Expert Treatment for Diseases of the Liver
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The hepatologists at University Hospitals Digestive Health Institute have extensive experience treating the full spectrum of liver conditions and diseases. Our team of hepatologists, liver surgeons, gastroenterologists, interventional radiologists and other other specialists uses state-of-the-art diagnostic techniques and some of the most advanced treatment options to treat the following conditions:
- Alcohol-associated liver disease
- Alcohol-related hepatitis
- Alpha-1 antitrypsin deficiency
- Autoimmune hepatitis
- Benign liver tumors
- Drug-induced liver disease
- Fatty liver disease
- Liver cancer
- Liver failure
- Primary biliary cholangitis (PBC)
- Primary sclerosing cholangitis (PSC)
- Viral hepatitis (A, B, C, D, E)
- Wilson’s disease
Advanced Diagnostic Techniques for Liver Disease
When a patient comes to UH with symptoms of liver disease, a multidisciplinary team will collaborate so that an accurate diagnosis can be made. A variety of advanced diagnostic tests and interventional techniques may be used to determine the type and severity of the liver disorder. Diagnostic tests and procedures include:
- Blood Tests
Your liver provider will run a variety of blood tests including a liver panel to measure certain enzymes and proteins in your blood as well as bilirubin levels – bilirubin is a waste product that forms when red blood cells break down. Too much bilirubin in your blood can result in jaundice (yellowing of the skin and eyes) which is a common symptom of liver disease. Low blood platelets may also be indicators of liver disease.
- Imaging Tests
Computed tomography (CT) scan
A CT scan can provide important information about the liver and is especially useful in finding tumors, abscesses (collections of pus) and other disorders including fatty liver disease.
The Fibroscan liver exam, is a noninvasive, pain-free test used to measure the stiffness of the liver. Liver stiffness, helps your provider determine the best course of treatment and can help your provider monitor your liver condition.
You will be asked to lie down on your back with your right arm raised and tucked behind your head. A clinician will place a probe, similar to an ultrasound probe, on your side near where your liver is. The probe sends painless vibration through your body into your liver, measuring the velocity, or how fast it takes the vibration to travel through the liver. The longer it takes the vibration to travel through the liver, the stiffer the liver.
Results from your exam will be sent to our hepatology providers for interpretation. Your provider will contact you with the results from your exam.
Magnetic resonance imaging (MRI)
MRI scans are useful for detecting a variety of liver disorders. This test provides information about the appearance of the liver and its structures (such as bile ducts) and blood flow through the liver. MRI can detect iron deposits, fatty deposits, and tumors. Unlike X-rays and CT scans, MRI scans do not use radiation.
Ultrasound is a completely noninvasive procedure that uses sound waves to obtain images of the liver and surrounding structures. Ultrasound can also help determine if jaundice (yellowing of the skin and/or eyes) is being caused by blocked bile ducts or by liver disease. Ultrasound technology may also be used to help guide needle insertion when the doctor is performing a biopsy of the liver.
A biopsy is a procedure to remove a small amount of tissue so that it can be studied under a microscope. A liver biopsy can help identify the type and extent of liver disease. Your doctor will perform the biopsy by inserting a thin needle into your liver to remove a small sample of tissue. The procedure is done with a local anesthetic and light sedatives so you shouldn’t feel pain, although you may feel some pressure or mild discomfort. The tissue sample is then analyzed by a UH pathologist using the most advanced lab tests available.
- Endoscopic Procedures
Endoscopy is a nonsurgical procedure that allows a doctor to examine the inside of a person’s digestive tract using a flexible tube (endoscope) with a light and camera attached to the end.
As part of the diagnostic workup for liver disease, our experienced specialists may perform an upper endoscopy to examine the esophagus, stomach and the beginning of the small intestine (duodenum). And, because some liver diseases may put you at higher risk for colorectal cancer, your doctor may also perform a colonoscopy which examines the rectum and large intestine (colon) to look for changes and abnormalities. During an endoscopic procedure, your doctor may also collect tissue samples to examine under a microscope (biopsy).
Endoscopic procedures are always done under some degree of sedation to ensure the patient is relaxed and comfortable. Many people report having no memory of the procedure.
A common symptom of advanced liver disease is ascites – an abnormal collection of fluid in the abdomen that can cause swelling, pain, difficulty breathing and even infection. Paracentesis is a procedure to remove this fluid and alleviate these symptoms. The fluid that is removed may also be examined in the lab to help determine if the ascites is caused by liver disease or other organ failure such as heart disease or kidney disease and the type and extent of the disease.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
In some cases of advanced liver disease, it may be necessary to place a shunt to lower the pressure around the liver. This shunt is called a transjugular intrahepatic portosystemic shunt (TIPS). This procedure is most often necessary in patients with severe internal bleeding due to enlarged veins in the esophagus (varices) or severe ascites, which is fluid buildup and swelling in the abdomen.
University Hospitals Has the Expertise to Treat Liver Disease
Sometimes, if caught early enough, liver problems can be managed or even reversed with lifestyle changes or medications. For example, the elimination of all alcohol intake, may allow the liver to heal if the damage is not too advanced. The liver is very resilient and can regenerate itself – producing new cells over time.
However, for many patients who are experiencing symptoms of liver disease, lifestyle changes may not be enough and medications and/or surgery may be necessary.
Medications for the Management of Liver Disease
The recommended medications to treat liver disease will depend on the type of liver disease and may include corticosteroids, anti-viral drugs, water pills, laxatives to eliminate toxins such as ammonia and more.
When medications are part of the total treatment plan for liver disease, it is very important that they be taken exactly as prescribed. However, some medications are expensive and may be difficult for some patients to obtain and/or afford. The liver specialists at University Hospitals work in tandem with the UH Specialty Pharmacy to assist UH patients in obtaining these medications in a timely and affordable manner. The pharmacy team will investigate benefits and work with the patient to provide the medication through the patient’s insurance plan and help facilitate medical benefit approval.
Surgical Treatment Options for Liver Disease
When surgery is required as part of the treatment plan, University Hospitals has a team of expert surgeons with advanced training and experience in performing the full spectrum of surgical procedures for liver disease.
For some patients with end-stage liver disease, liver transplantation may be their best treatment option.
Clinical Trials and Research
In collaboration with the Case Western Reserve University School of Medicine, the UH Digestive Health Institute is involved in ongoing clinical research related to liver disease. This research provides us with a path forward to develop new technology and innovations to provide our patients with the most advanced, value-based care and improved outcomes. For some patients, participation in a clinical trial is a part of their treatment plan.
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