Materiały źródłowe

• #1 Liver disease tests, diagnosis and screening – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/tests-diagnosis-and-screening/

  There are over 100 types of liver disease, which affect around two million people in the UK. The actual figure may be much higher, as many cases of liver disease go undiagnosed. […] If your GP suspects you have a liver problem, they may suggest a routine blood test to: Assess how well your kidneys and liver are working. […] If liver disease is suspected, more specific blood samples may be needed to test for viruses and antibodies common to disorders of the liver. […] The British Liver Trust does not recommend home liver tests offered by private companies. The results of these tests do not provide a comprehensive assessment for determining the presence of liver disease. If you have concerns about your liver health, we recommend that you consult your GP. They will conduct a range of tests, consider your medical history, and integrate all the results to make an informed decision about the necessity of additional tests or potential treatment.

• #2 Liver Disease: Signs & Symptoms, Causes, Stages, Treatment

  https://my.clevelandclinic.org/health/diseases/17179-liver-disease

  Some types of liver diseases have specific medical treatments. For example, antivirals treat viral hepatitis, while corticosteroids and immunosuppressants treat autoimmune diseases. […] However, early recognition is key to treating liver disease effectively before permanent damage is done. […] Liver disease can be reversed in the early stages if you and your healthcare team are able to remove or manage the cause effectively. […] Many types of liver disease are curable. Toxic and alcohol-related liver disease can improve when youre no longer exposed to the toxin.

• #3 The Importance of Early Detection and Diagnosis in Chronic Liver Disease- Dr. Vikrant Kale

  https://www.drkalegastroclinic.com/the-importance-of-early-detection-and-diagnosis-in-chronic-liver-disease/

  Chronic liver disease (CLD) is a silent epidemic that affects millions worldwide, with its prevalence steadily rising. […] In this blog, we delve into the importance of early detection and diagnosis in combating CLD and mitigating its impact on individuals and society. […] Early detection acts as a cornerstone in the management of CLD. Detecting the condition in its infancy offers several significant advantages: […] Recognizing chronic liver disease in its nascent stages allows for timely interventions to stop or slow its progression. […] Early diagnosis unlocks a more comprehensive array of treatment choices, many of which are more effective in the early stages of the disease. […] By intervening early, healthcare providers can help patients manage signs more effectively, thereby improving their quality of life. […] CLD complications, such as portal hypertension and liver failure, can be controlled or minimized with early intervention. […] Detecting chronic liver disease early can lead to significant cost savings by preventing expensive medical interventions associated with advanced liver conditions, such as liver transplantation or prolonged hospitalizations.

• #4 The Stages of Liver Disease – American Liver Foundation

  https://liverfoundation.org/about-your-liver/how-liver-diseases-progress/

  Diagnosing Liver Disease […] Early diagnosis may prevent damage from occurring in your liver. […] Many people with liver disease do not look or feel sick even though damage is happening to their liver. […] At a certain point in the progression of liver disease damage can become irreversible and lead to liver failure, liver cancer, or death. […] Persistent inflammation, or hepatitis, sends nonstop signals to repair cells to continue depositing collagen. […] This is how fibrosis develops. […] Cirrhosis is where your liver is severely scarred and permanently damaged. […] Liver transplantation is a surgical procedure performed to remove a diseased or injured liver from one person and replace it with a whole or a portion of a healthy liver from another person, called the donor. […] Be an active member of your care team by regularly visiting your healthcare provider, undergoing routine surveillance when needed, making the most of your appointments by asking questions and learning more about your health.

• #5 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Liver-disease-diagnosis.aspx

  Diagnosis of liver disease is based on initial history and physical examination. […] This makes diagnosis difficult and often there are a battery of tests that need to be performed in order to correctly diagnose the underlying cause for the disease. […] There are three main types of test that are performed in liver disease diagnosis: laboratory tests, radiological studies and biopsies. […] Certain blood tests that may provide confirmatory findings. […] Blood virological examinations are advised in viral hepatitis. […] Imaging and radiographical studies are used to detect and confirm liver diseases. […] This procedure involves using a long thin needle to aspirate bits of tissues of the liver under a local anesthetic agent. […] This is used to confirm the diagnosis.

• #6 Liver Disease: Signs & Symptoms, Causes, Stages, Treatment

  https://my.clevelandclinic.org/health/diseases/17179-liver-disease

  When healthcare providers refer to liver disease, theyre usually referring to chronic conditions that do progressive damage to your liver over time. […] A healthcare provider checking for liver disease will begin by physically examining you. Theyll look for visible signs and ask about your symptoms. They may also ask about your diet, lifestyle and health history. Finally, theyll use lab tests and imaging scans to check for liver disease. These may include: […] A panel of liver function tests can show signs of liver disease, liver disease severity and liver failure. These measure liver products like liver enzymes, proteins and bilirubin levels in your blood. […] A liver biopsy is a minor procedure to take a small tissue sample from your liver to test in a lab. A healthcare provider can usually take the sample through a hollow needle. You might need a liver biopsy to check for cancer or confirm cirrhosis and help determine the cause.

• #7 How to Diagnose Cirrhosis – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/background/how-to-diagnose.asp

  Identifying the presence of cirrhosis is essential in any patient with chronic liver disease. Making the diagnosis of cirrhosis will affect management and follow-up. […] Cirrhosis should be investigated in patients with chronic (6 months in duration) abnormalities in liver enzymes and/or in patients in whom risk factors for cirrhosis are present: alcohol use disorder, hepatitis C, hepatitis B, obesity, and metabolic syndrome (even in the absence of liver enzyme abnormalities). […] The diagnosis of decompensated cirrhosis is usually easy and straightforward. However, for compensated cirrhosis, a combination of clinical judgement, laboratory tests (e.g. FIB-4, imaging finding) should be used. Finally, elastography is the best non-invasive assessment of fibrosis. […] Transient elastography (Fibroscan) is a point-of-care method to measure liver stiffness (LS). Most reliable non-invasive test for diagnosis of suspected cirrhosis. Most useful for excluding cirrhosis.

