Question

How diagnose for liver problem?

Answer 1

The liver has an important role in body’s metabolism. According to the World Gastroenterology Organisation, deaths from liver cirrhosis is expected to become the 12th leading cause of death in 2020. The common liver conditions are cirrhosis, overuse of medications can adversely affect liver function, alcohol abuse, hepatitis, EBV, fatty liver and hemochromatosis. The main symptoms of liver disorders are weakness and fatigue, weight loss, nausea, vomiting, and jaundice.

Many diagnostic tests have been used to assess liver function and diagnose disease conditions besides the physical examination and symptoms.

1.Liver function tests

It is a group of blood tests that can help to diagnose liver disease or damage, and also monitor the response to treatment. This test assesses the performance or normal liver function.

Common liver function tests include:

Alanine transaminase (ALT) and Aspartate aminotransferase (AST) The liver releases this enzyme when damaged. Reference values are AST between 10 to 40 units per litre and ALT between 7 to 56 units per litre.

Albumin: assess the ability of the liver to assess in producing albumin.

Bilirubin: Estimates bilirubin clearance

Tests for hepatitis

Hepatitis A IgM antibody: Positive value indicates current or recent infection.

Hepatitis A IgG antibody: Presence of hepatitis A IgM antibody indicates past infection with hepatitis A and immunity from vaccination.

Hepatitis B surface (s) antigen: If positive, hepatitis B infection.

Hepatitis B early (e) antigen: It is a marker of active infection.

Hepatitis B early (e) antibody:            This will be present when the e-antigen is no longer present.

Hepatitis B core IgM antibody: indicates recent rather than chronic infection.

Hepatitis B core IgG antibody: found in people infected with hepatitis B.

Hepatitis B surface (s) antibody indicates immunity to hepatitis B.

Hepatitis C antibody: either current or recent infection, but the test can be negative in early infection.

Hepatitis C PCR: positive result indicates the current infection.

3. Liver biopsy
A thin needle is inserted into the liver to remove a minute portion of the liver tissue for histopathological examinations. Liver biopsy is done mainly in case of chronic hepatitis, metabolic liver diseases like Wilson’s disease, haemochromatosis or cancer.

Liver biopsies are usually recommended only after blood tests and imaging tests have failed to provide the necessary information.

4. Imaging tests

a. Ultrasound
- Ultrasound

- Doppler ultrasound

These are non-invasive, widely available imaging test and can provide information about anatomy and physiology of liver.

b. FibroScanR or Transient elastography
It is non-invasive technique and uses a modified ultrasound probe to measure the stiffness or fibrosis (the first stage of liver scarring).

c. CT and MRI scans
Computerised axial tomography (CT) and magnetic resonance imaging (MRI) are mainly used in advanced cases of liver disease.