Liver Function Tests: An Updated Review Article for Clinical Pathologists

Abstract

Background: The liver, a vital organ for detoxification, metabolism, and protein synthesis, requires precise evaluation to identify potential dysfunctions or injuries. Liver function tests (LFTs) assess hepatocellular damage, cholestasis, and synthetic capacity through a range of biomarkers like ALT, AST, ALP, GGT, and bilirubin.

Aim: This review provides a comprehensive overview of liver function tests, their interpretation, associated etiologies, and clinical implications for pathologists.

Methods: Data were collected from peer-reviewed studies focusing on LFTs, their diagnostic accuracy, and patterns of elevation. The review categorizes LFT abnormalities into hepatocellular, cholestatic, mixed injury, and isolated hyperbilirubinemia patterns while elucidating the pathophysiology and serological markers involved.

Results: Hepatocellular patterns predominantly indicate elevated aminotransferases linked to viral hepatitis, steatohepatitis, or autoimmune conditions. Cholestatic patterns, defined by increased ALP and GGT, suggest bile duct obstruction or hepatobiliary disorders. Mixed injury and isolated hyperbilirubinemia provide additional diagnostic insights. Advanced serological tests like AFP and CA19-9 aid in identifying malignancies, while synthetic function tests assess albumin production and prothrombin time. Specimen handling and storage play crucial roles in ensuring test accuracy.

Conclusion: Liver function tests remain indispensable in diagnosing hepatic dysfunctions. However, accurate interpretation requires an integrated understanding of biochemical patterns and clinical contexts. Advances in diagnostic tools and biomarker analysis further enhance the precision of hepatological assessments.