Hepatic function panel (liver panel)

What it measures

Most labs include ALT and AST (enzymes that leak out when liver cells are injured), alkaline phosphatase or ALP (from bile ducts and bone), total and direct bilirubin (a breakdown product of red blood cells that the liver clears), albumin, and total protein. Fatty liver, alcohol, viral hepatitis, some medicines and supplements, gallstones, and muscle injury can all shift these numbers. Albumin and bilirubin reflect liver function more directly, while ALT and AST reflect injury.

Who should consider it

• Adults with overweight, type 2 diabetes, or high triglycerides (higher fatty liver risk)
• People taking medicines that can affect the liver
• People who drink alcohol regularly
• Anyone with a past abnormal liver result

How to read your result

• Mildly raised ALT or AST is common and often tied to fatty liver, alcohol, medicines, supplements, or recent hard exercise. Reference ranges differ by lab.
• The American College of Gastroenterology notes that healthy ALT runs about 29 to 33 IU/L in men and 19 to 25 IU/L in women, lower than many lab cutoffs. A result inside your lab's range can still deserve a second look.
• AST about twice ALT or higher raises the question of alcohol-related liver injury. A high ALP with a high GGT points to the liver or bile ducts, while a high ALP with a normal GGT often points to bone.
• A mildly high bilirubin that is mostly indirect, with otherwise normal tests, often reflects Gilbert syndrome, a common harmless inherited trait. Normal liver tests do not rule out scarring (fibrosis).

Reference ranges differ between labs. Use the range printed on your own report.

When to get care right away. Yellow skin or eyes, dark urine with pale stools, severe belly pain, vomiting blood, or new confusion need urgent care. If symptoms are severe, go to an emergency room or call 911.

What to do next

Repeat a mildly abnormal result in a few weeks after skipping alcohol and hard exercise. If it stays high, see a clinician. For suspected fatty liver, the AASLD recommends a FIB-4 score (calculated from age, AST, ALT, and platelets) to estimate scarring risk, and a clinician may add hepatitis tests or an ultrasound.