Doctors diagnose liver disease by conducting a thorough physical exam, discussing the person’s symptoms, taking down the patient’s medical history, conducting blood tests, x-rays, MRIs, CT scans, ultrasounds, and sometimes even biopsies.
Medical professionals typically do not discover liver disease through routine medical checkups, but they can detect signs of it in blood tests. When a blood test comes back with the liver enzymes aminotransferases—specifically aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT)—present in the sample, doctors know there is damage to the liver. They know this because these enzymes are normally contained inside of liver cells, and if there is damage to the liver, then those cells spill into the bloodstream, where they should not be. This signals to the doctor that there is a problem.
After considering the results of the blood tests, the doctor may order more, or move onto the next step in diagnosis: x-rays. Physicians take x-rays to see if there are any abnormalities in the abdominal cavity, and to assess the patient’s condition.
Next come ultrasounds. These pictures show what the patient’s liver looks like, as well as the surrounding organs. Doctors look to see if the patient has an enlarged liver or spleen, and if there are any masses that should not be there, indicating possible tumors.
Doctors take liver scans with radiotagged substances to see the liver’s structure in detail, so they can see if the organ has changed or looks abnormal.
An ERCP—endoscopic retrograde cholangiopancreatography—procedure utilizes a thin tube, an endoscope, to look at the structures in and near the liver. This gives doctors more information about the tissue of the liver and nearby organs.
CT scans and MRIs of the abdomen tell specialists about the presence and extent of scar tissue, the stage of disease present, and how much the liver is functioning.
If all of the other tests prove to be inconclusive, physicians will take a biopsy of the liver tissue. This is a surgical procedure where a doctor removes a small piece of the liver tissue and examines it closely under a microscope. A doctor may take such a biopsy at the time of diagnosis and then periodically repeat the procedure to check the condition of the liver in response to treatment or to monitor the progress of the damage.
What patients do after diagnosis largely depends on what type of disease is afflicting the liver, what the patient’s overall health condition as well as the liver’s condition are, and how far along the disease has progressed. In some cases, doctors may prescribe medications—such as in those of hepatitis B, C, and D—with antivirals. For those with cirrhosis, vitamin and mineral supplements may be necessary, and in the most severe of liver disease patients, a liver transplant may be the only way to prolong the patient’s life.
In some cases of the final stages of liver failure, biopsy and surgery are not reasonable, and hospital staff can only try to make the patient comfortable by trying to drain their ascites and administering blood pressure and pain medication