• #8 Diagnosing Liver Disease: Biopsy, Risks & Preparation

  https://liverfoundation.org/liver-diseases/diagnosing-liver-disease/

  Diagnosing Liver Disease […] A liver biopsy is a medical procedure used to remove a small piece of liver tissue so doctors can examine the liver’s condition. […] When other tests indicate that your liver may not be working properly, your doctor may want to do a liver biopsy to more accurately learn the condition of your liver. […] A liver biopsy is an accurate way to learn the condition of your liver. A liver biopsy helps: diagnose liver disease and the stage it is in; detect cancer and infections; and provide reasons for liver swelling or abnormal levels of liver enzymes. […] Liver function tests help your doctor check your liver’s health and detect liver damage. These blood tests measure the levels of certain proteins and enzymes in your blood. […] Liver function tests may be done for many reasons. Some doctors perform these tests as part of a regular checkup. Other doctors may use liver function tests to screen patients who are at risk for liver disease. Doctors also use them to monitor a person’s liver disease and to check if treatment is working.

• #9 Liver Function Tests: Types, Purpose & Results Interpretation

  https://my.clevelandclinic.org/health/diagnostics/17662-liver-function-tests

  Liver function tests are blood tests that measure different substances produced by your liver, including proteins, enzymes and bilirubin. High or low levels of different substances can indicate different diseases. […] Liver function tests are blood tests that measure different substances produced by your liver. These measurements give your healthcare provider important information about the overall health of your liver and how well its working. […] Your healthcare provider might want to check these values to screen you for possible hepatitis or other liver diseases. If they already know that you have liver disease, they might want to check how its progressing or whether a treatment is working. […] Different values and ratios of different substances may tell your healthcare provider: If you have liver inflammation (hepatitis). Whether the inflammation is alcohol-related or nonalcoholic (metabolic). Whether you have a problem in your liver itself or in your bile ducts. If your liver function is impaired, and if so, how much. If your bile flow is impaired, and if so, how much. Whether your medications are affecting your liver, and if so, how much.

• #10 Liver Function Tests for Chronic Liver Disease | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/liver-kidneys-and-urinary-system/chronic-liver-disease/diagnosis/liver-function-tests.html

  A series of special blood tests can often determine whether or not the liver is functioning properly. These tests can also distinguish between acute and chronic liver disorders and between hepatitis and cholestasis. […] The most commonly performed blood tests include the following: […] Serum albumin test: This test is used to measure the level of albumin (a protein in the blood) and aides in the diagnosis of liver disease. […] Prothrombin time (PTT) test: The prothrombin time test measures how long it takes for blood to clot. Blood clotting requires vitamin K and a protein that is made by the liver. Prolonged clotting may indicate liver disease or other deficiencies in specific clotting factors. […] Alanine transaminase (ALT) test: This test measures the level of alanine aminotransferase (an enzyme found predominantly in the liver) that is released into the bloodstream after acute liver cell damage. This test may be performed to assess liver function, and/or to evaluate treatment of acute liver disease, such as hepatitis.

• #11 Clinical presentation of alcoholic liver disease and non-alcoholic fatty liver disease: spectrum and diagnosis – Sharma – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5544/html

  Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are commonest causes of chronic liver disease in developing as well as developed countries. […] Most of the time there is significant overlap between these diseases and clinical presentation depends upon the stage of liver disease. […] ALD requires significant history of alcohol intake which is supportive by radiological and biochemical tests. […] Liver biopsy is required for diagnosis of NASH as it is a histological diagnosis and sometimes in alcoholic hepatitis for confirmation if diagnosis is in doubt. […] No single laboratory or imaging study can confirm the diagnosis of ALD. […] In outpatient or inpatient department a diagnosis of ALD should be suspected in patients with a significant alcohol abuse who present with abnormal serum transaminases, level of aspartate aminotransferase (AST) which is greater than that of alanine aminotransferase (ALT), clinical finding of hepatomegaly with signs of chronic liver disease, and radiological evidence of liver steatosis or fibrosis/cirrhosis.

• #12 Clinical presentation of alcoholic liver disease and non-alcoholic fatty liver disease: spectrum and diagnosis – Sharma – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5544/html

  However, the pattern of elevation is helpful in making a diagnosis of liver injury due to alcohol as AST is typically two to three times greater than ALT in these patients. […] When the diagnosis is unclear, a liver biopsy may be considered to exclude other causes of liver disease. […] Liver biopsy is not necessary for the diagnosis of ALD except when other concomitant diseases are associated like viral disease or NAFLD or diagnosis in doubt due to unreliable history and laboratory findings. […] The diagnosis of AH can be made with good sensitivity and specificity thorough good reliable history, physical examination, and laboratory results. […] Liver biopsy is confirmatory if diagnosis is in doubt, but generally not required in day to day management of these patients. […] Diagnosis of ALD requires good reliable history of significant alcohol abuse and excluding other causes of liver disease. […] NAFLD is diagnosed based on clinical history, laboratory and radiological tests and confirmed on histological biopsy findings. […] However liver biopsy is needed in differentiating NASH from simple steatosis as NASH is a diagnosis based on histology.

