The basic diagnosis
The physical examination is usually done on the patient lying down. Outwardly visible signs of disease (inspection) are eg water retention, yellowish conjunctiva of the eyes and scratch marks or vascular spider on the skin. During palpation and percussion, the doctor can examine the liver and gallbladder under the right costal arch and see if they are sensitive to pain. At the same time he uses his stethoscope for listening (auscultation), he can also assess the bowel sounds and larger water retention.
Determine the liver values
The basic diagnosis also includes the determination of the so-called liver values,
- Transaminases (ALAT = GPT, ASAT = GOT),
- alkaline phosphatase (AP).
These are co-determined in most routine blood tests as they are well suited to give initial evidence of a liver disorder or gallbladder infection. If they are elevated, more specific tests must follow.
Since the liver is involved in a variety of metabolic processes, their performance can only be assessed in the synopsis of various tests. The most important role is played by blood tests:
- Bilirubin: The bile pigment is often elevated because it is no longer altered by the liver so that it can be excreted via the bile and the intestine. Instead, it stays in the blood, deposits in the eyes and skin and causes jaundice.
- Cholinesterase: This enzyme is normally produced by the liver cells and released into the blood. It is so degraded in case of malfunction.
- Ammonia: This metabolic end product is no longer sufficiently eliminated in liver disorders and thus accumulates in the entire body. In the brain, it leads to brain disorders.
- Albumin / Proteins: A reduced liver function also means a reduced synthesis of proteins. These are therefore - in a certain constellation - reduced in the blood.
- Quick value (or INR value): Many coagulation factors are produced in the liver. If their production is disturbed, the coagulation parameters change in the same way as the Quick value.
- Platelets: As the spleen is often enlarged due to liver failure, platelets are increasingly degraded there. This too leads to coagulation disorders.
- Bile acids: These, like bilirubin, are no longer excreted, increase in the blood and can lead to itching.
- Vitamins: In order to take up the vitamins A, D, E and K from the intestine, one needs an intact lipid metabolism. This is often disturbed in liver diseases. Alcohol abuse often reduces vitamin B, folic acid and trace elements such as zinc.
- Blood sugar: Not infrequently it comes in the advanced stage to disorders in the sugar metabolism up to a diabetes mellitus.
- Electrolytes: Salts such as sodium and potassium may be reduced or in excess in the blood.
The extent of liver failure and the prognosis can be assessed with a classification system (according to Child-Pugh) - three laboratory values (bilirubin, albumin, INR value) and two clinical findings (ascites, brain disorders) are related to each other.
With liver scintigraphy it is possible to assess the liver function, the bile flow and the flow through the liver vessels with the aid of radioactively marked red blood cells.