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ALL / Gastroenterology
Liver cirrhosis
Liver cirrhosis
Liver cirrhosis remains a significant problem in the developed world, account for 60,000 deaths in the UK each year.Causes:
- alcohol
- non-alcoholic fatty liver disease (NAFLD)
- viral hepatitis (B and C)
Diagnosis
- traditionally a liver biopsy was used. This procedure is however associated with adverse effects such as bleeding and pain
- other techniques such as transient elastography and acoustic radiation force impulse imaging are increasingly used and were recommended by NICE in their 2016 guidelines
- for patients with NAFLD, NICE recommend using the enhanced liver fibrosis score to screen for patients who need further testing
What is transient elastography?
- brand name 'Fibroscan'
- uses a 50-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
- measures the 'stiffness' of the liver which is a proxy for fibrosis
In terms of screening for cirrhosis NICE made a specific recommendation, suggesting to offer transient elastography to:
- people with hepatitis C virus infection
- men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
- people diagnosed with alcohol-related liver disease
Further investigations
- NICE recommend doing an upper endoscopy to check for varices in patient's with a new diagnosis of cirrhosis
- liver ultrasound every 6 months (+/- alpha-feto protein) to check for hepatocellular cancer
+PassMedicine Notes
Liver cirrhosis remains a significant problem in the developed world, account for 60,000 deaths in the UK each year.
Causes:- alcohol
- non-alcoholic fatty liver disease (NAFLD)
- viral hepatitis (B and C)
- traditionally a liver biopsy was used. This procedure is however associated with adverse effects such as bleeding and pain
- other techniques such as transient elastography and acoustic radiation force impulse imaging are increasingly used and were recommended by NICE in their 2016 guidelines
- for patients with NAFLD, NICE recommend using the enhanced liver fibrosis score to screen for patients who need further testing
- brand name 'Fibroscan'
- uses a 50-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
- measures the 'stiffness' of the liver which is a proxy for fibrosis
- people with hepatitis C virus infection
- men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
- people diagnosed with alcohol-related liver disease
- NICE recommend doing an upper endoscopy to check for varices in patient's with a new diagnosis of cirrhosis
- liver ultrasound every 6 months (+/- alpha-feto protein) to check for hepatocellular cancer