• #13 Physicians over-relying on a commonly used laboratory test can miss liver cirrhosis | MUSC | Charleston, SC

  https://web.musc.edu/about/news-center/2021/12/17/alcoholic-cirrhosis

  A recent study at the Medical University of South Carolinas (MUSC) Digestive Disease Research Core Center (DDRCC) provides insight into why physicians should be cautious when using a certain liver function test to diagnose alcoholic cirrhosis. […] A common method to diagnose patients with alcoholic cirrhosis is to look for elevated levels of enzymes known as aminotransferases in the liver. However, the MUSC study, published in The American Journal of Medical Sciences, found that patients with alcoholic cirrhosis have nearly normal levels of aminotransferases. […] The study’s findings are important because physicians who rely only on these tests can fail to diagnose alcoholic cirrhosis, said MUSC Health gastroenterologist and DDRCC director Don Rockey, M.D., who led the study. […] Often, patients may show subtle signs and symptoms in the early stages of alcoholic cirrhosis. However, if physicians look only at the laboratory results and not the patient, they are going to be faked out, said Rockey.

• #14 Diagnosis of Cirrhosis – NIDDK

  https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/diagnosis

  If your doctor suspects that you have cirrhosis, they may make a diagnosis based on your medical history, a physical exam, and the results of blood tests and imaging tests. […] Your doctor can use blood tests to tell how serious cirrhosis is. […] Based on the blood test results, your doctor may be able to diagnose certain causes of cirrhosis. […] Imaging tests can show the size, shape, and texture of the liver and show how much fat is in the liver. […] Your doctor may perform a liver biopsy to see how much scarring is in your liver. A liver biopsy can diagnose cirrhosis when the results of other tests are uncertain.

• #15 Liver Disease Laboratory Testing | Thermo Fisher Scientific

  https://www.thermofisher.com/phadia/us/en/our-solutions/elia-autoimmunity-solutions/liver-diseases.html

  Recommendations for the differential diagnosis of PBC and AIH include: […] Testing for anti-mitochondrial antibodies (AMA)/anti-M2 antibodies and anti-LKM-1 antibodies. […] Confirmatory testing of negative and positive immunofluorescence assay (IFA) results with high-quality solid phase tests to reduce false negative and false positive results. […] In a scientific study, the EliA M2 test demonstrated a comparable sensitivity (100 percent) and a superior specificity (98 percent versus 77 percent) to IFA. The EliA M2 test enables you to detect AMA/anti-M2 antibodies with confidence, efficiently. […] In a comparative study, the EliA LKM-1 test demonstrated a higher sensitivity than IFA (72.8 percent versus 69.1 percent), at the stratified specificity of 94.8 percent, to support the diagnosis of AIH (type 2). The EliA LKM-1 test helps clinicians make an accurate diagnosis in this difficult to diagnose disease that can lead to cirrhosis and whose onset usually occurs in childhood and young adulthood.

• #16 Diagnostic Testing for Liver Disease | UPMC Center for Liver Care

  https://www.upmc.com/services/digestive-disorders-center/services/liver-diseases/what-to-expect/diagnostic-testing

  Imaging tests help our physicians to see inside your body to learn more about the health of your liver. […] Some techniques allow doctors to make a liver disease diagnosis and treat it at the same time. […] At UPMC, our liver specialists, are experts in liver disease testing, diagnosis, and treatment.

• #17 Diagnosing Liver Disease: Biopsy, Risks & Preparation

  https://liverfoundation.org/liver-diseases/diagnosing-liver-disease/

  Your doctor may order tests that take images, or pictures, of your liver to help make the diagnosis of liver disease. Different types of images can be obtained by using various types of equipment, including: […] These tests cannot show inflammation or fibrosis, so your doctor can’t use them to determine whether you have simple fatty liver (newly renamed to steatotic liver disease) or NASH, now called metabolic dysfunction associated steatohepatitis or MASH. However, there are other types of imaging tests that are used to measure fibrosis by measuring the stiffness of your liver. […] This test measures liver stiffness with a special ultrasound machine, the most common being FibroScan. […] This is a newer, noninvasive test that combines features of ultrasound and MRI imaging to create a visual map showing gradients of stiffness throughout the liver.

• #18 Tests for Liver Damage – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/basics/liver-damage-tests.asp

  Most people with chronic liver disease will have no ongoing symptoms, and the damage will be detected only by blood tests. The tests (called a „liver panel”) measure: […] Your provider can run more blood tests if needed in order to find out what is causing the damage to your liver. […] Ultrasound, CAT scans, and MRI are the 3 main methods of taking pictures of the liver. They can often show if the liver injury has become serious. […] Fibroscan is a non-invasive procedure. It may be requested by your provider to assess the amount of fibrosis or scarring in the liver. In some situations, a liver biopsy may be needed to identify the cause of liver damage. A liver biopsy is a medical procedure in which a doctor uses a special needle to remove a small piece of tissue in order to check for signs and identify a causes for the liver damage. A liver biopsy isn’t necessary with many types of liver disease. If your doctor does recommend it, it will be helpful in learning more about your liver’s health and guiding treatment. […] During an examination, your doctor can feel the liver to find out if it is shrunken, hard, or swollen.

• #19 Diagnosis of liver cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/liver/diagnosis

  Liver function tests (also called a liver panel) are a group of blood chemistry tests that are often ordered together. While they do not diagnose liver cancer, they can tell the doctor that there may be a problem with the liver. […] To diagnose liver cancer, a CT scan is done 4 times. This is called a 4-phase, or multiphase, CT scan. A CT scan is first done without any contrast medium. The next 3 scans are done after contrast medium is injected into a vein. The way the contrast medium flows through the liver can tell doctors if a tumour in the liver is cancerous. […] In most cases, doctors use a CT scan to diagnose liver cancer. If they cant confirm that there is a tumour in the liver based on the imaging test results, doctors may do a liver biopsy. […] If doctors think someone has liver cancer, they will order a blood test to check for hepatitis viruses. Chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV) or both increases the risk of developing liver cancer. […] Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose liver cancer.

