The liver is the body’s “chemical factory”: it detoxifies the blood and produces, processes, and stores important substances. The bile it produces is used to absorb fats in the intestines and to eliminate metabolic waste products. Humans can exist without a gallbladder, but not without a liver. Nevertheless, liver diseases usually cause symptoms at a late stage.
Warning signs and symptoms
If problems occur in a chemical plant, it can show up in a number of places: If there are leaking valves or leaks, substances that don’t belong there get into the cooling water. If pipes are blocked, substances back up. If the machines no longer work properly, the materials are produced in the wrong composition. The warehouses in the factory are no longer filled up correctly or with the wrong products. Thus, with some delay, effects on the environment can be observed: Fish swim belly up in the river to which the cooling water is fed, or plants that come into contact with the altered chemicals become sick. Something similar happens to the liver: if tissue is destroyed – for example, by an inflammation – substances from the liver cells enter the blood and can be detected there. If the function of the liver declines, empty storage rooms appear for the reduced substances or the initial products accumulate because they cannot be processed properly. This can also be detected primarily in the blood. Nonspecific warning signals are often overlooked at first – only when effects on other organs such as the skin, spleen and brain also become apparent is the disease properly noticed. Liver symptoms are quite nonspecific, especially in the beginning:
- Fatigue and difficulty concentrating,
- Depressed mood,
- A feeling of tension in the upper abdomen,
- Loss of appetite and nausea
include. Itching, yellowing of the skin and conjunctiva, dark urine and pale stools, water retention in the abdomen, pain of muscles and joints, nosebleeds and bruising, and – in men – reduced growth of chest and abdominal hair usually appear later.
Basic diagnostics
First of all, there is the question of which doctor should be consulted for the examination of the liver and bile ducts. Mainly, a gastroenterologist deals with diseases of the liver, gallbladder, as well as the gastrointestinal tract. A hepatologist specializes exclusively in the liver and gall bladder. During the physical examination, the affected person usually lies. Externally visible signs of disease (inspection) include water retention, yellowish conjunctivae of the eyes, and scratch marks or vascular spiders on the skin. During palpation and percussion, the physician can examine the liver and gallbladder under the right costal arch and check whether they are sensitive to pain. If he uses his stethoscope for listening at the same time (auscultation), he can also assess bowel sounds and major water retention.
Determination of liver values
Basic diagnostics also include determining the so-called liver values. These include the transaminases (ALAT = GPT, ASAT = GOT), gamma-GT, and alkaline phosphatase (AP). These are also determined in most routine blood tests, as they are well suited to provide initial indications of liver disorder or biliary congestion. If they are elevated, more specific tests must follow.
Functional tests
Because the liver is involved in a variety of metabolic processes, its performance can only be assessed by looking at a number of tests together. Blood tests play the most important role in this regard:
- Bilirubin: The bile pigment is often elevated because it is no longer modified by the liver so that it can be excreted via the bile and intestines. Bilirubin can also no longer drain properly due to gallstones or tumors. Instead, it remains in the blood, deposited in the eyes and skin, and leads to jaundice.
- Cholinesterase: this enzyme is normally produced by liver cells and released into the blood. It is therefore decreased in dysfunction.
- Ammonia: This metabolic end product is no longer sufficiently excreted in liver disorders, such as cirrhosis, and thus accumulates throughout the body. In the brain, it leads to brain disorders.
- Albumin / proteins: Decreased liver function also means decreased synthesis of proteins. These are therefore – in certain constellation – reduced in the blood.
- Quick value (or INR value): many clotting factors are produced in the liver. If their production is disturbed, the clotting parameters such as the Quick value change accordingly.
- Platelets (thrombocytes): since as a result of liver failure is often also the spleen enlarged, the platelets there are increasingly degraded. This also leads to clotting disorders.
- Bile acids: Like bilirubin, these are no longer sufficiently excreted. Due to this bile stasis (cholestasis), the components of bile rise in the blood and can lead to itching.
- Vitamins: To absorb vitamins A, D, E and K from the intestine, you need an intact fat metabolism. This is often disturbed in liver disease. In alcohol abuse are often also vitamin B, folic acid and trace elements such as zinc reduced.
- Blood sugar: sugar is absorbed into the blood via the liver and intestines. It is not uncommon in the advanced stage of liver disease to disturbances in sugar metabolism up to diabetes mellitus.
- Electrolytes: salts such as sodium and potassium may be decreased or in excess in the blood.
The extent of liver failure and prognosis can be assessed using a classification system (according to Child-Pugh) – for this purpose, three laboratory values (bilirubin, albumin, INR value) and two clinical findings (abdominal fluid, brain dysfunction) are related to each other and divided into points. The point values of the classification system mean the following:
- 5 to 6 points: good liver function (stage A).
- 7 to 9 points: moderate liver function (stage B).
- > 10 points: low liver function (stage C).
