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DECEMBER 2017 | Published by RCPA

Issue #076

Liver function tests catch Santa at his own game

Liver function tests catch Santa at his own game

Forget Santa’s naughty and nice list. Our liver reveals what we’ve really been up to making liver function tests (LFTs) a valuable tool in the medical toolbox. These tests are under continuing review to maintain their relevance as health demographics change.

“The reference ranges for LFTs are being debated and reviewed as our population becomes more obese. The commonest reason for increased alanine aminotransferase (ALT), a test in the LFT panel which reflects liver cell damage, is now fatty liver disease,” explained Dr Penny Coates, Clinical Director of Chemical Pathology at SA Pathology.

Reference ranges are set to ensure that just over 95% of a healthy population will fall within the 'normal range'. Our expanding waistlines are redefining what that healthy population looks like.

“Treatment options for liver disease usually depend on laboratory results. If the reference ranges don’t reflect medically significant changes in the population then these tests might not flag ill health, or the results might be mostly ignored because they are ‘always abnormal’,” she explained.

Keeping LFTs relevant is important. To illustrate how informative they can be let’s turn the tables on Santa and find out what he’s been up to as well. Based on how long he’s been carrying excess weight, and on his food and alcohol consumption on Christmas Eve alone (about 1 billion pieces of cake and schooners of beer), his LFT panel would probably light up like the Rockefeller Center Christmas Tree.

“If a person over indulges in alcohol through a single binge they can get acute hepatitis, and this can show up in a LFT as high gamma-glutamyl transferase (GGT) and transaminases. GGT is also increased in seven out of 10 heavy drinkers, and for the other three increased GGT will probably be due to other causes such as medications or obesity,” explained Dr Coates.

If Santa’s been taking certain medications, or if his liver isn’t recovering from years of extreme binging, or if he has fatty liver disease linked to his weight issue, then these will be picked up by tests in an LFT panel too.

The information collected from these tests form a valuable early warning system. Symptoms of liver disease might not show up until it’s quite advanced, yet early changes flagging a potential problem will show up in LFTs. Keeping these tests medically relevant by adjusting their reference ranges is therefore important. And even though we caught him out this year, we’re sure the rotund guy in the red suit with questionable dietary and drinking habits, who is also a high-risk candidate for fatty liver disease, would agree.

A bit more about LFTs

  • They are a group of tests run together to detect, evaluate and monitor liver inflammation and damage.
  • These tests measure enzymes, proteins and substances the liver either produces or excretes, or that are affected by a liver injury, infection or disease.
  • Interpreting the pattern of results from the panel of tests helps determines the diagnosis.

A bit more about the liver and fatty liver disease

  • The liver’s main function is to filter the blood that comes from the digestive tract before passing it on to the rest of the body. It also produces substances that help the blood to clot, helps regulate blood sugar levels, and breaks down alcohol and other drugs, and chemicals.
  • Fatty liver disease is a build-up of fat in the liver. Its risk factors include overweight and obesity, type 2 diabetes and excessive alcohol consumption.
  • Fatty liver carries a risk for progression to chronic hepatitis and cirrhosis. In some cases it results in liver failure.




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