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Bile Acids

Liver
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Report in 120Hrs

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At Home

fastingrequire

Fasting Required

Details

Detects early hepatic dysfunction, even before other liver tests elevate

₹915₹2,390

62% OFF

Bile Acids Test Information Guide

  • Why is it done?
    • Measures the concentration of bile acids (or bile salts) in the blood serum, which are molecules produced by the liver and stored in the gallbladder
    • Evaluates liver function and bile production, particularly useful in assessing cholestasis (bile flow obstruction) and hepatocellular injury
    • Diagnoses and monitors cholestatic liver diseases including primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and intrahepatic cholestasis of pregnancy (ICP)
    • Assesses gallbladder and biliary tract disorders, including bile duct obstruction and gallstone disease
    • Evaluates patients with chronic liver disease, cirrhosis, and hepatitis to assess disease severity and prognosis
    • Performed during pregnancy screening when intrahepatic cholestasis is suspected, particularly in third trimester
    • Ordered when patients present with jaundice, dark urine, pale stools, or pruritus (itching) to determine hepatic origin
  • Normal Range
    • Reference Range: 0.3-10.2 µmol/L (micromoles per liter) or 0-7 µg/mL (micrograms per milliliter), depending on laboratory methodology and assay used
    • Fasting Values: Typically 0.3-5.9 µmol/L in fasting state; may increase 2-10 fold after meals (postprandial state)
    • Normal Values Interpretation: Indicates normal bile acid metabolism, adequate liver function, and unobstructed bile flow; suggests absence of cholestasis
    • Elevated Values: >10.2 µmol/L or >7 µg/mL indicates impaired bile acid clearance and possible cholestasis
    • Units of Measurement: µmol/L (micromoles per liter) in SI units or µg/mL (micrograms per milliliter) in conventional units; laboratories may report total bile acids or individual species
    • Laboratory Variation: Reference ranges vary between laboratories and testing methods; always consult specific laboratory reference intervals for accurate interpretation
  • Interpretation
    • Mild Elevation (10-20 µmol/L): May indicate subclinical cholestasis, mild liver dysfunction, or early-stage cholestatic disease; may require clinical correlation and repeat testing
    • Moderate Elevation (20-100 µmol/L): Suggests significant cholestasis, intrahepatic cholestasis, or biliary obstruction; warrants further investigation with imaging and additional liver function tests
    • Severe Elevation (>100 µmol/L): Indicates severe cholestasis, complete bile duct obstruction, advanced liver disease, or acute hepatic dysfunction; requires urgent evaluation and intervention
    • Pregnancy-Related Interpretation: In pregnant patients, bile acids >10.2 µmol/L or >7 µg/mL may indicate intrahepatic cholestasis of pregnancy (ICP), associated with increased fetal risk; values >40 µmol/L represent significant maternal and fetal risk
    • Clinical Significance in Cirrhosis: Elevated bile acids in cirrhosis indicate hepatic synthetic dysfunction and reduced hepatic extraction; correlates with disease severity and prognosis
    • Factors Affecting Results: Fasting vs. postprandial state (values increase after meals); time of sample collection; medications affecting liver function; kidney disease; hemolysis of sample; recent cholecystectomy
    • Relationship to Other Liver Tests: Bile acids may be elevated while alkaline phosphatase and bilirubin remain normal in early cholestasis; more sensitive marker than GGT for detecting hepatic dysfunction
  • Associated Organs
    • Primary Organ Systems: Liver (production and metabolism); Gallbladder and biliary tract (storage and delivery); Small intestine (enterohepatic circulation and reabsorption); Kidneys (involvement in liver-kidney syndrome)
    • Cholestatic Liver Diseases: Primary Biliary Cholangitis (PBC) - autoimmune inflammation of bile ducts; Primary Sclerosing Cholangitis (PSC) - progressive fibrosis of bile ducts; Intrahepatic Cholestasis of Pregnancy (ICP) - hormonally-induced cholestasis
    • Biliary Obstruction: Gallstones (choledocholithiasis); Bile duct strictures; Pancreatic tumors compressing bile ducts; Biliary tract malignancies
    • Hepatic Diseases: Viral hepatitis (A, B, C); Alcoholic liver disease; Non-alcoholic fatty liver disease (NAFLD); Cirrhosis; Hepatocellular carcinoma; Drug-induced liver injury; Autoimmune hepatitis
    • Systemic Diseases Affecting Bile Acid Metabolism: Sepsis; Renal failure; Heart failure; Portal hypertension; Hemolytic anemia
    • Potential Complications from Elevated Bile Acids: Pruritus (severe itching) affecting quality of life; Portal hypertension; Hepatic encephalopathy; Variceal bleeding; Ascites; Hepatic-renal syndrome; Coagulopathy; In pregnancy, increased fetal distress and intrauterine fetal death
  • Follow-up Tests
    • Liver Function Panel: Alkaline phosphatase (ALP), Gamma-glutamyl transferase (GGT), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Total and direct bilirubin, Albumin, Prothrombin time (PT/INR)
    • Imaging Studies: Ultrasound of abdomen/liver (first-line imaging for biliary obstruction); CT scan of abdomen; MRI/MRCP (magnetic resonance cholangiopancreatography) for detailed ductal visualization; ERCP if therapeutic intervention needed
    • Serological Testing: Hepatitis A, B, C antibodies/antigen; Autoimmune markers (ANA, anti-mitochondrial antibody for PBC, anti-smooth muscle antibody); Viral serologies if acute hepatitis suspected
    • Specialized Liver Tests: FibroTest or FibroScan (assess degree of hepatic fibrosis); 5-nucleotidase; Lipoprotein X (Lp-X) in cholestasis; Individual bile acid species analysis if available
    • Pregnancy-Specific Follow-up: Repeat bile acids if elevated in pregnancy (typically weekly or biweekly); Fetal monitoring/cardiotocography; Ultrasound for fetal well-being; Consider early delivery planning if severe elevation confirmed
    • Monitoring Frequency: For chronic cholestatic diseases: every 3-6 months; For acute presentations: repeat within 24-48 hours; In pregnancy with ICP: weekly to twice weekly; In cirrhosis: every 3 months or as clinically indicated
    • Complementary Tests: Lipid panel if cholestasis present; Coagulation studies (PT, aPTT); Complete blood count; Kidney function tests (creatinine, BUN); Ammonia level if hepatic encephalopathy suspected
  • Fasting Required?
    • Fasting Required: YES
    • Fasting Duration: Minimum 12 hours overnight fast; ideally 12-14 hours; some laboratories recommend up to 16 hours for optimal results
    • Special Instructions: No food or beverages except water during fasting period; consume water freely; avoid alcohol for 24 hours prior to test; avoid excessive exercise 24 hours before test
    • Medications to Avoid: Bile acid sequestrants (cholestyramine, colesevelam) - discontinue 48-72 hours before test if possible; Estrogen-containing medications may affect results, consult physician; Continue other medications as normally prescribed unless instructed otherwise; Consult with laboratory regarding specific medications
    • Timing of Blood Draw: Early morning is preferred (between 7-10 AM); bile acid levels naturally vary throughout the day; consistent timing facilitates better clinical comparison of serial samples
    • Other Patient Preparation: Avoid stress and strenuous activity before blood draw; rest for 10-15 minutes before venipuncture; avoid smoking 1 hour prior to test; maintain upright posture before blood collection; inform laboratory of any recent medication changes or significant illness

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