• #20 Cirrhosis of the Liver – Diagnosis, Evaluation & Treatment

  https://www.radiologyinfo.org/en/info/cirrhosisliver

  Cirrhosis can be diagnosed by radiology testing such as computed tomography (CT), ultrasound or magnetic resonance imaging (MRI) or via a needle biopsy of the liver. […] Elastography can detect stiffness of the liver caused by liver fibrosis earlier than other imaging tests. […] Other tests include: Biopsy: Part of the liver tissue is sampled and examined by a pathology doctor to analyze the extent of liver damage. […] Liver function test: This test involves analyzing the blood for particular enzymes that signal that liver damage is present.

• #21 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  Liver biopsy remains the reference standard; however, transient elastography has become more widely available and is rapidly replacing biopsy as the preferred method for liver fibrosis staging. […] All patients with cirrhosis should be evaluated for hepatocellular carcinoma with ultrasonography every six months. […] Patients with decompensated cirrhosis or compensated cirrhosis and liver stiffness 20 kilopascals (measured by transient elastography) or platelet count 150,000 per mm3 should be screened for gastroesophageal varices with endoscopy. […] Liver biopsy remains the reference standard in diagnosing cirrhosis; however, a 20% error rate still occurs in fibrosis staging. […] After the diagnosis of cirrhosis is established, Child-Pugh and Model for End-Stage Liver Disease scores should be used to identify the stage of cirrhosis and mortality risk, respectively.

• #22 Liver Disease Diagnosis & Treatment – Katy Gastroenterology Center

  https://thegastroenterologycenter.com/liver-testing/

  The FibroScan test is a completely non-invasive, simple and painless procedure that takes approximately 10 minutes to complete. […] The liver is located in the right upper abdomen under the rib cage. Patients are asked to lie flat on an examination table. A technician places the FibroScan probe between the ribs on the right side of the lower chest wall. A series of painless pulses are then applied to the liver. The results are recorded on the equipment and an overall liver stiffness score is generated. This score is then interpreted by a qualified physician to predict the likelihood of advanced fibrosis or cirrhosis. […] The test measures the extent of steatosis (fatty inflammation) and fibrosis (scar tissue in liver which may lead to cirrhosis which might lead to liver failure) of the liver.

• #23 Liver Disease Diagnosis & Treatment – Katy Gastroenterology Center

  https://thegastroenterologycenter.com/liver-testing/

  Your fibrosis result is a measurement of the amount of scarring in your liver. FibroScan measures scarring by measuring the stiffness of your liver. […] The fibrosis result is measured in kilopascals (kPa) It’s normally between 2 and 6 kPa. The highest possible result is 75 kPa. Many people with liver disease(s) have a result that’s higher than the normal range. […] Fibrosis score F0 to F1: No liver scarring or mild liver scarring. Fibrosis score F2: Moderate liver scarring. Fibrosis score F3: Severe liver scarring. Fibrosis score F4: Advanced liver scarring (cirrhosis). […] Your fibrosis result may be overestimated (your liver may have less scarring than what your fibrosis result says) if you have: Liver inflammation. This can be caused by a recent liver illness or drinking alcohol. Benign (not cancerous) or cancerous tumors in your liver. Liver congestion (when your liver is too full of blood or other fluids). This is usually caused by heart failure. Your FibroScan results may also be less accurate if you have: A body mass index (BMI) higher than 30 (obesity). A build-up of fluid in your abdomen (ascites). Too little bile flowing out of your liver (biliary obstruction).

• #24 Testing for cirrhosis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/testing-for-cirrhosis.html

  There are several tests that combine serum and clinical parameters to predict the presence of cirrhosis. Indirect serum fibrosis tests include the AST:ALT ratio, the AST to platelet ratio index (APRI score) and, in non-alcoholic fatty liver disease (NAFLD), the FIB-4 and NAFLD fibrosis score. […] Once the diagnosis of cirrhosis is made, monitoring for deteriorating liver function or complications is important. […] Referral to a hepatologist should be considered for the assessment of all patients with liver cirrhosis, when the diagnosis of chronic liver disease is uncertain and for the management of complications. […] The prevalence of cirrhosis is increasing. Patients are likely to have a better prognosis if there is an early diagnosis. […] Making the diagnosis requires a clinical suspicion of liver disease, particularly in at-risk populations. The initial investigations include biochemical tests and imaging. Serum markers and clinical features can be combined to predict the presence of liver fibrosis. Liver fibrosis can also be assessed by measuring the tissue stiffness with elastography. Biopsy is now rarely used for the diagnosis of cirrhosis.

• #25 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  Cirrhosis is the 12th leading cause of death in the United States. […] When clinical signs, symptoms, or abnormal liver function tests are discovered, further evaluation should be pursued promptly. […] Initial workup includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio, if not already ordered. […] Common serum and ultrasound-based screening tests to assess fibrosis include the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, FibroTest/FibroSure, nonalcoholic fatty liver fibrosis score, standard ultrasonography, and transient elastography. […] Generally, noninvasive tests are most useful in identifying patients with no to minimal fibrosis or advanced fibrosis.

