LIVER INFORMATION
Frequently Asked Questions
The Questions we are asked most often:
- What is acute liver disease?
- What is chronic liver disease?
- What is cirrhosis?
- What is a Liver Biopsy?
- What is a CT scan?
- What is an MRI scan?
- What is an ultrasound scan?
- How long will it take before I know what is wrong with me?
- Do I need to be on a special diet with liver disease?
What is acute liver disease?
A person develops acute liver disease over a short time period, between a week and six months with associated symptoms including extreme nausea and vomiting and abdominal pain from swelling of the liver. If the symptoms of yellowing of the eyes and confusion occur then this is termed Fulminant Hepatic Failure (FHF) and indicates that the progress of the disease may be more extensive and you should see a Hepatologist immediately. The causes of acute damage vary but include paracetamol poisoning, hepatitis A and B and reactions to certain drugs and foods. It may even be that a dormant liver condition develops suddenly. It is vital that a patient gets a prompt referral to a liver centre with access to a transplant service if they are suspected of having acute liver disease or FHF.
What is chronic liver disease?
This is liver disease that is seen when the liver has abnormal test results over a longer time frame, typically taking up to 10 years to establish true chronicity. Chronic liver disease may go on to form liver cirrhosis but this is not true of all chronic liver disease and close monitoring of the liver will establish whether this has happened.
What is cirrhosis?
A cirrhotic liver being removed prior to liver transplantation.
Cirrhosis is the term used to describe scarring of the liver tissue whilst the healthy parts of the liver have tried to regenerate and therefore created a nobbly appearance to the surface of the liver. Cirrhosis occurs when the liver has been chronically unwell for many years, typically 20-30 years and it does not relate to any particular cause of liver disease.
What is a Liver Biopsy?
There are two types of biopsy – Transjugular and Percutaneous
- Transjugular liver biopsy:
Transjugular Liver Biopsy is a biopsy of your liver tissue done in the X-ray department. A needle is placed via a vein in your neck down to your liver and a piece of tissue is taken internally. You will be given a mild sedative to make you a little sleepy but you should still be aware of your surroundings. The best thing about this form of liver biopsy is the reduction in risks and side effects. Following the biopsy you return to the ward on bed rest for approximately 4 hours. You can eat and drink as soon as you feel you want to and should be fit for discharge six hours after your biopsy has taken place. Another advantage of this form of liver biopsy as it can be carried out on a day case basis and if you are admitted at 8am you should be able to be discharged by 2pm. Overall there are huge advantages to being able to offer the Transjugular liver biopsy service. It can be performed regardless of clotting result (although there are limits to this) and it is generally less painful than the percutaneous route. - Percutaneous liver biopsy:
A percutaneous liver biopsy is carried out under local anaesthetic. It involves a needle being inserted between the lower ribs of your chest on the right hand side. The whole procedure can take less than 20 minutes from start to finish. Afterwards you will be on bed rest for 6 hours at the beginning of which you will be positioned on your right side to compress the area and so reduce the likelihood of bleeding. You will need to stay in hospital 8 hours after your biopsy and the potential risks are slightly greater with this form of biopsy than with a Transjugular approach; however this is dependent upon who performs the biopsy.
What is a CT scan?
A CT scan of the abdomen showing the abdominal structures
A CT Scan (Computerised Axial Tomography) is a painless and very fast procedure that requires 6 hours fasting prior to the scan. It shows a cross section of the liver anatomy and gives us accurate measurements of the segments that make up the liver. During the test you will lie on a bench that moves slowly through a scanner circle. Multiple X-ray beams pass through human tissue giving a picture. These pictures give the doctors a very clear picture of the state of the liver and allow us to visualize the biliary and vascular anatomy. You may have a dye injected into a vein to give more accurate images.
What is an MRI scan?
An MRI of the bile duct system
An MRI scan (magnetic resonance imaging) takes between 30-45 minutes. It is a painless procedure that requires 4 hours fasting prior to the scan. It shows a cross section of the liver anatomy and gives us accurate measurements of the segments that make up the liver. You will be asked to remove any metal jewellery and drink an iodinated contrast medium (this is similar to an orange drink) which enables the liver, blood vessels and bile ducts to be clearly seen.
NB: if you are diabetic you must stop your Metformin for 24 hours pre scan and 48 hours post scan, you will be advised further on this on admission. You cannot have an MRI if you have a metal prosthesis of any kind internally, this includes a pacemaker and any pins in joints for example hip joints.
What is an ultrasound scan?
This is a procedure involving an ultrasound scanner being passed across the abdominal wall. A jelly solution, is applied over your stomach allowing the scanning head to glide gently over your skin. The ultrasound allows accurate measurements of the dimensions of the liver, spleen, portal vein and gall bladder. The radiologist will also look for the presence of cysts, stones or other abnormalities. Blood flow of the portal vein, hepatic artery and vein is also checked using a Doppler attachment. To prepare for this test you should not drink or eat any products containing milk for up to 8 hours prior to the test. You will also have nothing to eat or drink for four hours prior to the test.
How long will it take before I know what is wrong with me?
This really depends on your individual health history. Using the specialist skills of Physicians, Surgeons, Radiologist, and Histopathologists, we diagnose and begin treatment on a majority of patients within a two week period. The timing also relies on the completion of often very complex blood tests.
Do I need to be on a special diet with liver disease?
The most important thing to remember is that if you have cirrhosis of the liver you are liable to lose body weight and muscle strength and therefore it is essential to maintain a balanced diet that includes dairy and protein from animal sources (i.e. meat, chicken, milk, eggs and fish) as well as starchy foods and fruit and vegetables. It is vital for you to be able to consume enough nutrition and calories in sufficient quantities to prevent poor nutrition and its side effects and the best way of achieving this is to eat a varied and protein rich diet. If you are unable to eat an adequate diet you may require nutritional supplements which can be prescribed by your doctor or dietitian. If you have the symptom of ascites (fluid in the abdominal cavity) we would ask that you limit your salt intake by not adding salt onto foods or use it in cooking, however you should not restrict the types of foods that you eat. If you have any further questions about nutrition please contact us or a dietitian who has experience in caring for people with liver disease.