Which medical professionals can diagnose and treat liver abnormalities?
- General practitioners (GPs or primary care physicians)
- Internal medicine specialists (Internists)
- Gastroenterologists (specialists in digestive disorders, organs and the liver)
- Hepatologists (specialists in the liver, biliary tree, gallbladder and the pancreas)
Specific causes of liver disease may need the involvement of other medical professionals such as infectious disease specialists, oncologists, critical care specialists, surgeons, haematologists and emergency medicine specialists.
The general diagnostic procedure will follow the below steps:
1. Detailed medical history
A doctor will discuss in detail the nature of all obvious symptoms, their level of severity, the length of time they have been experienced and also note a complete medical history to date. A doctor will also wish to assess necessary family history details to assess any signs of genetic influences. Honesty during this evaluation is important as it may reveal potential underlying causes, such as long-term alcoholism, use of IV (intravenously administered) drugs, a family history of autoimmune conditions, or perhaps exposure to hepatitis C infections.
2. Physical examination
During a physical examination, a doctor will look for obvious physical signs of impaired liver function – pale skin, jaundice, red palms, impaired or decreased alertness, excess breast tissue (in men), small or enlarged testicles, hand tremors, or an enlarged liver or spleen. An enlarged liver can often be felt along the lower edge of the right rib cage (this will feel firmer and more irregular). The tip of an enlarged spleen can sometimes be felt just below the left rib cage.
3. Laboratory tests
A doctor will then wish to assess potential damage to the liver, as well as just how extensive scarring may be. The best means of determining this is through testing. Options include:
- Liver function (blood tests): A blood sample will be taken for assessment of any enzymes indicating damage as well as to check for the presence of excess bilirubin.
- Kidney function (blood tests): Another blood sample will assess creatinine levels (a waste product which will help to determine normal or abnormal function of the kidneys). During the latter stages of cirrhosis, the kidneys begin to experience loss of function as well.
- Other blood tests: Samples will be used to screen for hepatitis infections (mainly B and C), check blood clotting functionality (coagulation), a complete blood count / CBC (including an assessment of associated anaemia), and the measurement of albumin levels (this can also be tested in urine), which may be reduced when the liver is damaged. Samples will also be used to evaluate abnormal elevations of ALT and AST liver enzymes which may suggest damage and inflammation, possibly elevated levels of iron and the presence of auto-antibodies (anti-smooth muscle antibody, anti-nuclear antibody and anti-mitochondrial antibody).
- Imaging tests: Non-invasive medical imaging techniques such as magnetic resonance elastography (MRE) can help to measure the mechanical properties of soft tissues (stiffness), or transient elastography (FibroScan) which helps to quantify liver fibrosis (scarring). An MRI (magnetic resonance imaging), CT scan (computerised tomography) or ultrasound can also be used to create details images of the liver for diagnosis, picking up abnormalities (scarring) on or within the organ.
- Liver biopsy: In order to determine the extent, cause and severity of damage to the liver (fibrosis), a doctor may recommend a liver biopsy (tissue extraction for laboratory assessment). A biopsy is the best way to determine cirrhosis (this is regarded as a definitive test). A biopsy does carry a degree of risk and is thus often reserved for when the type of liver disease or severity of cirrhosis is not entirely clear by any other means.
- Laparoscope: A tiny camera at the end of a long, thin tube is inserted through a small incision made in the abdomen to view the liver directly. Visual images will be assessed on a monitor which is linked to the camera. An upper endoscopy can also be used to check for oesophageal varices.
- Liver cancer screening: This can involve the picking up of hepatocellular carcinoma (during a CT, MRI or ultrasound scan) or an alpha fetoprotein blood test (could indicate elevation of tumour markers).
Other tests which may be recommended likely relate to signs of a potentially underlying condition causing cirrhosis. The presence of complications may very well point a doctor in this direction to determine the root cause of liver damage and make an appropriate diagnosis accordingly.
If cirrhosis of the liver is determined, it is likely that a doctor will recommend regular consultations and tests to monitor the extent of the condition, signs and symptoms and also keep a watchful eye on disease progression. This is important so as to avoid worsening of the condition (i.e. development of complications, such as liver cancer).