• #26

  https://journals.lww.com/hep/fulltext/2022/01000/population_screening_for_liver_fibrosis__toward.19.aspx

  Early diagnosis of CLD enables initiation of specific measures or treatments to prevent disease progression and improve survival, including antiviral therapy for HBV or HCV, alcohol abstinence in ALD, and behavioral changes and treatment of diabetes and obesity in NAFLD. In addition, patients with cirrhosis, once diagnosed, require surveillance for varices and HCC. […] A populationbased, crosssectional study with 3076 participants in the Barcelona area using TE for at front screening in primary care reported that TE values 9.2 kPa had highest accuracy to exclude fibrosis stages F2F4. […] The implementation of a screening program has to take into account not only regionspecific health risk profiles (age, sex, comorbidities, ethnicity) but regionspecific participation barriers and health inequities (socioeconomic differences, distance, mobility), the structure of the health care system (in particular community and primary care, links to other screening programs such as colon and breast cancer), as well as regulatory requirements (ethics, data protection, coverage of costs).

• #27 Recent advances in non-invasive diagnosis and medical management of non-alcoholic fatty liver disease in adult | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-020-00043-x

  Multiple non-invasive tests are available for diagnosis of NAFLD, and its different stages however gold standard test is liver biopsy. […] Liver biopsy is the gold standard test for diagnosis, grading, and histological assessment of NAFLD, and a four-point histopathologic grading system is used to assess severity of steatosis that ranges from 0 to 3, depending on presence of the percentage of fat-containing hepatocytes. […] Before considering the diagnosis of NAFLD, alcoholic fatty liver has to be excluded. […] Significant alcohol intake is considered when alcohol consumption 7 standard drinks/week (70g ethanol) in women and 14 (140g ethanol) in men. […] The optimal cut-off values of CAP for estimation of hepatic steatosis grades such as S1, S2, and S3 are 263dB/m, 281dB/m and 283dB/m respectively.

• #28 Liver Failure: Causes, Symptoms, Treatments, Tests & More

  https://www.webmd.com/fatty-liver-disease/digestive-diseases-liver-failure

  Tests and procedures used to diagnose liver failure and liver disease include: […] Blood tests. These let your doctor know how well your liver is working. You might get a prothrombin time test, which measures how long it takes your blood to clot. With acute liver failure, blood doesn’t clot as quickly as it should. […] Imaging tests. These take pictures that let your doctor see whats going on in your liver and figure out whats causing the problem. They may recommend: Ultrasound, Abdominal CT scanning, MRI. […] Biopsy. The doctor uses a needle to remove a small piece of liver tissue and looks at it in the lab. A transjugular liver biopsy is a special procedure that lets the doctor put the needle into a vein in your neck.

• #29 Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0901/p756.html

  If clinical, laboratory, and radiographic data are inconclusive, but suspicion of cirrhosis remains, a diagnostic liver biopsy should be performed. […] Abdominal ultrasonography is a specific, reliable, noninvasive, fast, and cost-effective test that should be used as a first-line radiographic study for diagnosing cirrhosis. […] No serologic test can diagnose cirrhosis accurately. […] Although various radiographic studies may suggest the presence of cirrhosis, no test is considered a diagnostic standard. […] Referral for liver biopsy should be considered after a thorough, noninvasive serologic and radiographic evaluation has failed to confirm a diagnosis of cirrhosis; the benefit of biopsy outweighs the risk; and it is postulated that biopsy will have a favorable impact on the treatment of chronic liver disease.

• #30 Finding the right diagnosis with liver biopsy | MUSC | Charleston, SC

  https://web.musc.edu/about/news-center/2024/01/24/liver-biopsy

  The popularity of noninvasive options to diagnose liver disease has been growing, but are there times when more traditional methods like liver biopsy are still needed for a precise diagnosis? […] Our study shows that that biopsy continues to be valuable as part of our diagnostic arsenal, said Rockey. […] For example, a liver biopsy can be performed if a doctor suspects something is wrong with a patients liver. […] Biopsy is one tool in a large toolbox for diagnosing liver disease, which also includes imaging and blood tests. […] Despite the risks, Rockey still recommends that providers consider liver biopsy in some circumstances. […] Rockey and his team found that biopsy was often crucial to making the right diagnosis. […] The diagnoses that patients received before their biopsies matched up with their biopsy results just under two-thirds of the time. […] In fact, Rockey suggests that patients advocate for their own biopsy when there is no clear diagnosis. […] Biopsy is an important part of making a correct diagnosis for many patients, he said.

• #31

  https://journals.lww.com/hep/fulltext/2018/01000/the_diagnosis_and_management_of_nonalcoholic_fatty.31.aspx

  Guidance Statement: Liver biopsy should be considered in patients with NAFLD who are at increased risk of having SH and/or advanced fibrosis. […] Guidance Statement: NFS or FIB4 index are clinically useful tools for identifying NAFLD patients with higher likelihood of having bridging fibrosis (stage 3) or cirrhosis (stage 4). […] Guidance Statement: VCTE or MRE are clinically useful tools for identifying advanced fibrosis in patients with NAFLD.

• #32 Tests for Liver Disease Diagnosis | Hepatology – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/liver-diseases-hepatology/diagnosis

  Diagnosing Liver Diseases. Diagnostic details are essential to planning the best liver treatment for each patient. Liver specialists at our Center for Liver Diseases including University of Chicago Medicine interventional radiologists use an array of advanced diagnostic methods to find the cause of an individuals liver disorder and to determine the degree of severity. […] If you are being tested for liver disease, your doctor will explain which tests and procedures you will undergo and why. […] Liver biopsies are useful for diagnosing liver cancer and other conditions. During the biopsy, a small amount of liver tissue is removed. UChicago Medicine pathologists use the most advanced lab tests available to analyze the tissue and identify cancer or other liver diseases. This comprehensive analysis reveals the type of liver disease as well as important details about its stage or severity, genetic abnormalities or other critical data. In most cases, your liver doctor will perform the liver biopsy.

