Pathophysiology
- Alcohol
- Non-alcoholic fatty liver disease (NAFLD)
- Viral hepatitis (B and C)
Clinical features
Signs
- Hepatocellular carcinoma (100%)
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