Extended Liver Health Panel

The Extended Liver Health Panel includes six tests from one blood sample: AST, ALT, GGT, alkaline phosphatase (AP), total bilirubin and total protein. Alongside the liver enzymes in the basic panel, it shows bile flow and how the liver excretes bilirubin, making it suitable for symptoms, jaundice or previously elevated liver enzymes. Results flag possible changes, while a doctor establishes the cause using other investigations.

Who the panel is for

• people with yellowing of the skin and eyes, dark urine, pale stools or itchy skin;
• people with discomfort under the right rib cage, nausea or persistent fatigue;
• people whose AST, ALT or GGT were already elevated in the basic panel;
• people with suspected gallstones or another bile duct disorder;
• people who regularly drink alcohol, are at risk of fatty liver or take long-term medicines that may affect the liver;
• people with known liver disease, to monitor the condition.

If jaundice appears with severe abdominal pain, fever, chills or confusion, see a doctor immediately.

What the panel includes and indicates

• ALT is found mainly in liver cells and is the most specific indicator of damage to them.
• AST is found in the liver but also in the heart and muscles, so it also rises after strenuous exertion or muscle injury.
• GGT is sensitive to changes in the bile ducts, alcohol and certain medicines.
• Alkaline phosphatase (AP) rises when bile flow is impaired, but also with increased bone formation, for example in children, during pregnancy or in bone disease.
• Total bilirubin is a yellow pigment excreted by the liver in bile; it rises in liver and bile duct disease, Gilbert’s syndrome and increased breakdown of red blood cells.
• Total protein is the sum of albumin, produced by the liver, and globulins, which include antibodies.

Enzymes indicate strain on or damage to the liver, while bilirubin and proteins also reflect how the liver performs its functions. Even the extended panel does not rule out all liver disease: results can be normal or only mildly abnormal in fatty liver and even cirrhosis. To assess liver synthetic function, a doctor may also request albumin and prothrombin time. Cholinesterase (CHE), which also reflects liver synthetic function, is neither included nor replaced by this panel and is not measured at Poliklinika Analiza.

Preparation and sample

Blood is taken from a vein. Fasting is not essential for this panel, but if glucose, lipids or PT are being tested from the same sample, come in the morning after fasting. Do not fast longer than a normal overnight fast, because prolonged fasting can raise bilirubin. Avoid alcohol for at least a day beforehand and very strenuous exercise for several days beforehand, because it can temporarily raise AST and sometimes ALT. At blood sampling, state which medicines, 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. One elevated value is rarely enough for a conclusion, so the doctor looks at which tests are abnormal and the pattern they form.

Typical patterns

• ALT and AST predominate: suggests liver cell damage, most often due to fatty liver (MASLD), alcohol, medicines or viral hepatitis. In fatty liver, ALT is usually higher than AST; with alcohol, AST is often higher, sometimes twice as high.
• AP and GGT predominate: suggests impaired bile flow, for example due to a stone or narrowing of bile ducts, medicines or disease of the bile ducts within the liver.
• Only AP is elevated, with normal GGT: the source is more likely to be the bones; higher values are expected in children and pregnant women.
• Only bilirubin is elevated: most often Gilbert’s syndrome, a harmless inherited condition, and less often increased red blood cell breakdown. The doctor then requests direct bilirubin.
• Bilirubin elevated alongside AP and GGT or liver enzymes: suggests liver or bile duct disease and requires more prompt investigation.
• Abnormal total protein: low levels may accompany chronic liver disease, poor nutrition or protein loss through the kidneys, while high levels most often indicate dehydration or increased globulins, for example in chronic inflammation.

AST and ALT values several times above the upper limit suggest acute liver damage and require prompt medical assessment. With mild changes, the doctor usually repeats testing after a few weeks. If abnormalities persist, the next steps are hepatitis markers and other blood tests and liver ultrasound (we performabdominal ultrasound only in Split), with referral to a gastroenterologist if needed. In fatty liver, a doctor can calculate the FIB-4 index from AST, ALT, age and platelet count to help assess the risk of liver scarring (fibrosis).

Basic or extended panel

Liver Health Panel includes AST, ALT and GGT and is sufficient for a preventive liver enzyme check, for example with a risk of fatty liver or while taking medicines. The extended panel is more suitable for symptoms, jaundice, suspected bile duct disease or previously elevated basic enzymes.

How to arrange testing

You can have blood taken without an appointment or referral at one of our branches across Croatia (listed on the Contact page). Prices for all tests and panels are available in the service price list.

Frequently asked questions

Do I need to fast?

No, fasting is not essential for this panel. If glucose, lipids or PT are also being tested from the same sample, come in the morning after fasting; you may drink water. Fasting beyond an overnight fast is unnecessary because it may temporarily raise bilirubin.

Does the panel show fatty liver?

Not directly. ALT and GGT are often mildly elevated in fatty liver, but may also be normal. Fatty liver is most often detected by ultrasound, and the doctor interprets results alongside body weight, blood glucose and lipids.

Can the panel detect liver cancer?

It can neither confirm nor exclude it. Liver tumours can affect liver test results, but fatty liver, alcohol and medicines are much more common causes of abnormalities. We discuss symptoms requiring examination in First signs of liver cancer.

Can medicines and exercise affect results?

Yes. Some medicines and herbal preparations raise liver enzymes or GGT, while strenuous exercise temporarily raises AST and sometimes ALT. Do not stop medicines yourself; show the results to your doctor, and repeat testing after a few days of rest following strenuous exercise.