Question about liver blood test results

[Healthnut22]

Hello all,

I was wondering about the sensitivity/accuracy of liver blood tests. I have always been very health conscious, as a lot of serious medical issues run in my family. I always go to my yearly doctor visits where they order routine blood work for blood counts, organ function, thyroid, etc. I always look at my results and what the numbers mean, etc. Overall, I have always been generally healthy and I try to take good care of myself. I do drink alcohol and have done so for about 15 years - some of which included moderate to heavy social drinking in college, etc. After having kids, I would say it has been just light to moderate drinking, but I probably have exceeded the 7 drinks a week recommended limit at times. I have recently been reading that liver blood work can remain normal in some cases even when liver disease is present. My liver blood work has always been well within normal ranges, which has given me comfort, but after reading that normal tests may not always indicate a healthy liver, it got me wondering what other kind of preventive screening can be done to detect liver issues in early stages. I did have an abdominal ultrasound done about 2.5 years ago to check on my gallbladder after having a baby and that was also completely normal for all organs including liver. I obviously know that diet, lifestyle, etc. plays a big role. But is blood work even able to detect small amounts of disfunction? How sensitive are these tests? Is it common to have normal blood work in early stages of liver disease? Just trying to educate myself on this and stay on top of preventative care, etc.

[briccolone]

hi there, it's a good question. from my own experience my fatty liver issues were picked up by a blood test in Italy (raised GGT) caused by too much vino over too many years. Initially ultrasound picked up nothing until the fatty liver worsened. So in my case blood tests were accurate as I also had digestive symptoms. I think the issue in the UK is that they don't do these standard tests like GGT unless specifically asked. We probably have an epidemic of folk with un-diagnosed fatty liver out there. For the record my normal liver panel other than GGT has always been normal.

[Healthnut22 in reply to briccolone]

Thanks briccolone. I hope you are feeling well. I am fairly certain my doctors have never ordered GGT tests for me. They must not be part of the “normal” liver panel ordered during my yearly physicals. I have read that those can be the most sensitive though, so it does seem odd that doctors wouldn’t want to include that in a routine screening. Is it possible that it is too sensitive? I have read that having any alcohol within a few days of the test can raise the numbers. It still seems like it may be worth looking into if it can show early signs of liver disease. It sure seems like there are a lot of people who have normal other blood and ultrasounds and later go on to experience more liver issues. Personally for me, I would definitely reconsider even drinking every now and then if any of my tests came back as elevated/abnormal. But if everything checked out fine, I would likely not stress over having a glass of wine a few times a week knowing that my liver was still healthy and functioning normally. I may ask about this at my next visit. It seems like anyone who drinks even moderately can be at risk for liver disease because everyone’s body handles alcohol differently. Makes my health conscious, obsessive mind go a little crazy 😄

[lyn3]

Hi I can only go on concerning my husband and the experience with him but i think everyone is different..Hes has had bloods done to check on his liver many many times over the years, and each time has come back normal. Even when he was very ill they came back normal. Hes been getting worse over the last few months,gone from sleeping normally to sleeping any where from 7 hours to 15 hours, and still being tired, walking to the kitchen is exasuting for him, hes got swollen legs and feet,enlarged belly, almost no appetite, and generally feeling unwell all the time. He ended up at the hospital a few weeks ago to be checked over and his bloods came back normal. I wasnt happy with the results because i knew somethings wrong (hes was a heavy drinker for over 35,but hes hardly drinking now,so there is no way his liver is fine). So i wrote to the dr again explaining his symptoms etc and concerns and after examining him ,he ordered an M.O.T blood tests on his liver and surrounding organs.Now they have all come back with abnormalities and he had an full scan of all his organs yesterday, so waiting on his results. But one friend of his had bloods come back with abnormalities in the liver and hes not had any symptoms ,he had routine blood tests for something else. So everyone is different.

[Healthnut22 in reply to lyn3]

I am so sorry to hear your husband is not well. That is concerning and puzzling to hear that his routine tests have not picked up something sooner considering how sick he feels. I wish there were more decisive tests to confirm these things early on. Did he have normal GGT numbers as well? I certainly hope that the results of his most recent tests are something that can be managed. Take care.

[sophiaS1980]

I have read what different ones have to say, and they are right, everyone is different. However, many call ALT/AST liver enzymes which can be normal in cirrhosis. A GGT test can tell you more what's going on with your liver and some doctors use this test to monitor a person that is still drinking (transplant listing). My doctor stated, you should be looking at your ALT/AST BUT albumin, Platelets and hemoglobin can put a doctor on alert that further testing is needed. Many with cirrhosis due to alcohol have low platelets and show signs of anemia (lower hemoglobin).

[Healthnut22 in reply to sophiaS1980]

I have also read that can be the case with cirrhosis and ALT/AST. I have read this can be due to the death of liver cells basically normalizing the number because it isn’t able to produce enzymes anymore. I guess I am wondering why normal results are still registered in folks with early or minor liver disease. Like briccolone’s experience above - mild fatty liver but only GGT elevated and all other numbers normal. I know my doctors have never routinely ordered GGT tests as part of a liver panel. But it seems like that is many times the only number that elevates in early liver disease for some people. There must be a reason for it - possibly it is too sensitive and can produce unnecessary further testing? But still seems to be a useful test in many cases. I wish it were more routinely given to diagnose liver problems early on. Or that the other tests were more accurate predictors.

[sophiaS1980 in reply to Healthnut22]

GGT is sensitive to alcohol, and in ALD this level is the hardest to go down when there is damage., Usually, if there is little damage, this level will go down quickly after a person stops alcohol. Maybe, doctors only order this test when we go in and tell our doc that we are concerned about our liver and drinking. Most people don't share the amount they drink with their doc.

[CarpeDiem11]

Ggt is an inflammatory marker and can be raised for a number of reasons, including a recent cold or infections. It is not specific to the liver, hence it not being ordered. ALT is the one used to monitor the liver, but used with AST gives an indication of liver damage from alcohol, although AST can be raised for a variety of reasons. Liver damage can be caused in a variety of ways and unless there are suggestive symptoms these liver tests are not ordered as standard.

Many people see the normal numbers and if they are just slightly out of this range, they become alarmed when it could just be they had an infection that caused it. For reference when I was diagnosed with an autoimmune disease of the liver my ALT was over 1000. These liver tests produce varying results, even over a short space of time, so docs tend to be looking at overall trends : numbers alone do not tell the whole story.

Labtestsonline will give you a detailed explanation of each test ordered and may correct some of what I have said as I am going from memory.

Try not to worry and carry on living a healthy life. All the best🙂

[Healthnut22 in reply to CarpeDiem11]

It sounds like it is quite sensitive to many factors. And I can definitely see some benefit in not over testing people without specific symptoms. I personally had an experience with a doctor who once ordered a ton of various blood work and a slight abnormality of one number opened the door to a bunch of other unnecessary tests that turned up with nothing - unrelated to liver health. It also caused me a whole lot of worry. It ended up being normal when tested again down the road. It is just concerning that liver disease is growing so quickly all over the world, and that if we have tests to possibly pinpoint it early on, it seems like that may make a difference in terms of lifestyle choices for many people. I remember reading about GGT for the first time last year and wondering why it has never been ordered for me in routine bloodwork. Maybe because I always classify myself as a “social” drinker. I was quite overly social in my 20s though, so the word social has a very different meaning these days. If we are ever able to resume normal life and in person doctor visits, I will definitely ask about the benefits and drawbacks of having this tested as part of my routine tests. Thanks for your input everyone, it’s very interesting hearing everyone’s different experiences.