What is the relationship between impaired liver function and total bile acids?

Aug 06, 2025 Source: Cainiu Health

Dr. Gao Jun

Introduction

In general, impaired liver function is closely related to total bile acid levels, which are among the sensitive indicators reflecting liver function. Clinically, total bile acids are often tested in combination with other liver function parameters, such as bilirubin and albumin, to assess the degree of liver damage, determine prognosis, and play an important role in the diagnosis and monitoring of liver cirrhosis and cholestatic liver disease.

Generally, liver function impairment is closely related to total bile acid levels. Total bile acids are among the sensitive indicators reflecting liver function. Detailed analysis is as follows:

Bile acids are mainly synthesized in the liver and excreted through the biliary tract. Under normal conditions, they are efficiently reabsorbed and reused via the enterohepatic circulation, maintaining serum total bile acid levels within a low range. When hepatocytes are damaged, such as in hepatitis or cirrhosis, the liver cells' ability to take up, synthesize, and excrete bile acids declines, leading to bile acid accumulation in the blood and elevated total bile acid levels. If biliary obstruction occurs, such as due to gallstones or cholangiocarcinoma, bile excretion pathways are blocked, causing bile acids to reflux into the bloodstream, which also significantly raises total bile acid levels.

Therefore, elevated total bile acid levels may indicate hepatocyte injury or biliary excretion disorders. Its sensitivity is even higher than traditional indicators such as alanine aminotransferase, especially more easily detected in early liver damage or chronic liver diseases, such as non-alcoholic fatty liver disease.

In clinical practice, total bile acid levels are often measured together with other liver function indicators, such as bilirubin and albumin, to assess the degree of liver damage, determine prognosis, and play an important role in the diagnosis and monitoring of diseases such as cirrhosis and cholestatic liver disease.

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