Liver Function Tests (LFT's)
a collective term for a number of different liver tests which give us
information about the health (or otherwise) of various parts of the
AST -aspartate aminotransferase
ALT -alanine aminotransferase
GGT- gamma glutamyltransferase
Cirrhosis of the Liver
What is cirrhosis?
is the result of chronic longstanding damage to the liver. This damage
leads to the development of scar tissue which replaces healthy liver
tissue. As a result of the scaring and disruption of the normal
structure of the liver, blood can not flow through the liver as it
should which leads to problems. Scarring also impairs the liver’s
of being smooth, this image shows a typical liver that
cirrhosis and has been removed at the time of
liver transplantation. The
liver has numerous large nodules
(macronodular cirrhosis) and a
distorted shape due to the
constant regeneration of the liver cells.
What causes cirrhosis?
Cirrhosis has various causes. In the UK,
heavy alcohol consumption is the commonest cause of cirrhosis. Other
common causes are chronic hepatitis C and hepatitis B, some inherited
liver diseases and auto-immune liver diseases (where the body produces
antibodies which lead to damage of its own liver) . Obesity is becoming a
common cause of cirrhosis especially when associated with diabetes, but
also as a sole cause or in combination with alcohol, hepatitis C, or
both. Many people with cirrhosis have more than one cause of liver
is not caused by trauma to the liver or other acute, or short-term,
causes of damage. Usually years of chronic injury are required to cause
What are the symptoms of cirrhosis?
the early stages of the disease (which may last many years) most people
with cirrhosis have no symptoms . However, as the disease progresses
and gets more advanced, a person may experience the following symptoms:
What are the complications of cirrhosis?
liver function deteriorates, one or more complications may develop. In
some people we may only discover they have cirrhosis when they present
with one of the following complications:
Oedema and ascites:
When liver damage progresses to an advanced stage, fluid collects in
the legs, called oedema, and in the abdomen, called ascites. The
presence of ascites means the patient may develop bacterial peritonitis,
a serious infection arising in this fluid.
This image shows a patient with large ascites and distended veins on the abdomen.
Bruising and bleeding: When the liver slows or stops producing the proteins needed for blood clotting, a person will bruise or bleed easily.
Normally, blood from the intestines and spleen is carried to the liver
through the portal vein (see above) but in patients with cirrhosis the
normal flow of blood slows down because the blood finds it difficult to
flow though the scarred liver. This increases the pressure in the portal
vein. This condition is called portal hypertension and leads to the
development of ascites, oesophageal varices and splenomegaly (see below)
Oesophageal varices and gastropathy:
When portal hypertension occurs, it may cause enlarged blood vessels in
the oesophagus (gullet), called varices, or in the stomach, called
gastropathy, or both. Enlarged blood vessels are more likely to burst
due to thin walls and increased pressure. If they burst, serious
bleeding can occur in the oesophagus or upper stomach, requiring
immediate medical attention.
The left hand image is of a normal lower oesophagus and on the right is another
lower oesophagus with 4 columns of tortuous large varices.
When portal hypertension occurs, the spleen frequently enlarges and
holds white blood cells and platelets, reducing the numbers of these
cells in the blood. A low platelet count may be the first evidence that a
person has developed cirrhosis.
Jaundice occurs when the diseased liver does not remove enough
bilirubin from the blood, causing yellowing of the skin and whites of
the eyes and darkening of the urine. Bilirubin is the pigment that gives
bile its reddish-yellow colour. Jaundice does not occur in all liver
diseases and many patients with cirrhosis do not have jaundice.
Sensitivity to medications:
Cirrhosis slows the liver’s ability to filter medications from the
blood. When this occurs, medications act longer than expected and build
up in the body. This causes a person to be more sensitive to medications
and their side effects.
A failing liver cannot remove toxins from the blood, and they
eventually accumulate in the brain. The build-up of toxins in the
brain—called hepatic encephalopathy—can decrease mental function and
eventually cause coma. Signs of decreased mental function include
confusion, personality changes, memory loss, trouble concentrating, and a
change in sleep habits. Encephalopathy can occur rapidly in response to
infection, bleeding, abnormal levels of blood sodium or potassium or
even constipation. If these are treated then the encephalopathy can
often be reversed.
