Liver function tests are one of the most commonly requested ‘routine’ blood tests. The pattern of abnormal constituents of liver blood tests may provide a clue to the underlying diagnosis. Whilst this does not always offer an explanation for the original symptoms, it is important to investigate and diagnose any liver disease at an early stage.

Excess alcohol intake is the commonest cause of chronic liver disease. When harmful drinking or alcohol dependence is diagnosed, a thorough assessment of any established liver disease is crucial to determine long term prognosis and monitoring needs. The ongoing management requires a multi-disciplinary team input including hepatology, psychiatry/psycholology, and dietetics support.

Chronic Hepatitis B is an emerging problem in the developed countries, through increasing international air travel and migration. Hepatitis B is a virus that can be transmitted through blood or sexual contact. In individuals with no prior exposure to Hepatitis B, it is a preventable condition with a course of vaccination. Chronic Hepatitis B requires life long monitoring and anti-viral treatment in some cases. A specialist medical report may be necessary for immigration to certain countries.

Fatty liver disease, as the name suggests, occurs due to an excess amount of fat being stored in the liver cells. There are a few common clinical scenarios leading to the diagnosis of fatty liver disease:

• Patients may have blood tests showing by chance abnormal liver function tests (LFTs). Fatty liver is suspected due to increased body mass index (BMI) and/ or metabolic syndrome. 
• Patients who have blood tests showing abnormal LFTs undergo an abdominal ultrasound, and this shows fatty liver.
• Fatty liver is noted on imaging (ultrasound, CT or MRI liver) by chance, when the imaging was requested for other reasons.

The consideration or findings of fatty liver on imaging requires follow up. The patients should be further assessed for possible causes of fatty liver or Non-Alcohol related Fatty Liver Disease (NAFLD).

Fibroscan (also known as Transient Elastography) is a painless non-invasive alternative test to liver biopsy to evaluate the stage of liver fibrosis.

In this test, a mechanical pulse generated (at the surface of the skin) triggers propagation of an elastic wave (through the liver) whose velocity is measured by ultrasound. The velocity of the wave is governed by the hardness of the environment it crosses, in this case the stiffness of the liver, which directly correlates to the level of fibrosis. The harder the liver, the more severe the underlying fibrosis.