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A Complete Guide to Liver Blood Tests

You’ve Been Handed Test Results You Don’t Understand

Your doctor says your liver enzymes are “a little elevated.” Or maybe you’ve been diagnosed with fatty liver disease, MASLD, or even cirrhosis. You’re handed lab reports filled with abbreviations, ALT, AST, GGT, FIB-4, MELD, and told to “keep an eye on things.”

But what do these numbers actually mean? When should you worry? What’s the difference between a liver enzyme and a liver function test? And why does your doctor keep checking your kidneys when it’s your liver that’s the problem?

This book answers all of that in plain language.

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What’s Inside

8 Comprehensive Chapters Covering Every Test That Matters

Chapter	What You’ll Learn
1. Liver Enzymes	AST, ALT, ALP, GGT: what they measure, why they rise, and what patterns reveal about your liver
2. True Liver Function Tests	Bilirubin, albumin, PT/INR: the tests that show how well your liver actually works
3. Blood Count (CBC) Findings	Why low platelets matter, what your hemoglobin reveals, and warning signs on a simple blood test
4. Kidney Tests & Electrolytes	The critical liver-kidney connection, and why sodium levels predict survival
5. Metabolic Health Markers	Insulin resistance, cholesterol, blood sugar, uric acid: the metabolic drivers of liver disease
6. Liver Cancer Biomarkers	AFP, AFP-L3, PIVKA-II, and newer tests for early detection of hepatocellular carcinoma
7. Disease-Specific Tests	Hepatitis B & C panels, autoimmune markers, iron overload, Wilson disease, and more
8. Prognostic Scores & Calculators	MELD, Child-Pugh, FIB-4, NAFLD Fibrosis Score, ELF, Agile scores: what they mean for your prognosis

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Who This Book Is For

✅ Patients newly diagnosed with fatty liver disease (MASLD/NAFLD)
✅ People with chronic liver disease trying to understand their labs
✅ Cirrhosis patients monitoring for complications
✅ Caregivers and family members supporting someone with liver disease
✅ Primary care clinicians wanting a comprehensive reference
✅ Anyone tired of Googling lab values and getting confused

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What Makes This Book Different

Scientifically Rigorous

Every chapter is backed by peer-reviewed research and current guidelines (AASLD, EASL, Baveno VII: all updated through 2024-2025).

Written in Two Layers

• Technical explanations for those who want the details
• “Understanding in Simple Terms” sections that translate medical jargon into plain English

Clinically Practical

Not just what tests measure, but what to do when they’re abnormal, including when to worry and when not to.

Covers Scoring Systems

Finally understand what your FIB-4 score, MELD score, or Child-Pugh class actually means for your health and prognosis.

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Sample Topics Covered

From Chapter 1: Liver Enzymes

• Why the ALT/AST ratio matters (and what it reveals about alcohol vs. fatty liver)
• The “optimized” ALT cutoffs that catch disease earlier
• When GGT elevation is concerning vs. benign

From Chapter 4: Kidney Tests in Liver Disease

• Why creatinine is misleading in cirrhosis patients
• The hepatorenal syndrome explained simply
• What low sodium really means for your prognosis

From Chapter 8: Prognostic Scores

• FIB-4: The free screening test every fatty liver patient should know
• MELD 3.0: How the transplant priority score now accounts for sex differences
• When to trust these scores and when they fail

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Detailed Table of Contents

Chapter 1: Liver Enzymes Explained

• ALT (SGPT): the most liver-specific enzyme
• AST (SGOT): why it’s found in more than just your liver
• The De Ritis Ratio (AST/ALT): what patterns mean
• GGT: the sensitive but non-specific marker
• ALP: distinguishing liver from bone

Chapter 2: Liver Function Tests

• Bilirubin: direct, indirect or conjugated, and why jaundice happens
• Albumin: what low levels really indicate
• PT/INR: measuring your liver’s clotting factor production