Hepatocellular carcinoma is a type of liver cancer that can occur in
people with cirrhosis. Hepatocellular carcinoma has a high mortality
rate, but several treatment options are available. Some patients with
cirrhosis are screened every 6 months with an ultrasound scan and a
special blood test called AFP (alpha-foetoprotein)
Cirrhosis can cause immune system dysfunction, leading to the risk of
infection. Cirrhosis can also cause kidney and lung failure, known as
hepatorenal and hepatopulmonary syndromes
How is cirrhosis diagnosed?
diagnosis of cirrhosis is usually based on the presence of a risk
factor for cirrhosis, such as alcohol use or obesity, and is confirmed
by physical examination, blood tests, and scans. The doctor will ask
about the person’s medical history and symptoms and perform a physical
examination to observe for clinical signs of the disease. For example,
on abdominal examination, the liver may feel hard or enlarged with signs
of ascites. The doctor will order blood tests that may be helpful in
evaluating the liver and increasing the suspicion of cirrhosis.
view the liver for signs of enlargement, reduced blood flow, or
ascites, the doctor may order an ultrasound scan (USS), computerized
tomography (CT) scan or magnetic resonance imaging (MRI) scan. If available locally your doctor may be able to perform a Fibroscan to assess your liver for the presence of fibrosis and cirrhosis.
liver biopsy can confirm the diagnosis of cirrhosis but is not always
necessary. A biopsy is usually done if the result might have an impact
on treatment. The biopsy is performed with a needle inserted between the
ribs or into a vein in the neck. Precautions are taken to minimize
discomfort. A tiny sample of liver tissue is examined with a microscope
for scarring or other signs of cirrhosis. Sometimes a cause of liver
damage other than cirrhosis is found during biopsy.
How is the severity of cirrhosis measured?
are many different ways of measuring severity of liver cirrhosis. One
of the commonest and longest used system is measurement of the
Child-Pugh Score. Five
variables are considered: presence of ascites, encephalopathy, serum
levels of albumin, total bilirubin, and prolongation of the clotting
time. Each of these variables is assigned a score between 1 and 3
according to its severity or degree of abnormality. The scoring system
was originally used to predict mortality of cirrhotic patients with
regard to shunt surgery but later any type of surgery. Nowadays, the
Child-Pugh score is used to assess prognosis of cirrhotic patients in
Moderate or Severe
Bilirubin in Primary Biliary Cirrhosis (micromole/L)
The sum of the five scores from the above table is used to assign a “Child-Pugh grade” (also known as a Child’s grade) of A, B or C to the patient’s clinical condition at that point in time. This grade is used to gauge mortality using the following table:
Indicates a well functioning liver
Indicates significant functional compromise
Indicates decompensation of the liver
There are a number of other scoring systems currently in use for patients with cirrhosis such as the MELD score (Mayo End Stage Liver Disease Score- make sure you use the correct units in this calculator) PELD, MELD Na,etc.
How is cirrhosis treated?
for cirrhosis depends on the cause of the disease and whether
complications are present. The goals of treatment are to slow the
progression of scar tissue in the liver and prevent or treat the
complications of the disease. Some diseases that cause cirrhosis can
be cured and thus stop the cirrhosis progressing. Examples of this would
be people who stop drinking, patients with hepatitis C who may be cured
of this virus with treatment. Some diseases such as autoimmune liver
diseases and hepatitis B can be controlled for many years with
medication. However there are some liver diseases that we don’t have any
treatment for and these diseases are slowly progressive.
Hospitalisation may be necessary for cirrhosis with complications.
When is a liver transplant indicated for cirrhosis?
liver transplant is considered when complications cannot be controlled
by treatment. Liver transplantation is a major operation in which the
diseased liver is removed and replaced with a healthy one from an organ
donor. A team of health professionals determines the risks and benefits
of the procedure for each patient. Survival rates have improved over the
past several years because of drugs that suppress the immune system and
keep it from attacking and damaging the new liver.
number of people who need a liver transplant far exceeds the number of
available organs. A person needing a transplant must go through a
complicated evaluation process before being added to a long transplant
waiting list. Generally, organs are given to people with the best chance
of living the longest after a transplant. Survival after a transplant
requires intensive follow-up and cooperation on the part of the patient
Alcohol and the Liver
If you want information on alcohol, visit NHS Choices or go to NHS Choices via this link-
Units of alcohol calculator