• #33 Metabolic Dysfunction–Associated Liver Disease (MASLD) – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/metabolic-dysfunction-associated-liver-disease-masld

  Metabolic dysfunctionassociated liver disease (MASLD) includes simple fatty infiltration (a benign condition called steatotic liver disease), whereas metabolic dysfunctionassociated steatohepatitis (MASH) is defined as the presence of fat leading to lipotoxicity and inflammatory damage to hepatocytes. […] To diagnose MASH, underlying alcohol use must be ruled out. […] Differentiating simple steatosis from MASH can be difficult without a liver biopsy, and elevated liver enzymes are not a sensitive predictor for identifying MASH. […] The diagnosis of MASH should be suspected in patients with metabolic syndrome (typically obesity, type 2 diabetes mellitus or a high fasting plasma glucose level, hypertension, and dyslipidemia) and in patients with unexplained laboratory abnormalities suggesting liver disease.

• #34

  https://link.springer.com/article/10.1007/s12072-024-10704-3

  To distinguish between MAFLD and dual (or more) aetiology diseases, the patient should be assessed for other liver diseases, particularly viral hepatitis and alcohol use disorder. […] Liver biopsy is indicated in cases of MAFLD to confirm a diagnosis in patients with an atypical presentation, in patients within the grey area, to estimate prognosis, and to identify individuals with additional causes for liver disease. […] The fatty liver inhibition of progression (FLIP) algorithm, the Brunt score, the NAFLD activity score (NAS), and the steatosis, activity, and fibrosis (SAF) score are the commonly used systems to assess MAFLD biopsies. […] NITs can be used to diagnose MAFLD, to assess the stage of disease, and to monitor treatment response. […] The diagnosis of MAFLD depends on identifying hepatic steatosis either by histology or imaging.

• #35 Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

  https://www.mdpi.com/1422-0067/24/3/2844

  Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease that affects approximately one-quarter of the global adult population, posing a significant threat to human health with wide-ranging social and economic implications. […] Liver biopsy is currently considered the gold standard for the diagnosis and staging of NAFLD because of the absence of noninvasive and specific biomarkers. […] Therefore, the early detection, diagnosis and treatment of NAFLD has become urgent. The present review describes current findings about the pathogenesis of NAFLD and highlights progress in its diagnosis and treatment, which may help improve the outcomes of NAFLD cases. […] Developing reliable and practical tools for diagnosing NAFLD during disease screening is very important in the early detection and effective therapy of NAFLD.

• #36 Diagnosis of NAFLD & NASH – NIDDK

  https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/diagnosis

  Doctors use your medical history, a physical exam, and tests to diagnose nonalcoholic fatty liver disease, or NAFLD (also referred to as metabolic dysfunction-associated steatotic liver disease, or MASLD). […] Your doctor will ask if you have a history of health conditions that make you more likely to develop NAFLD. […] During a physical exam, a doctor usually examines your body and checks your weight and height to calculate your body mass index. […] Doctors use blood tests, imaging tests, and sometimes liver biopsy to diagnose NAFLD and to tell the difference between NAFL and NASH. […] Your doctor may suspect you have NAFLD if your blood test shows increased levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). […] Routine imaging tests can show fat in your liver. […] Liver biopsy is the only test that can prove a diagnosis of NASH and show clearly how severe the disease is.

• #37 Fatty Liver Disease | MedlinePlus

  https://medlineplus.gov/fattyliverdisease.html

  Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body’s natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis. […] Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use: Your medical history, A physical exam, Various tests, including blood and imaging tests, and sometimes a biopsy.

• #38 Fatty Liver Disease Treatment & Diagnosis – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/liver-diseases-hepatology/fatty-liver-disease/treatment

  Fatty/steatotic liver disease often goes undetected because it may not cause symptoms and may not cause obvious liver blood tests. Yet getting a timely and accurate diagnosis, particularly if you have established liver scarring, is critical to protect your liver and intervene if needed. […] To determine if you have fatty/steatotic liver disease, your team at UChicago Medicine will give you a physical exam and ask about your past health. We may then recommend: […] Blood tests to check the function of your liver and rule out other causes of fat buildup in the liver or abnormal liver tests. […] A noninvasive test called a FibroScan, and possibly more imaging such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) of your liver. […] A liver biopsy. This is often needed if another liver diagnosis is suggested by your blood tests or if you have had elevated liver tests over an extended period of time. During this test, performed by interventional radiologists, a hollow needle is used to remove a tiny tissue sample from your liver. This tissue is then checked under a microscope for signs of damage. This test can also help determine the cause of the damage and how far the disease has progressed. […] According to new recommendations, people with obesity and type 2 diabetes should be screened for fatty liver disease.

• #39 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and conversion of the normal liver architecture into structurally abnormal nodules. The progression of liver injury to cirrhosis may occur over several weeks to years. […] Patients should be referred for consideration for liver transplantation after the first signs of hepatic decompensation appear. […] Relatively recent practice guidelines highlight the importance of making an early diagnosis of clinically significant portal hypertension (CSPH). […] Clinicians now have access to multiple noninvasive liver disease assessments (NILDAs) that can assist them as they attempt to determine whether or not their patients with chronic liver disease have CSPH. […] Unfortunately, the perfect diagnostic test does not exist.

