Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasonography of abdominal organs).
- For primary diagnosis [changes in liver texture indicate steatosis hepatis (fatty liver) or liver fibrosis; see liver sonography below].
- Secondary (in the course diagnostics) every 6 months for screening of hepatocellular carcinoma (HCC; hepatocellular carcinoma (liver cirrhosis is considered precancerous (possible precursor of cancer)!)
- Color duplex sonography (imaging technique that can dynamically visualize fluid flow (especially blood flow)) – to estimate portal hypertension/portal hypertension [signs are: Dilatation of the portal vein, decreased portal flow velocity, reversal of blood flow, abolished respiratory variability of the splenic and splanchnic veins]
- Magnetic resonance imaging of the abdomen (abdominal MRI); if necessary, with contrast medium – assignment of focal liver lesions (liver changes); for quantification of steatosis (fatty degeneration) in fatty liver and iron storage in hemochromatosis (iron storage disease).
- Computed tomography (CT) of the abdomen (abdominal CT) – for the assessment of focal liver lesions; in a quarter of the examinations, the early form is not recognizable; if necessary, implementation with contrast medium.
- Esophago-gastro-duodenoscopy (ÖGD; reflection of esophagus, stomach and duodenum) – to estimate the risk of variceal hemorrhage and estimate their bleeding risk.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, ie, that the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument))/ERCP (endoscopic retrograde cholangiopancreatography; procedure for visualizing and examining the bile and pancreatic ducts) – in cases of suspected obstruction of bile flow (gallstones, tumor)Note: ERCP is performed only when there is a clear therapeutic indication.
- Elastography (fibrosan; ultrasound procedure that measures the degree of connective tissue in the liver) – to assess the stage of liver fibrosis.
- Laparoscopy (abdominal play gel) – to assess the liver surface and biopsy if necessaryNote: use only when sonographic assessment is not sufficient.
- Liver puncture (liver biopsy) for histologic (fine tissue) examination; this is indicated for:
- Unclear etiology (cause) of liver disease and when.
- the stage of liver disease cannot be clearly designated by the following parameters:
- Diagnosis of liver cirrhosis clinically and by imaging (e.g., restriction of liver synthesis, decompensation signs with ascites (abdominal fluid)).
- Therapeutic consequences from the evidence of etiology.
Important notice. In the stage of liver cirrhosis, the etiology of a disease leading to liver cirrhosis is usually histologically impossible or difficult to determine.For more details on liver puncture see below the term of the same name.
Further notes
- In the adult Spanish population without known liver disease in which liver stiffness was measured by transient elastography (Fibroscan 402 system), higher liver stiffness (≥ 6.8 kPa) could be detected in up to 9% of the study participants; depending on the choice of cut-off value, a proportion between 3.6% and 9% could be detected[1].
