Pathophysiology

Clinical features

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