Liver Health

30 January 2015

Diagnosing liver disease

Liver diseases can be difficult to diagnose as they are often without symptoms in the early stages.


As there are so many causes of liver problems, these can be difficult to diagnose. The symptoms of liver disease are also often symptoms of other conditions, and are therefore sometimes overlooked. Liver disease is often without symptoms, which is one of the reasons it is frequently diagnosed when the condition is already serious, or even irreversible.

Some signs of possible liver disease include jaundice, a swollen abdomen or tenderness in the area of the liver.

If a doctor thinks you may have liver disease, they will try to determine which risk factors you may have been exposed to, says the Canadian Liver Foundation. These could include trying to find out more about the following:

- Prescription or over-the-counter medication usage

- Past blood transfusions

- Sexual activity

- Alcohol consumption

- Occupational exposure to blood products

- Exposure to toxic chemicals

- Family history of liver disease

- Travel to high-risk areas

- Use or experimentation with injection drugs

In order for treatment of liver disease to have a chance of success, future exposure to risk factors needs to be reduced, if possible. This can be done in the case of factors such as alcohol consumption and drug use, but not in the case of a viral infection that is already present.

Liver function tests

Blood tests, known as liver function tests can help doctors assess liver disease but no single blood test can diagnose cirrhosis accurately, warns an article from the University of Michigan Medical School that was published in the journal American Family Physician. Simple X-rays cannot detect liver disorders.

Blood tests provide a profile of the pattern of injury of the liver as well as whether there is jaundice present according to the Merck Manual. These liver function tests are also used to test a patent’s response to treatment for liver disease. The tests measure levels of enzymes and other substances that the liver produces. It also measures the presence of antibodies or virus particles that could point to inflammation. These tests can be used to determine how well the liver is making proteins and secreting bile – two of its main functions.

Liver biopsy

A thin needle is inserted into your liver to remove a portion of liver tissue, which is then examined under a microscope.

This test is often used to determine the level of excess fat in the liver, chronic hepatitis, metabolic liver diseases such as Wilson’s disease (an excess of copper) and haemochromatosis (an excess of iron), and cancer that has spread to the liver. Liver biopsies are usually only considered after blood tests and imaging tests have failed to provide the doctor with the needed information.

A variety of imaging tests

Ultrasound - uses sound waves to produce images, but cannot show blood flow. For this Doppler ultrasound is used.  It measures and visualizes actual blood flow.

This is a non-invasive widely available image test that can provide information about the appearance and the blood flow of the liver. It should be the first test to be performed if liver disease is suspected, as it is the least expensive of the imaging tests and does not pose a radiation exposure risk.

CT and MRI scans

Computerised axial tomography (CT) and magnetic resonance imaging (MRI) are generally not very good at detecting changes in the form and structure of the liver affected by early cirrhosis. These tests are also very expensive. They are generally only used to determine changes in the liver in advanced cases of liver disease or to further image a growth in the liver.

Other diagnostic methods

A radioisotope is a harmless radioactive substance that highlights the liver and makes it possible for the doctor to see it clearly on a screen. There is also a laparoscopic (a thin lighted tube is put through a small incision to look at internal organs) procedure where an instrument relays pictures to a computer screen.

Reviewed by Dr. Mark W Sonderup, B Pharm, MB ChB, FCP (SA). Senior Specialist, Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town (January 2015).

Read more:

What is liver disease?
Symptoms of liver disease
Causes of liver disease

Image: Liver - Male anatomy of human organs - x-ray view from Shutterstock


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