• #40 Cirrhosis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/liver-diseases/cirrhosis/treatment

  Cirrhosis of the liver is typically diagnosed through a hepatologist (liver specialist). It involves an investigation of personal health history, including how much alcohol is regularly consumed, and risk factors for hepatitis. A physical exam can check for symptoms such as an enlarged liver or tenderness in the abdomen. […] To confirm a cirrhosis diagnosis, your doctor may request the following tests: […] Blood tests can determine how well the liver is functioning. Specific tests can check for abnormal enzyme levels, including increased levels of bilirubin and decreased levels of proteins. […] Hepatitis B or C testing. A blood test can determine if you have viral infections, particularly hepatitis B or C, that can cause cirrhosis. […] Imaging tests. An ultrasound, CT scan, or MRI can detect a hardening or stiffening of the liver. […] Liver biopsy. A sample of liver tissue may help determine how severe the liver damage is and an underlying cause.

• #41 Do I Have Cirrhosis? What Tests and Exams Will My Doctor Use to Find Out?

  https://www.webmd.com/fatty-liver-disease/tests-for-cirrhosis

  Cirrhosis creates scars that damage your liver. This damage can prevent this vital organ from doing important jobs like helping with digestion and removing toxins from your body. The sooner your doctor diagnoses cirrhosis, the faster you can get treated and put a stop to the damage. You might even be able to reverse some of the scarring. […] If you do have symptoms like yellow skin (jaundice), fatigue, and easy bruising or bleeding, see your doctor right away. Blood tests and imaging scans can show whether you have cirrhosis. […] If you have symptoms of cirrhosis or you’re at risk for the disease, your doctor will take a sample of your blood. These help spot signs of cirrhosis liver damage. They may help your doctor learn what caused the disease. […] Your doctor can use the results of these tests to give you a Model for End-Stage Liver Disease (MELD) score. This shows how much your liver has been damaged, and whether you need a liver transplant.

• #42 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  The American Association for the Study of Liver Diseases (AASLD) classifies hepatic fibrosis as follows: Significant fibrosis: F2 fibrosis; Advanced fibrosis: F3 and F4 fibrosis; Cirrhosis: F4 fibrosis. […] The finding of cirrhosis can identify individuals at the highest risk of developing liver decompensation, HCC, or liver-related mortality. […] The next section reviews traditional assessments for cirrhosis, as well as more recent advances in the use of noninvasive testing. […] The advent of NILDAs over the past decade has revolutionized the ability of clinicians to accurately assess liver fibrosis. […] NILDAs can assist clinicians attempting to determine whether or not their patients have advanced fibrosis or cirrhosis. […] Use of NILDAs is evolving. […] A proposed algorithm for investigating patients with possible cirrhosis recommends performing an FIB-4 calculation.

• #43 Liver Disease Laboratory Testing | Thermo Fisher Scientific

  https://www.thermofisher.com/phadia/us/en/our-solutions/elia-autoimmunity-solutions/liver-diseases.html

  Liver diseases of various etiologies can lead to liver cirrhosis and the need for a liver transplant but are often characterized by unspecific symptoms, such as jaundice, chronic fatigue, or abdominal pain. Although rare, autoimmune liver diseases represent a major cause of liver cirrhosis, and their differential diagnosis from non-autoimmune liver diseases (such as viral hepatitis) enables the clinician to make informed treatment decisions and to improve a patients quality of life. […] Primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) are the most clinically important autoimmune liver diseases. PBC is characterized by a chronic inflammation of the small bile ducts and impaired bile formation that can lead to liver cirrhosis and the need of a liver transplant. In case of AIH, an inflammation of the hepatocytes can lead to liver failure.

• #44 Diagnosis | AIHA – Autoimmune Hepatitis Association

  https://aihep.org/diagnosis/

  Diagnosing a patient with AIH can be difficult and in some cases take many months or even years. […] Before a diagnosis of AIH is made, a hepatologist or gastroenterologist will rule out other causes of liver injury (for example, fatty liver disease) and may ask questions about alcohol and drug use including prescribed medications, vitamins, supplements, and recreational drugs to determine if these could have contributed to liver injury. […] The doctor will probably order blood tests to determine if you have ongoing liver inflammation (abnormal liver tests) or autoantibodies. […] The most important liver tests in AIH include alanine transaminase (ALT) and aspartate transaminase (AST), which are enzymes present in liver cells. […] The presence of autoantibodies can help diagnose autoimmune disorders. […] A liver biopsy is commonly ordered to help establish a diagnosis of AIH and to see if there is any scarring of the liver. […] A FibroScan is a noninvasive test that doctors often use to track liver stiffness (fibrosis) in patients after diagnosis.

• #45 Diagnosis and tests for autoimmune hepatitis – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/autoimmune-hepatitis/diagnosis/

  You might find out you have autoimmune hepatitis during tests for other health problems. If your GP suspects you have autoimmune hepatitis they will do some blood tests and then refer you to a liver specialist. […] They will try to find out what the problem is and how damaged your liver is. This will include a thorough medical history, physical examination, special blood tests and scans. Most people also need a liver biopsy. Blood tests, scans and biopsies are usually carried out at a hospital. […] An early diagnosis can often mean your treatment will be more effective. […] Blood tests are an important guide to who might have liver disease. But they aren’t accurate enough to rule out liver disease by themselves. If your liver blood tests are abnormal it is important that your doctor investigates. This could include more blood tests, a scan and often a liver biopsy.

• #46 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  Unlike for advanced liver fibrosis, the practical rules for the early non-invasive diagnosis of cirrhosis in NAFLD remain not well defined. Here, we report the derivation and validation of a stepwise diagnostic algorithm in 1568 patients with NAFLD and liver biopsy coming from four independent cohorts. The study algorithm, using first the elastography-based tests Agile3+ and Agile4 and then the specialized blood tests FibroMeterV3G and CirrhoMeterV3G, provides stratification in four groups, the last of which is enriched in cirrhosis (71% prevalence in the validation set). A risk prediction chart is also derived to allow estimation of the individual probability of cirrhosis. The predicted risk shows excellent calibration in the validation set, and mean difference with perfect prediction is only 2.9%. These tools improve the personalized non-invasive diagnosis of cirrhosis in NAFLD.

