Chronic liver disease is a major problem in the
United States with over 4 million people infected
with Hepatitis C alone. Many of these patients
show no signs or symptoms of disease. When
patients become symptomatic it is often too late
for treatment and these patients may require
liver transplant evaluation. Patients with any of
the following should be screened for chronic
liver disease:
- a history of blood transfusion prior to 1992
- previous use of injection drugs or
intranasal cocaine
- multiple sexual partners
- birth or parental birth in Asia, Africa,
Eastern Europe or the Mediterranean
- history of arthritis or abnormal liver tests
- family history of liver disease
All patients should be screened for excessive
alcohol use with a CAGE questioner. By judicious
screening of a healthy population, much liver
disease can be discovered in the presymptomatic
stages and treatments can be offered for
viral hepatitis, alcoholic liver disease, early
cirrhosis, and autoimmune and inherited forms
of liver disease.
When patients become symptomatic from
chronic liver disease with the development
of jaundice, ascites, encepholopathy, muscle wasting, gastrointestinal bleeding or
coagulopathy, they need to be referred to a
liver transplant center regardless of their age or
etiology of liver disease. Many of these patients
could be candidates for liver transplantation
which is a life-saving procedure.
Most patients with symptomatic liver disease
will not live three years, and half of those with
severe symptoms will not live six months without
a liver transplant. With proper management, the
majority (over 80 percent) of those selected for
the Liver Transplant List will survive to receive
a transplant. Of these, 90 percent will survive
one year after the transplant, and 80 percent
will survive five years after liver transplant with
excellent quality of life.
One of the most dreaded complications of chronic
liver disease is the development of Hepatocellular
carcinoma. Currently, all patients with cirrhosis
should be screened at least every six months with
Alpha-Fetoprotein and ultrasound to detect early
Hepatocellular carcinomas. Small cancers can be
resected from noncirrhotic livers, while tumors
in cirrhotic livers will usually be managed with
liver transplantation. All patients with liver cancer
should be referred to a transplant center where
optimal management strategies are available.
Patients with the Following Conditions Should be Referred to Hepatology
- Hepatitis C
- Active Hepatitis B (Hepatitis B surface antigen positive)
- Symptomatic liver disease (ascites, jaundice, muscle wasting, severe
fatigue, etc.)
- Elevated Alfa-Fetoprotein
- Liver masses seen on ultrasound, CT or MRI
- Abnormal liver tests and Inflammatory Bowel Disease
- Cirrhosis of the liver, if the patient wants to be considered for liver
transplantation
- Chronic liver disease such as Primary Sclerosing Cholangitis and
Primary Biliary Cirrhosis
- Autoimmune Hepatitis
- Benign and Malignant Strictures of the Bile Ducts
- Non-Alcoholic Fatty Liver (NAFL or NASH)
Patients with the Following Should be Referred for Transplant Consideration
- Symptomatic Liver Disease
- Abstinent Alcoholic Liver Disease with Cirrhosis
- Viral Hepatitis with Cirrhosis
- Cirrhosis with liver mass on imaging study
- Cirrhosis with acute or chronic gastrointestinal bleeding
- Ascites that does not respond to diuretics
- Patients with liver disease and encephalopathy
- Budd-Chiari Syndrome
- Metabolic Diseases such as Hemochromatosis, Wilsons Disease,
Primary Oxalosis, alfa-1 anti-trypsin deficiency, Glycogen
storage disease
- Symptomatic Polycystic Liver Disease