Liver Function Test

A liver function test (LFT) is a group of blood tests that check how well your liver is working and whether it is inflamed or damaged. A standard panel includes ALT (SGPT), AST (SGOT), ALP, bilirubin (total, direct and indirect), total protein, albumin and the albumin/globulin ratio, and sometimes GGT.

The enzymes (ALT, AST, ALP, GGT) rise when liver or bile duct cells are injured, while bilirubin, albumin and protein show how well the liver is processing and producing substances. The pattern tells doctors a lot: a high ALT/AST suggests liver cell injury (fatty liver, hepatitis), a high ALP and GGT suggests bile duct blockage, and a low albumin points to long-standing liver disease.

In India, the commonest reasons for abnormal LFTs are fatty liver, viral hepatitis, alcohol, and medicines. Many liver diseases cause few symptoms in early stages, so LFTs are valuable for early detection.

Reading the pattern in your LFT report

No single number on a liver panel tells the full story; doctors look at the pattern. A hepatocellular pattern, with ALT and AST raised much more than ALP, suggests injury to liver cells, as in fatty liver, viral or alcoholic hepatitis and drug injury. A cholestatic pattern, with ALP and GGT disproportionately raised, with or without high bilirubin, suggests a blocked or inflamed bile duct, for example from gallstones. A low albumin or raised prothrombin time suggests the liver's ability to make proteins is reduced, as in advanced disease.

The AST:ALT ratio also helps. A ratio above 2 is typical of alcohol-related injury, while ALT higher than AST is typical of fatty liver and viral hepatitis.

Fatty liver: the commonest finding

Fatty liver, now called metabolic dysfunction-associated steatotic liver disease (MASLD), affects a large share of urban Indians, including many who are not overweight. It is often silent, discovered through mildly raised ALT or a fatty liver on ultrasound. Weight loss of 7–10%, regular exercise, cutting sugary drinks and refined carbohydrates, controlling diabetes and cholesterol, and avoiding alcohol can reverse it in many people. Ignored, it can progress to inflammation, fibrosis and cirrhosis.

Jaundice and bilirubin

Raised bilirubin makes the eyes and skin look yellow. Raised indirect bilirubin points toward increased red-cell breakdown or Gilbert's syndrome, which is common and harmless. Raised direct bilirubin points toward a problem within the liver or bile ducts and needs further evaluation, such as ultrasound.

Medicines, supplements and the liver

Many medicines can affect the liver, including paracetamol at high doses, TB treatment, some antibiotics, statins and certain herbal or "ayurvedic" preparations. Tell your doctor everything you take, and do not stop prescribed medicines on your own because of a mildly raised enzyme.

When to see a doctor urgently

Seek prompt medical attention for yellow eyes with severe weakness, persistent vomiting, confusion or drowsiness, black stools or vomiting blood, or marked abdominal swelling.

Booking an LFT

LFT is available as a standalone test and within most health packages. Prices vary by lab and city, so compare options on LabDekho, choose NABL-accredited labs and home collection if you prefer, and fast as advised.