• #47 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  If the FIB-4 score is 2.67 and the LSM is high, a diagnosis of cirrhosis is possible. Additional testing (including liver biopsy) may be required to confirm the diagnosis of cirrhosis. […] The challenge to clinicians caring for patients with cirrhosis is how to implement the strategies that maximize patients’ chances for remaining well-compensated and minimize their risk for liver decompensation.

• #48 A New Liver Disease Diagnostic and Prevention Approach | TechTarget

  https://www.techtarget.com/pharmalifesciences/answer/A-New-Liver-Disease-Diagnostic-and-Prevention-Approach

  A new software developed by Oncoustics may improve liver disease diagnosis and prevention. Current diagnostic methods for liver disease have proven ineffective in early diagnosis. The product they are investigating is an AI software to be used with ultrasound technology for liver disease diagnosis. Traditional methods of diagnosing liver disease are invasive and are not consistently accurate. Traditionally, liver disease is diagnosed via multiple referrals. If a primary care doctor suspects a patient has liver disease, the physician will usually start with blood tests, which aren’t highly accurate. This procedure is notoriously inaccurate. There’s a whole group of people that are trying to rename liver function tests because these tests don’t really say anything about the function of the liver. As a matter of fact, over 70% of patients with full-blown cirrhosis will have normal liver enzymes. In addition to accuracy limitations, the process of liver disease diagnosis has multiple steps, making it more difficult to obtain care. If a doctor suspects something is going on, they’ll refer that patient to a hepatologist. The hepatologist can do a number of exams, including a fibroscan. Sometimes it might be in the office, or they’ll refer that patient to radiology. So, the whole process takes multiple referrals, high-end imaging, or highly invasive biopsy. Rogozinski explains that the plan for this device is to enable point-of-care doctors with devices as small as an ultrasound wand. Despite not producing the actual device, the software created by Oncoustics will allow for reduced cost and increased access to liver disease diagnostics. At the primary care office, a quick scan of the liver can be done to have a much deeper understanding of where a patient is at with liver disease. This device will mitigate time barriers allowing patients to receive care more readily. Rogozinski anticipates that Oncoustics AI diagnostics will be covered by insurance, pending the approval and universal use of the software. In addition to alleviating liver disease’s temporal and financial burden, Oncoustics anticipates that this device will improve global access to diagnostic tools. Rogozinski describes Oncoustics goal as an unmet market. The company is already beginning to consider ways in which it can improve health equity by implementing different approaches to deploy the software globally. Overall, this software shows promise in improving healthcare accessibility globally. Rogozinski noted that one of the company’s main aims is to develop products to address unmet needs while decreasing costs, increasing access, and allowing for early diagnosis and intervention. As the investigational use of Oncoustics progresses, providers will await approval and consider how they may implement the product in their daily practices.

• #49

  https://journals.lww.com/hep/fulltext/2022/01000/population_screening_for_liver_fibrosis__toward.19.aspx

  There is an urgent need to change the paradigm of diagnosis of CLD from late diagnosis (i.e., decompensated cirrhosis) to early diagnosis (i.e., fibrosis or compensated cirrhosis). This new approach would require identification of asymptomatic patients using noninvasive methods of assessment of fibrosis in large portions of the population.

• #50 Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-nonalcoholic-fatty-liver-disease-nafld-in-lean-individuals/

  Experts provide 15 best practices for the diagnosis and treatment of lean individuals with NAFLD. […] 1. Lean NAFLD should be diagnosed in individuals with NAFLD and body mass index <25 kg/m2 (non-Asian race) or body mass index <23 kg/m2 (Asian race). [...] 2. Lean individuals with NAFLD should be evaluated routinely for comorbid conditions, such as type 2 diabetes mellitus, dyslipidemia and hypertension. [...] 3. Lean individuals with NAFLD should be risk stratified for hepatic fibrosis to identify those with advanced fibrosis or cirrhosis. [...] 4. Lean individuals in the general population should not undergo routine screening for NAFLD; however, screening should be considered for individuals older than 40 years with type 2 diabetes mellitus. [...] 5. NAFLD should be considered in lean individuals with metabolic diseases (such as type 2 diabetes mellitus, dyslipidemia and hypertension), elevated liver biochemical tests or incidentally noted hepatic steatosis.

• #51 Diagnosis and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-nonalcoholic-fatty-liver-disease-nafld-in-lean-individuals/

• #52 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of abnormal liver function tests (LFTs) in the UK with approximately a third of the population being affected. […] Many patients with NAFLD remain undiagnosed, and recognising those at risk is the first step. […] Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, the majority of patients can be effectively diagnosed non-invasively with tests that are routinely available in the clinic today. […] A diagnosis of NAFLD requires that there is evidence of hepatic steatosis on imaging or histology, and other causes of liver disease or steatosis have been excluded. […] NAFLD is usually asymptomatic, so diagnosis usually follows the incidental finding of abnormal liver enzymes or steatosis on imaging.

• #53 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  These tests provide an indirect measure of fibrosis and are potentially appealing non-invasive markers of fibrosis as they are inexpensive and are performed in all patients with liver disease. […] Fibrotic livers have reduced elasticity due to the deposition of fibrous tissue in the hepatic parenchyma. […] The LSM correlates well with the degree of hepatic fibrosis in a range of liver diseases, including NAFLD. […] However, there are significant limitations to using TE in NAFLD. […] A pragmatic diagnostic and staging approach is needed. […] Accurate diagnosis and staging is important in determining the appropriate long-term management for patients with NAFLD.

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