2. Initial Diagnosis, Workup, and Assessment of Severity of Liver Disease in Adults

Summary

A complete history and physical examination will indicate to the clinician several clues with regard to both etiology and severity of any liver disease. Initial assessment and workup of liver disease involves widely available blood tests to determine hepatocellular versus cholestatic liver disease. Liver function tests such as INR and total bilirubin confirm the degree of liver synthetic dysfunction and indicate the need for liver transplantation, particularly in those with acute liver failure. A carefully performed abdominal ultrasound can detect, but not exclude, cirrhosis. Evaluation of the degree of liver dysfunction can be made with simple blood tests. At present, liver biopsy, despite its limitations, remains the gold standard for evaluation of hepatic fibrosis. Non-invasive testing, including FibroTest and FibroScan, may reduce the need for biopsy, but they have not been validated across the spectrum of liver disease. Child–Turcotte–Pugh and Model for End-stage Liver Disease scores offer the best estimate of survival of cirrhotic patients and are used as a guide for the timing of transplant for non-malignant liver disease and risk assessment for perioperative complications for those who have liver disease but require non-hepatic surgery.