If we have hepatitis B or hepatitis C, we should have liver tests done regularly to ensure our liver is functioning as it should, and so we can respond as needed to any problems. In BC, we can be treated for hepatitis C even if our liver tests are normal—hepatitis treatment can help ensure your liver stays healthy. If you have had treatment for hepatitis, it is important to continue having liver tests done to measure your liver health.
Liver tests check for liver damage, fibrosis (scarring), and liver cancer—they can also check if your liver health has improved. Liver testing can be done by blood tests, which can measure how well your liver is working through checking certain chemicals in our blood, and other tests that can determine if fibrosis (scarring), damage, or cancer have developed.
Liver Function (blood) tests:
These tests are done to measure how well your liver is working and the results also can show if inflammation or liver injury is present. Some of the most common types of liver function tests are:
International normalized ratio (INR) or Prothrombin Time (PT) test
These tests measure how long it takes blood to coagulate (clot). For blood to clot it needs vitamin K and a protein produced within the liver.
Bilirubin
This test measures the amount of bilirubin (a substance produced by the liver that is found in blood.) High levels of bilirubin in blood can indicate a problem with the liver and bile systems.
Albumin and total protein
This test measures the levels of albumin (a protein) found in blood. Low albumin levels can indicate poor liver functioning.
Liver Enzyme Level Tests
Alanine transaminase (ALT)
This test measures the level of ALT (a liver enzyme). This type of enzyme is released into the bloodstream after acute liver cell damage.
Alkaline phosphatase (ALP)
This test may be used to assess liver function and to determine if lesions that may be causing bile obstruction. ALP is a type of enzyme that is found in many tissues throughout the body but is found most in the liver, bile duct and bone.
Gamma-glutamyl transferase (GGT)
This test is used to measure the level of the gamma-glutamyl transferase enzyme. This test can provide information about liver function as well as if specific liver diseases are present.
Aspartate transaminase (AST)
This type of test also measures enzyme levels of the enzyme aspartate transaminase in the bloodstream. This enzyme is secreted when there has been acute liver cell damage and can be an indicator of poor liver functioning.
Other Liver Tests
Mitochondrial antibodies test
This test detects presence of antibodies that can indicate primary biliary cirrhosis, chronic active hepatitis or certain autoimmune disorders.
Alpha-fetoprotein test (AFP)
This is a specific type of blood protein made by fetal and tumour cells. Testing for this protein can be done to predict a person’s risk of developing certain types of liver cancer, such as hepatocellular carcinoma, and can be used to monitor the effectiveness of treatment for other types of liver cancer such as hepatomas.
Serum alpha-1 antitrypsin test (A1AT)
This test is not commonly done but can be done to measure the level of alpha-1 antitrypsin in blood. If alpha-1 antitrypsin is too low, it can cause cirrhosis and lung damage in adults and children. Alpha-1 antitrypsin deficiency is caused by a genetic disorder and is relatively rare.
AST to Platelet Ratio Index (APRI)
APRI is not a blood test itself but uses the results of other blood tests to calculate an estimate of liver fibrosis. It is used to predict “significant” or advanced fibrosis.
Fibrotest (and ActiTest)
Fibrotest estimates the amount of liver inflammation using a calculation based on six other liver tests. It is used to evaluate fibrosis in people with chronic hepatitis C and can be used to diagnose fibrosis in people with the hepatitis B virus.
ActiTest uses the same methods as Fibrotest but adds in ALT results.
Learn more about how Fibrotest/ActiTest results are calculated.
Other blood tests
Other blood tests may be done to assess your overall health. These tests include:
- Lipid panel
- Complete blood count (CBC)
- Liver (hepatic) function panel
- Blood chemistry screening tests
- Other tests including those to check levels of different nutrients such as vitamin D.
Liver Imaging Tests
Other imaging tests such as CT scans (computerized tomography, sometimes called computerized axial tomography or CAT scan), MRI (magnetic resonance imaging) or ultrasound may be used in some cases to check your liver. A peer navigator can talk with you about your situation and why your doctor may be recommending these tests.
Fibroscan (ultrasound elastography test)
Fibroscan is a non-invasive test (done outside the body). It uses ultrasound (sound waves) to measure liver stiffness—how much scarring or thickening is present in your liver (fibrosis). It may be used alone or with other blood tests to identify scarring, damage to liver tissue, or fatty liver disease.
Fibroscan is not available in all areas of the province, and blood tests are accurate and useful. However, if you or your doctor prefer Fibroscan to check your liver, it is an option to help inform your decisions.
Fibroscan is not currently covered under BC’s Medical Services Plan (your health card). If you need help locating a clinic that does Fibroscan near you, a Peer Navigator at Help4Hep BC can provide information and help you through the process.
A peer navigator can help you understand your Fibroscan results if you still have questions after going over them with your doctor. Read more about results here.
Further Reading on FibroScan
For more detailed information about FibroScan, we recommend the FibroScan and Liver Disease resource from University Health Network in Toronto.
Get more information.
Sources:
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/common-liver-tests
- https://www.mayoclinic.org/tests-procedures/liver-function-tests/about/pac-20394595
- https://www.healthlinkbc.ca/medical-tests/hw144350
- https://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-staging/calculating-apri