Diagnosis of Liver Cirrhosis | PACE Hospitals #shortvideo #livercirrhosis

Summary

This video script discusses the diagnostic approach to liver cirrhosis, starting with an ultrasound as the initial investigation to identify signs like portal hypertension, liver enlargement, and ascites. Blood tests help assess liver function, while liver elastography measures fibrosis to stage the disease. Liver biopsy, although reserved for select cases, remains the gold standard for diagnosis. Additional tools include endoscopy to detect esophageal varices and CT scans for better liver imaging. Blood tests for autoimmune markers, viral hepatitis, and alpha-fetoprotein (AFP) for liver cancer detection are also crucial. The combination of these methods ensures accurate diagnosis and management of liver cirrhosis and its complications.

Takeaways

• 😀 The first step in diagnosing cirrhosis of the liver is an ultrasound, which may reveal signs of portal hypertension, liver enlargement or shrinkage, ascites, and possibly liver nodules.
• 😀 Ultrasound can also detect regenerative nodules or silent liver cell carcinoma, especially in cirrhosis patients.
• 😀 Blood tests such as liver function tests, complete blood count, and bilirubin levels help assess liver damage, with low albumin and elevated bilirubin indicating decompensated liver disease.
• 😀 Liver enzymes (SGOT, SGPT) may be normal in advanced cirrhosis but elevated in cases of alcoholic hepatitis or autoimmune hepatitis.
• 😀 Liver elastography is a non-invasive test to assess liver stiffness, providing valuable insight into the level of fibrosis and potentially reducing the need for a liver biopsy.
• 😀 Liver biopsy, though still a gold standard in some cases, can be performed percutaneously, via endoscopic ultrasound, or laparoscopically based on patient conditions.
• 😀 Hepatic wedge pressure gradient estimation and endoscopy are used to evaluate complications of cirrhosis, such as esophageal varices.
• 😀 Endoscopy helps detect esophageal varices, which can cause serious complications like bleeding and black stools.
• 😀 Additional tests include autoimmune profiles, viral markers (like Hepatitis B and C), and markers like serum ceruloplasmin and ferritin to determine the cause of liver disease.
• 😀 CT scans are superior to ultrasound for assessing liver surface irregularities and identifying nodules, especially in unclear cases, and can detect Alpha-Fetoprotein elevation in patients with HCC.

Q & A

What is the first investigation of choice when diagnosing cirrhosis of the liver?

The first investigation of choice is an ultrasound of the abdomen and liver, which can detect signs of portal hypertension, liver enlargement or shrinkage, and ascites.

What are common ultrasound findings that suggest cirrhosis of the liver?

Common ultrasound findings include dilated portal veins, splenomegaly, ascites, liver enlargement or shrinkage, and the presence of regenerative nodules or liver cell carcinoma (HCC).

What blood tests are important for diagnosing cirrhosis?

Key blood tests include a complete blood count (CBC), liver function tests (LFTs), total protein, albumin, bilirubin levels, and liver enzymes like SGOT and SGPT. Elevated bilirubin and low albumin often indicate liver dysfunction.

How can liver elastography help in diagnosing cirrhosis?

Liver elastography measures liver stiffness to assess the extent of fibrosis and cirrhosis. It helps in staging the liver disease and may reduce the need for a liver biopsy in many cases.

When is liver biopsy used in the diagnosis of cirrhosis?

Liver biopsy is reserved for cases where other diagnostic methods are inconclusive. It helps confirm the diagnosis and assess the degree of liver damage.

What are the different methods for performing a liver biopsy?

Liver biopsy can be performed percutaneously, using ultrasound guidance, or via more invasive methods such as endoscopic ultrasound or laparoscopic biopsy, depending on the patient's condition.

What role does CT scanning play in diagnosing liver disease?

CT scanning is superior to ultrasound in detecting irregularities in liver surface texture, such as nodules or signs of liver damage, especially in unclear cases.

What complications of cirrhosis can be assessed through endoscopy?

Endoscopy is used to detect esophageal varices, which are enlarged veins in the esophagus that can rupture and cause life-threatening bleeding in patients with cirrhosis.

What is the significance of alpha-fetoprotein (AFP) testing in cirrhosis patients?

AFP testing is important for detecting hepatocellular carcinoma (HCC), especially in cirrhotic patients, as AFP levels can rise even if the ultrasound shows no abnormal findings or the lesion is small.

How is the hepatic venous pressure gradient (HVPG) used in cirrhosis diagnosis?

The HVPG test is an invasive procedure used to assess the pressure in the liver, which can help gauge the severity of cirrhosis and the risk of complications such as variceal bleeding.