should be considered in differential diagnosis when ALP is markedly elevated
    • Gastrointestinal Tract: Absorption of nutrients affects albumin and globulin synthesis. Malabsorption or gastritis may contribute to protein deficiency and elevated bilirubin patterns
    • Portal Venous System: Low glutamine and altered amino acid profiles indicate portal hypertension. Complications include portal hypertensive gastropathy, variceal bleeding, and hepatic encephalopathy
    • Kidneys: Hepatorenal syndrome may develop with severe liver disease, reflected in combined electrolyte and protein abnormalities. Ascites formation and renal perfusion reduction complicate management
    • Heart: AST elevation may reflect myocardial infarction or heart failure with hepatic congestion. Right-sided heart failure causes hepatic congestion and enzyme elevation
    • Brain: Elevated glutamine and ammonia cause hepatic encephalopathy. Altered amino acid ratios (low BCAA:AAA) contribute to neuropsychiatric symptoms including confusion, asterixis, and coma
    • Associated Pathologies: Viral hepatitis (A, B, C, E), alcoholic liver disease, nonalcoholic fatty liver disease (NAFLD), autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, cirrhosis of any etiology, hepatic fibrosis, drug-induced liver injury, hemochromatosis, Wilson disease
    • Complications of Abnormal Results: Hepatic encephalopathy (altered consciousness, behavioral changes), portal hypertension (variceal bleeding, ascites), hepatorenal syndrome (acute kidney injury), spontaneous bacterial peritonitis, hepatic pulmonary syndrome, thrombosis
    • Coagulation System: Low albumin and impaired synthesis lead to decreased clotting factor production, manifesting as elevated PT/INR, prolonged bleeding time, and increased hemorrhage risk
  • Follow-up Tests
    • For Elevated Aspartic Acid and AST: Complete blood count (CBC), additional transaminase evaluation, viral hepatitis serology (anti-HAV IgM, HBsAg, anti-HCV), autoimmune markers (ANA, anti-smooth muscle antibodies), consider muscle biopsy if myositis suspected
    • For Amino Acid Abnormalities (Aspartic Acid, Beta-Alanine, Glutamine): Comprehensive metabolic panel including electrolytes and ammonia level, branched-chain amino acid (BCAA) levels, Fischer ratio calculation, consider hepatic encephalopathy grading
    • For Decreased Albumin: Prealbumin (transthyretin) measurement for acute nutritional assessment, liver synthetic reserve evaluation, portal pressure gradient measurement if cirrhosis suspected, consider albumin infusion if level <2.5 g/dL
    • For Elevated Alkaline Phosphatase: 5'-nucleotidase or Gamma GT to confirm hepatic origin, bone-specific alkaline phosphatase if bone disease suspected, liver ultrasound to assess biliary ductal dilatation
    • For Elevated Bilirubin: Liver ultrasound or HIDA scan to assess biliary function, endoscopic ultrasound (EUS) if choledocholithiasis suspected, ERCP if extrahepatic obstruction confirmed, reticulocyte count for hemolysis evaluation
    • For Elevated ALT: Viral serology, autoimmune hepatitis panel (anti-LKM, anti-GBM), alpha-1 antitrypsin level, ceruloplasmin and serum copper (Wilson disease), serum ferritin and iron saturation (hemochromatosis)
    • For Decreased Total Protein or A/G Ratio <1: Serum/urine protein electrophoresis, immunoglobulin quantification, thyroid function tests, repeat testing to assess trend
    • For Elevated Gamma GT: Alcohol use biomarkers (gamma glutamyl transpeptidase activity in RBC, phosphatidylethanol), medications review, ultrasound for fatty infiltration or cirrhosis features
    • Imaging Studies: Liver ultrasound with Doppler for cirrhosis features and portal hypertension assessment, CT abdomen/pelvis for lesion characterization or staging, MRI with MRCP for comprehensive bile duct evaluation
    • Hepatic Reserve Assessment: Prothrombin time (PT/INR) and activated partial thromboplastin time (aPTT) for synthetic function, platelet count for portal hypertension assessment, fibrinogen level
    • Fibrosis and Cirrhosis Markers: Hyaluronic acid, procollagen III peptide (P3NP), tissue inhibitor of metalloproteinases (TIMP-1), FibroScan (transient elastography), liver biopsy for definitive histology
    • Monitoring Frequency: Stable chronic liver disease requires testing every 3-6 months; acute hepatitis requires weekly monitoring; cirrhosis surveillance includes 6-monthly ultrasound and serum markers; post-transplant monitoring at 1 week, 1 month, 3 months, 6 months, then annually
    • Disease-Specific Follow-up: Viral hepatitis monitoring includes HBV DNA/HCV RNA quantification, liver stiffness measurement, hepatocellular carcinoma surveillance (AFP, ultrasound); alcoholic liver disease requires abstinence counseling and thiamine supplementation; drug-induced injury requires causative agent discontinuation
  • Fasting Required?
    • Fasting Required: Yes - 8-12 hours fasting is recommended for optimal results of the Advanced Liver Package
    • Fasting Duration: Minimum 8 hours recommended; preferably 12 hours overnight fast. This standardizes results for transaminases, bilirubin, albumin, and glucose-dependent markers
    • Fluid Intake: Water intake is permitted and encouraged during fasting period to maintain hydration and ensure adequate blood volume for specimen collection
    • Medications to Avoid: Consult with healthcare provider regarding medications containing acetaminophen or NSAIDs within 24 hours before testing, as these can affect liver enzyme levels. Do not discontinue any prescribed medications without medical guidance
    • Dietary Restrictions: Avoid heavy, fatty, or greasy meals for 24 hours before testing as lipemia (elevated blood lipids) can interfere with measurements. Avoid high-fat dairy products and fried foods
    • Alcohol Avoidance: Refrain from alcohol consumption for at least 24 hours before testing, as alcohol directly elevates liver enzymes and can produce misleading results about liver status
    • Physical Activity: Avoid strenuous exercise or heavy physical exertion for 24 hours before testing, as muscle injury from exercise can elevate AST and create false impressions of hepatic injury
    • Testing Time: Schedule testing in early morning (7-9 AM) when fasting compliance is optimal and diurnal variations in enzyme levels are minimized
    • Specimen Collection: Blood should be collected by venipuncture into appropriate tubes (SST for serum, EDTA for plasma depending on lab protocol). Gentle handling minimizes hemolysis which can falsely elevate transaminases
    • Caffeine: Avoid caffeine-containing beverages (coffee, tea, caffeinated sodas) for at least 2 hours before testing to prevent potential metabolic alterations
    • Supplements and Herbal Products: Disclose all supplements, herbal products, and over-the-counter medications to healthcare provider, as many (St. John's Wort, kava, saw palmetto) can affect liver enzyme levels
    • Stress Reduction: Minimize psychological stress before testing, as stress hormones can influence enzyme metabolism and protein levels
    • Smoking: Avoid smoking for at least 30 minutes before blood draw to prevent respiratory changes that might affect results

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