Bile Acid Test

Bile acids are formed in the liver. They are crucial for the digestion and absorption of lipids, nutrients, and fats into the intestine. Waste products, including bilirubin, are removed from the body by secretion into bile and feces.

The bile test is used to diagnose jaundice, gallbladder disease, and hepatobiliary diseases such as acute hepatitis or liver cancer, etc. It analyzes your liver by measuring the bilirubin value in your blood or urine. Excess of bilirubin, obstruction, or inflammation of the liver may be the cause of liver problems. In the case of a high bilirubin range, you may suffer from jaundice or other liver-related diseases.

The bile acid test shows the bilirubin level in your blood or urine. The bile test results are usually expressed as mg/dL (milligrams of bilirubin per deciliter of blood). The high or low bilirubin levels don't indicate any specific disease but help in diagnosing the causes of liver non-functioning and blood problems etc.

In fact, higher bilirubin levels could cause severe diseases. That's why when a person suffers from any problem in the liver functioning and shows symptoms like dark urine, yellowing of skin and eyes, abdominal pain or swelling, light-colored stools, etc., he or she is advised to take the test.

In blood, the bilirubin exists in two forms. A total bilirubin blood test includes unconjugated (indirect) and conjugated (direct) bilirubin. Initially, bilirubin is unconjugated, which means that bilirubin remains attached to albumin (protein in blood that carries vitamins, enzymes, and other crucial substances to your liver). It becomes conjugated after undergoing the process of conjugation in the liver with glucuronide. This is water-soluble and excreted into the bile.

Delta bilirubin is formed when the excretion of conjugated bilirubin by the liver is impaired due to bile duct obstruction, etc. Neonatal bilirubin is common in newborns, in which total bilirubin increases, specifically due to the increase in unconjugated bilirubin. However, its level reaches normal one week after the baby's birth. Still, higher bilirubin causes fatal damage to infants and that's why newborns are often tested shortly after their birth.

The urinary bilirubin test measures levels of bilirubin in your urine.

Jaundice, hepatitis, cirrhosis, gallbladder disease, hemolytic anaemia, cholestasis of pregnancy, hepatobiliary disease.

The test is prescribed to measure blood and urine bilirubin levels. Through the test, the healthcare experts diagnose the cause of liver-related diseases, jaundice, liver cancer, pancreas damage, hepatobiliary diseases, Ampullary carcinoma etc.

The bilirubin blood tests measure bilirubin present in your blood and the urinary bilirubin test checks the presence of bilirubin in your urine.

Your doctor may suggest you get tested if you notice the below-mentioned symptoms:

• Dark urine
• Nausea
• Abdominal pain/swelling
• Clay-coloured stools
• Jaundice (yellowing of eyes and skin)
• Anaemia or low red blood cells
• Drug toxicity
• Flu-like symptoms, such as fever and chills

These symptoms aren't inclusive and may include other related symptoms connected to bilirubin abnormality or imbalance in the opinion of healthcare experts.

If the bile test report shows higher bilirubin levels in blood or urine, then your doctor may order other tests to determine the causes of the high bilirubin levels.

Once your medication starts, the doctor may ask you to take one or more of the bile tests periodically to monitor the effectiveness of your medication and treatment. If your doctor diagnosed that your liver or gallbladder isn't functioning properly, then you may order imaging tests to ensure there are no structural abnormalities.

Various newborns get jaundice, so they are often tested shortly after birth because a high bilirubin level may affect the brain, lead to deafness and cause intellectual or developmental disabilities.

Before the Test

In most cases, special preparations are not needed for an Bile Acid test. However, if you are having this blood test done along with another, your healthcare provider may advise you to avoid certain foods. It's a good idea to consult your doctor beforehand for the best possible outcomes.

During the Test

The procedure begins with a blood draw from a vein in your arm. Here's a rundown of what happens during the process:

• The insertion site is cleaned with an antiseptic solution.
• A tourniquet will be applied to your arm to make the veins more visible.
• A disposable needle is inserted into the vein to collect the blood. This may cause a brief, sharp sensation and typically takes only a few seconds.
• The collected blood is placed in a container or a small test tube labelled with your test information.

After the Test

Following the collection of the blood sample:

• An adhesive bandage will be applied to the site to stop any bleeding.
• Minor bruising may occur, but feeling dizzy is uncommon. You may be advised to rest for a few minutes.
• If you notice any bleeding, discomfort, or skin reactions at the puncture site, contact your healthcare provider.

The bile test uses one parameter, i.e. measuring the level of bilirubin present in your blood and urine.

A high range of bilirubin may damage your liver, bile ducts, gallbladder, etc. A comprehensive bilirubin blood test measures accurate levels of all three bilirubin in your blood: direct, indirect and total.

The lower level of bilirubin isn't dangerous generally; however, according to certain research, bilirubin works as an antioxidant and protects your tissues. Lower bilirubin levels might expose your body organs to damage and can cause certain fatal conditions such as Coronary artery disease, Ulcerative colitis, Brain lesions, eye diseases, strokes, etc.

Bile test reports show reference ranges that are the bilirubin normal range. Bilirubin range above the reference range may be an indication of disease.

The reference ranges for the bile acid test may vary depending on the laboratory that analyzes your blood or urine samples. According to The American Board of Internal Medicine, the normal bilirubin reference ranges for adults are mentioned below:

The normal values and reference ranges of the test may vary from lab to lab. Please refer to the ranges mentioned in the report and consult a doctor to understand the interpretation of lab reports.

As these ranges aren't universal, you must discuss your bile acid test reports with a specialist doctor or Gastroenterologist.

In a newborn, normal indirect bilirubin is under 5.2 mg/dL within the first 24 hours of birth. However, many newborns have high bilirubin levels above 5 mg/dL.

A urinary bilirubin test result indicates bilirubin positive/negative. Bilirubin positive means the presence of bilirubin in your urine and negative means the absence of bilirubin. A healthy person having a healthy liver doesn't have bilirubin in urine.

Newborns have normally higher bilirubin levels which remain higher for usually 48 hours of birth.

If your urinary bilirubin test is positive, then it indicates the presence of bilirubin in your urine. The presence of bilirubin in your urine sample given for diagnosis may indicate the following health conditions:

• liver disease such as hepatitis
• blockage in the structures that carry bile from your liver
• abnormal liver function or unhealthy liver

Bilirubin in urine tests isn't an indication of a specific disease. So if your results are abnormal, your doctor may order additional blood and urine tests. He may also order a panel test such as urinalysis, liver panel or comprehensive metabolic panel. These panels include multiple blood and urine tests that measure various enzymes, proteins and substances in the liver to diagnose liver diseases.

High bilirubin may be an indication of blood-related problems or diseases of the liver, bile ducts or gallbladder such as:

• Hepatitis
• Cirrhosis
• Gilbert's syndrome
• Biliary stricture due to which bile duct becomes narrow to allow fluid to pass
• Gallstones or gallbladder or pancreas cancer
• Drug toxicity

In infants, high bilirubin levels might cause certain serious damage such as:

• Sickle cell anaemia
• Erythroblastosis fetalis
• Deficiency of crucial proteins due to genetic defects
• Prematurity infections