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Liver Enzymes & Blood Tests
Individual blood markers measured in a standard liver panel โ what they are, why they rise, and what abnormal results mean.
Alanine Aminotransferase โ the most liver-specific enzyme. Elevated ALT is the primary signal of hepatocyte injury in fatty liver, hepatitis, and medication toxicity.
Aspartate Aminotransferase โ present in liver, muscle, and heart. The AST/ALT (De Ritis) ratio helps distinguish alcoholic liver disease from MASLD.
Alkaline Phosphatase โ elevated in bile duct obstruction (cholestasis), PBC, PSC, and bone disorders. Key for distinguishing hepatocellular from cholestatic injury patterns.
Gamma-Glutamyl Transferase โ the most sensitive (but least specific) liver enzyme. Rises early with alcohol use, fatty liver, and medications. Often the first marker to become abnormal.
The collective term for ALT, AST, ALP, and GGT โ the four key markers of liver cell damage and bile flow obstruction measured in a standard liver panel.
The breakdown product of red blood cells. Elevated total bilirubin causes jaundice (yellow skin/eyes). Direct vs. indirect bilirubin distinguishes liver disease from haemolysis.
The main protein made by the liver. Low serum albumin (hypoalbuminaemia) reflects reduced synthetic function โ an early sign of decompensated cirrhosis and poor prognosis.
The International Normalised Ratio and Prothrombin Time measure clotting factor production โ a direct test of liver synthetic function. Elevated INR signals serious liver disease.
The LFT panel โ bilirubin, albumin, PT/INR โ measures what the liver actually does, as opposed to enzymes that only signal damage. These tests assess true hepatic function.
The complete set of blood investigations in liver disease โ from enzymes and function tests to CBC, kidney markers, and metabolic panels. Everything explained together in one reference.
Disease & Conditions
The spectrum of chronic liver disease โ from early fat accumulation through to inflammation, fibrosis, and cirrhosis.
Fat accumulation in liver cells (steatosis) affecting ~25% of adults globally. Ranges from benign fat to MASH, advanced fibrosis, and cirrhosis. Now called MASLD under the 2023 nomenclature.
Metabolic-Associated Steatotic Liver Disease โ the 2023 replacement for NAFLD. Requires fat on imaging plus at least one cardiometabolic risk factor. Removes the exclusive alcohol threshold of NAFLD.
Non-Alcoholic Fatty Liver Disease โ the former name for metabolic fatty liver, officially replaced by MASLD in 2023. Still widely used in older research and clinical settings worldwide.
Non-Alcoholic (now: Metabolic) Steatohepatitis โ fatty liver with inflammation and hepatocyte ballooning. NASH/MASH carries significant risk of progression to advanced fibrosis and cirrhosis.
The clinical term for fat accumulation in liver cells. Graded S0โS3 on ultrasound and CAP. Detected by ultrasound, CT, MRI-PDFF, or CAP on FibroScan. Reversible with metabolic intervention.
End-stage liver scarring replacing normal tissue with fibrous bands. Classified as compensated or decompensated. Monitored with MELD score, Child-Pugh class, and HCC surveillance. Prevents normal liver function.
Progressive scarring of liver tissue, staged F0 (none) to F4 (cirrhosis). Significant fibrosis is F2+. Detected by FIB-4, FibroScan, and MRE. Key determinant of prognosis in chronic liver disease.
Fibrosis Scoring & Clinical Calculators
Non-invasive scores that combine blood markers and imaging values to stage liver fibrosis and guide clinical decisions โ without a biopsy.
The FIB-4 Index uses age, AST, ALT, and platelets to screen for significant liver fibrosis. A score <1.30 rules out significant fibrosis; >2.67 warrants specialist referral. First-line tool in MASLD guidelines.
FibroScan-enhanced scoring systems that combine LSM (liver stiffness), AST, platelets, age, sex, and diabetes status. AGILE 3+ detects advanced fibrosis (F3+); AGILE 4 detects cirrhosis (F4). Far more accurate than FIB-4 alone.
The Model for End-Stage Liver Disease uses creatinine, bilirubin, INR, and sodium to predict 90-day mortality and prioritise transplant allocation. MELD 3.0 now includes sex as a variable for equity.
Calculate 9 fibrosis and steatosis scores simultaneously โ FLI, FIB-4, NFS, APRI, SAFE, FNI, AGILE 3+, AGILE 4, and LSM โ in a single entry. Includes MASLD risk classification with detailed clinical interpretation.
