Liver cells under the microscope

Diagnosis of cirrhosis – new approaches to liver disease detection

Your humble liver could be described as the human body’s hard-working janitor – it furiously mops up compounds in our blood left over once the body metabolises everything we ingest.
Rates of liver disease are rising globally and pathology is central to detection and reducing risk of serious damage.

Liver damage can be caused by viral infections, drugs of abuse, long-term medication and chronic alcoholism. Over time, the cells die and form scar tissue called fibrosis. Severe fibrosis is called cirrhosis and often requires a liver transplant. Prospective Victorian Senator and media personality Derryn Hinch knows this only too well.

Traditional blood tests to indicate liver health include

  • ALT, AST, ALP are enzymes found in high concentrations in liver cells. When a liver cell dies, its cell membrane splits, releasing its contents into the blood stream. High levels of the enzymes indicate damage.
  • Bilirubin is a pigment from dying blood cells as they pass through the liver.
  • GGT is another liver enzyme that increases when the bile duct is blocked- sometimes indicating alcohol-related damage.

These tests provide an indication of liver health, but sometimes doctors will need more information via a liver biopsy – an involved procedure usually reserved for patients with serious liver disease.

New blood tests are beginning to replace biopsy for evaluation of fibrosis and cirrhosis. Recently the Enhanced Liver Fibrosis (ELF) test has become available in Australia, and provides a clear picture of damage from non-alcoholic fatty liver disease. The test developer, London-based Professor William Rosenberg, says:

“Chronic liver disease is the fifth most common cause of death in Britain. Of those top five causes, it is the only one that is on the rise. By the time symptoms of liver disease appear, it can be too late to repair damage. Catching liver damage early gives the patient a better chance of avoiding transplantation.”

Dr Rosenberg is presenting study findings on the ELF test at the AACB/AIMS meeting in Brisbane in September.

Australian medical research continues to make advances in liver disease diagnosis. HepaScore is a formula developed through a Perth based collaboration between Hepatologists and the PathWest Pathology laboratory. The HepaScore formula is based on a series of four blood test results that together with age and sex of the patient gives doctors a score from 0-1.0 to predict the amount of fibrosis present. The formula is becoming popular among Western Australian doctors working in hospitals.