Chapter 3: CBC Findings in Liver Disease

• Platelets: the earliest warning sign of portal hypertension
• Hemoglobin and anemia patterns in cirrhosis
• The Neutrophil-to-Lymphocyte Ratio (NLR): simple prognostic marker
• Red Cell Distribution Width (RDW): an underappreciated predictor
• Spur cell anemia: a grave sign on peripheral smear

Chapter 4: Kidney Tests & Electrolytes

• Why kidneys fail when livers fail
• Creatinine’s limitations in cirrhosis
• Cystatin C: the better kidney marker
• Hyponatremia: the most important electrolyte in liver disease
• ICA-AKI criteria: the new definition of kidney injury in cirrhosis
• Hepatorenal syndrome explained

Chapter 5: Metabolic & Cardiometabolic Markers

• HOMA-IR: measuring insulin resistance
• Fasting glucose and HbA1c interpretation
• Lipid panels and the “atherogenic dyslipidemia” of MASLD
• Statins are SAFE in liver disease (the evidence)
• Ammonia and hepatic encephalopathy
• Uric acid, ferritin, vitamin D, thyroid function
• Emerging biomarkers: CK-18, FGF-21, Pro-C3

Chapter 6: Liver Cancer Biomarkers

• AFP: strengths and limitations
• AFP-L3: the cancer-specific fraction
• DCP/PIVKA-II: a complementary marker
• The GALAD score: combining biomarkers for better detection
• Liquid biopsy and circulating tumor DNA

Chapter 7: Disease-Specific Tests

• Hepatitis B: interpretation guide for HBsAg, anti-HBs, anti-HBc, HBV DNA tests
• Hepatitis C: Antibody vs. RNA testing, treatment monitoring
• Autoimmune hepatitis: ANA, SMA, anti-LKM1, IgG levels
• PBC and PSC: AMA, p-ANCA
• Hemochromatosis: Ferritin, transferrin saturation, HFE gene testing
• Wilson disease: Ceruloplasmin, 24-hour urine copper
• Alpha-1 antitrypsin deficiency

Chapter 8: Prognostic Scores & Calculators

• MELD, MELD-Na, MELD 3.0: transplant allocation and mortality prediction
• Child-Pugh Score: the classic cirrhosis staging system
• CLIF-C ACLF: for acute-on-chronic liver failure
• FIB-4 Index: the essential fibrosis screening tool
• NAFLD Fibrosis Score: designed for fatty liver
• APRI: simple but limited
• ELF Score: the blood-based fibrosis panel
• FibroTest/FibroSure
• SAFE Score: the new 2023 tool
• MEFIB: combining MRE with FIB-4
• Agile 3+ and Agile 4: FibroScan-based scores
• ALBI Score: for hepatocellular carcinoma
• VOCAL-Penn: surgical risk in cirrhotics
• Liver Frailty Index

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Frequently Asked Questions

Q: Is this book too technical for a non-medical person?
A: No. Every section includes “Understanding in Simple Terms” explanations written specifically for patients. The technical detail is there if you want it, but you don’t need a medical degree to benefit from this book.

Q: Is the information current?
A: Yes. This book reflects guidelines and research through 2024-2025, including the latest AASLD, EASL, and Baveno VII recommendations.

Q: I have fatty liver but no symptoms. Is this book relevant to me?
A: Absolutely. Understanding your lab tests early, before symptoms develop, is exactly how you stay ahead of liver disease progression.

Q: Will this replace my doctor’s advice?
A: No, and it’s not meant to. This book helps you understand your test results so you can have more informed conversations with your healthcare team.

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About the Series

A Complete Guide to Liver Blood Tests is Book 1 of the Liver Health Series.

Book	Title	Status
Book 1	A Complete Guide to Liver Blood Tests (This book)	✅ Available
Book 2	A Complete Guide to Liver Imaging & Diagnosis	✅ Available

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How the Books Work Together

Book 1: “Your tests are abnormal: what do these numbers mean?”
↓
Book 2: “Now what? What scans do you need? What does diagnosis mean?”

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