Liver health panel

The liver health panel includes three liver enzymes from a single blood draw: AST, ALT and GGT. When liver cells or bile ducts are under strain or damaged, larger amounts of these enzymes enter the blood, so elevated values warn that the liver needs attention. The cause is established only through other results and a medical examination.

Who the panel is for

• people attending a general or preventive health check;
• people with excess body weight, type 2 diabetes or elevated blood fats, because of the risk of fatty liver;
• people who regularly drink alcohol;
• people taking medicines long term that may affect the liver, when their doctor recommends monitoring;
• people with fatigue, nausea, discomfort below the right ribs, yellowing of the skin and eyes, dark urine or pale stools;
• people with known liver disease, such as chronic hepatitis, for monitoring.

If yellowing of the skin and eyes occurs with severe abdominal pain, fever or confusion, seek medical attention immediately.

What the panel contains and shows

• ALT (alanine aminotransferase) is found predominantly in liver cells, making it the most specific indicator of damage to these cells.
• AST (aspartate aminotransferase) is found in the liver, but also in the heart and skeletal muscles, so it also rises after strenuous physical activity or muscle injury.
• GGT (gamma-glutamyltransferase) is most sensitive to changes in the bile ducts, alcohol and certain medicines.

Liver enzymes indicate strain on or damage to the liver, but not how well it functions. For this, the doctor looks at bilirubin, albumin and blood clotting. Normal enzymes do not rule out every liver disease: in fatty liver and even cirrhosis, values may be normal or only slightly elevated.

Preparation and sample

Blood is taken from a vein. Fasting is not essential for liver enzymes, but if glucose or blood fats are measured from the same draw, attend fasting. Avoid alcohol for at least the day before, and very strenuous exercise for several days beforehand, because it may temporarily raise AST and sometimes ALT. State which medicines, dietary supplements and herbal preparations you take.

How results are interpreted

Reference intervals depend on the method, sex and age and are printed on the report. A slight elevation is common and usually does not indicate serious disease, but should not be ignored. The doctor considers how elevated the enzymes are, which predominates and how long the elevation has lasted.

Most common causes of elevated liver enzymes

• Fatty liver: metabolic dysfunction-associated steatotic liver disease (MASLD, formerly non-alcoholic fatty liver disease) is the most common cause of mildly elevated enzymes. ALT is usually higher than AST, and GGT is often slightly elevated.
• Alcohol: GGT is typically elevated, while AST is often higher than ALT, sometimes twice as high.
• Medicines and dietary supplements: for example, high doses of paracetamol, certain antibiotics, epilepsy medicines, statins and herbal preparations.
• Viral hepatitis: hepatitis B and C may cause no symptoms for years and are checked using hepatitis markers.
• Bile duct disease: stones or narrowing of the bile ducts; alkaline phosphatase is then usually elevated alongside GGT.
• Causes outside the liver: strenuous physical activity or muscle injury (primarily AST), thyroid disease and coeliac disease.

Very high values, several times above the upper limit, indicate acute liver damage, for example from viruses, medicines or poisons, and require prompt medical assessment.

What follows an elevated result

For a mild elevation, the doctor usually repeats the tests after several weeks, avoiding alcohol and strenuous exercise. If the elevation persists, the doctor usually requests additional blood tests and a liver ultrasound (abdominal ultrasound is available only in Split), and refers you to a gastroenterologist if necessary. In fatty liver, the doctor can use AST, ALT, age and platelet count to calculate the FIB-4 index, which helps assess the risk of liver scarring (fibrosis).

Basic or extended panel

Extended liver health panel includes, alongside AST, ALT and GGT, alkaline phosphatase (AP), total bilirubin and total proteins. It is more suitable for symptoms such as jaundice, suspected bile duct disease, or when basic enzymes have previously been elevated.

How to arrange testing

You can come for blood collection without an appointment or referral at one of our branches throughout Croatia (listed on the Contactpage). Prices for all tests and panels are listed in the service price list.

Frequently asked questions

What are normal liver enzyme values?

Limits depend on the laboratory, method, sex and age, so always use the reference interval printed on the report. Men generally have slightly higher values than women.

Can liver enzymes be elevated after exercise?

Yes. Strenuous exercise, particularly weight training or prolonged running, temporarily raises AST and sometimes ALT, because these are also present in muscles. GGT remains normal. If you have exercised intensively, repeat the test after several days of rest.

Do normal liver enzymes mean the liver is healthy?

Not always. In fatty liver and even advanced cirrhosis, enzymes may be normal. If you have risk factors, the doctor may recommend ultrasound or other tests.

Can medicines raise liver enzymes?

Yes, often causing a mild and temporary elevation. Do not stop medicines yourself; show the results to your doctor, who will assess whether to change treatment or simply repeat the tests.