Liver Disease (cont.)

Often, the onset of a liver disease is gradual and there is no specific symptom that brings the affected individual to seek medical care. Fatigue, weakness and weight loss that cannot be explained should prompt a visit for medical evaluation.

Jaundice or yellow skin is never normal and should prompt an evaluation by a medical professional.

Persisting fever, vomiting, and abdominal pain should also prompt medical evaluation as soon as possible.

Acetaminophen or Tylenol overdose, whether accidental or intentional, can cause acute liver failure. Emergent evaluation and treatment is required. Antidotes to protect the liver can be provided, but are effective only when used within a few hours. Without this intervention, acetaminophen overdose can lead to liver failure and the need for liver transplant.

The precise diagnosis of liver disease involves a history and physical examination performed by the health care professional. Understanding the symptoms and the patient's risk factors for liver disease will help guide any diagnostic tests that may be considered.

Sometimes history is difficult, especially in patients who abuse alcohol. These patients tend to minimize their consumption, and it is often family members who are able to provide the correct information.

Liver disease can have physical findings that affect almost all body systems including the heart, lungs, abdomen, skin, brain and cognitive function, and other parts of the nervous system. The physical examination often requires evaluation of the entire body.

Blood tests are helpful in assessing liver inflammation and function.

Specific liver function blood tests include:

• AST and ALT ( transaminase chemicals released with liver cell inflammation);
• GGT and alkaline phosphatase (chemicals released by cells lining the bile ducts);
• bilirubin; and
• protein and albumin levels.

Other blood tests may be considered, including the following:

• complete blood count (CBC), patients with end stage liver disease may have bone marrow suppression and low red blood cells, white blood cells and platelets. As a result, patients with cirrhosis may have bleeding;
• INR blood clotting function may be impaired due to poor protein production and is a sensitive measure of liver function;
• lipase to check for pancreas inflammation;
• electrolytes, BUN and creatinine to assess kidney function; and
• ammonia blood level assessment is helpful in patients with mental confusion.

Imaging studies may be used to visualize, not only the liver, but other nearby organs that may be diseased. Examples of imaging studies include:

• CT scan (computerized axial tomography),
• MRI (magnetic resonance imaging), and
• ultrasound (sound wave imaging, which is especially helpful in assessing the gallbladder and bile ducts.

Liver biopsy may be considered to confirm a specific diagnosis of liver disease. Under local anesthetic, a long thin needle is inserted through the chest wall into the liver, where a small sample of liver tissue is obtained for examination under a microscope.

Source: MedicineNet.com
http://www.medicinenet.com/liver_disease/article.htm