FibroSure is a commercially available blood-based fibrosis panel that estimates fibrosis stage. Learn how it compares to FibroScan (VCTE) and FIB-4 โ and which patients should use each approach.
Elastography & FibroScan
Non-invasive techniques that measure liver stiffness to stage fibrosis โ from FibroScan in the clinic to MRE in the MRI suite.
The family of techniques that measure liver stiffness as a surrogate for fibrosis โ including VCTE (FibroScan), pSWE, 2D-SWE, and MRE. Learn the principles, comparisons, and which method fits each clinical scenario.
The most widely used non-invasive fibrosis test. A probe sends shear waves into the liver; stiffness (kPa) is measured and mapped to fibrosis stages. M and XL probes for different body types. Takes ~10 minutes, no needles.
Vibration-Controlled Transient Elastography โ the specific ultrasound technique used in FibroScan. Understanding how VCTE works helps interpret your LSM (liver stiffness measurement) result and its quality criteria (IQR/median).
Controlled Attenuation Parameter โ FibroScan's fat measurement, reported in dB/m. CAP correlates with steatosis grade (S0โS3). Measured simultaneously with LSM. Key metric for fatty liver quantification.
Point and 2D Shear Wave Elastography โ ultrasound-based alternatives to FibroScan built into standard ultrasound machines. Available at more centres, no dedicated equipment required. Comparable accuracy to VCTE.
Magnetic Resonance Elastography โ the most accurate non-invasive fibrosis test (AUC ~0.90+). Measures liver stiffness across the entire organ using MRI. Gold standard for research and complex diagnostic cases.
Proton Density Fat Fraction โ MRI-based gold-standard quantification of liver fat (%). More accurate than ultrasound or CAP. Used in clinical trials and complex MASLD staging. Often performed alongside MRE.
Liver Imaging & Diagnosis
How ultrasound, MRI, CT, and other imaging modalities are used to detect, grade, and monitor liver disease โ and what the reports mean.
The most common first-line imaging for liver disease. Ultrasound detects fatty infiltration (bright liver), enlarged spleen, portal hypertension, nodules, and ascites. Graded mild/moderate/severe for steatosis.
Magnetic Resonance Imaging offers superior soft-tissue characterisation of the liver. Used for fat quantification (PDFF), fibrosis staging (MRE), HCC diagnosis (LI-RADS), and lesion characterisation without radiation.
An overview of all imaging modalities used in liver disease: abdominal ultrasound, CT, MRI, elastography (FibroScan, MRE), nuclear medicine, and endoscopy. How to interpret imaging reports and what to ask your doctor.
The full diagnostic pathway from abnormal LFTs to confirmed diagnosis โ combining blood tests, imaging, elastography, and (where needed) biopsy. Understanding where you are in the diagnostic process and what comes next.
Guides, Books & Tools
Every in-depth resource on LiverDecoded โ free guides, comprehensive ebooks, and interactive calculators โ in one place.
LiverDecoded Guide Hub
All free guides on liver enzymes, imaging, elastography, fibrosis scores, and metabolic health โ in one place.
A Complete Guide to Liver Blood Tests
8 chapters, 136+ pages. Every blood test in liver disease explained โ ALT to MELD, FIB-4 to FibroSure. AASLD/EASL 2024 guidelines.
A Complete Guide to Liver Imaging & Diagnosis
10 chapters, 180+ pages. FibroScan, MRE, ultrasound, CT, MRI, HCC surveillance, and a 72-hour post-diagnosis action plan.
Comprehensive Liver Risk Calculator
Enter your labs once โ get FLI, FIB-4, NFS, APRI, SAFE, AGILE 3+, AGILE 4, and more. Instant MASLD risk classification.
FIB-4 Score Calculator & Guide
Understand what your FIB-4 result means, how it's used in MASLD guidelines, and when further testing is needed.
AGILE 3+ & AGILE 4 Calculators
FibroScan-based scores for detecting advanced fibrosis and cirrhosis. Combine your LSM with blood results for more accurate staging.
MELD / MELD-Na / MELD 3.0 Calculator
All three MELD variants in one calculator. Understand what your score means for prognosis and transplant prioritisation.
Liver Health Book Series
Browse all LiverDecoded ebooks and see all content tagged under the Liver Books collection.
Report Explainer & Second Opinion
Upload your labs for a personalised breakdown, or connect with a hepatologist for expert review of complex cases.