Studies of the liver and bile ducts

The liver is the body’s “chemical factory”: It detoxifies the blood and produces, processes and stores important substances. The bile it produces is used to absorb fat in the intestine and to excrete metabolic waste. Humans can exist without a gallbladder, but not without a liver. Nevertheless,  liver diseases  usually only cause symptoms at a later stage.

Warning Signs and Symptoms

If problems occur in a chemical plant, this can show up at various points: If there are leaking valves or leaks, substances that do not belong there get into the cooling water. If pipes are closed, substances back up. If the machines no longer work properly, the materials are produced in the wrong composition.

The warehouses in the factory are no longer filled correctly or with the wrong products. Effects on the environment can be observed with a slight delay: the fish swim belly up in the river to which the cooling water is fed, or plants that come into contact with the modified chemical agents become ill.

Something similar happens with the liver: If tissue is destroyed – for example by an inflammation – substances from the liver cells get into the blood and can be detected there. If the function of the liver decreases, empty storage halls appear for the substances formed in reduced amounts or the starting products accumulate because they cannot be processed properly. This can also be demonstrated above all in the blood.

Unspecific warning signals are often overlooked at first – the disease is only correctly perceived when effects are also evident in other organs such as the skin, spleen and brain. Liver symptoms  are quite unspecific, especially at the beginning:

  • tiredness and lack of concentration,
  • gloomy mood,
  • a feeling of tightness in the upper abdomen,
  • loss of appetite and  nausea

belong to. Itching , yellowing of the skin and conjunctiva,  dark urine  and light-colored stools, fluid retention in the abdomen, pain in muscles and joints, nose bleeding and bruising and – in men – reduced growth of chest and abdominal hair usually only appear later.

The basic diagnostics

First of all, the question arises as to which doctor should be consulted for the examination of the liver and bile ducts. A gastroenterologist primarily deals with diseases of the liver, the gallbladder and the gastrointestinal tract. A hepatologist specializes exclusively in the liver and bile.

During the physical examination, the person concerned usually lies down. Externally visible signs of illness (inspection) are, for example, water retention, yellowish conjunctiva of the eyes and scratch marks or spider veins on the skin. With palpation and tapping (percussion), the doctor can examine the liver and gallbladder under the right costal arch and check whether they are sensitive to pain. If he uses his stethoscope to listen (auscultation) at the same time, he can also assess the intestinal noises and larger water retention.

Determination of liver values

The basic diagnosis also includes the determination of the so-called liver values. These include the transaminases (ALAT = GPT, ASAT = GOT), gamma-GT and alkaline phosphatase (AP). These are also determined in most routine blood tests, as they are well suited to provide the first indications of a liver disorder or bile stasis. If they are elevated, more specific tests must follow.

functional tests

Since the liver is involved in a large number of metabolic processes, its performance can only be assessed by looking at various tests together. Blood tests play the most important role here:

  • Bilirubin:  The bile pigment is often elevated because it is no longer modified by the liver in such a way that it can be excreted via the bile and the intestines. Gallstones or tumors also prevent bilirubin from draining properly. Instead, it stays in the blood, lodges in the eyes and skin, and causes  jaundice .
  • Cholinesterase:  This enzyme is normally produced by the liver cells and released into the blood. It is therefore reduced in the event of functional disorders.
  • Ammonia:  This metabolic end product is no longer sufficiently excreted in liver disorders such as  liver cirrhosis and thus accumulates throughout the body. In the brain, it leads to cerebral performance disorders.
  • Albumin / proteins:  Reduced liver function also means reduced synthesis of proteins. These are therefore – in a certain constellation – reduced in the blood.
  • Quick value (or INR value):  Many coagulation factors are produced in the liver. If their production is disrupted, the coagulation parameters, such as the Quick value, change accordingly.
  • Blood platelets (thrombocytes):  Since the spleen is often enlarged as a result of liver failure, the blood platelets are increasingly broken down there. This also leads to coagulation disorders.
  • Bile acids:  Like bilirubin, these are no longer sufficiently excreted. This build-up of bile (cholestasis) causes the components of the bile to rise in the blood and can lead to itching.
  • Vitamins:  In order to absorb vitamins A, D, E and K from the intestine, you need an intact lipid metabolism. This is often disturbed in liver diseases. In the case of alcohol abuse, vitamin B, folic acid  and trace elements such as  zinc are often also   reduced.
  • Blood Sugar :  Sugar is absorbed into the blood via the liver and intestines. It is not uncommon for disorders in the sugar metabolism to occur in the advanced stage of liver disease, including  diabetes  mellitus.
  • Electrolytes:  Salts such as  sodium  and  potassium  can be low or excess in the blood.

The extent of liver failure and the prognosis can be assessed using a  classification system (according to Child-Pugh)  – three laboratory values ​​(bilirubin, albumin, INR value) and two clinical findings (ascites, cerebral dysfunction) are related to each other and divided into points .

The point values ​​of the classification system mean the following:

  • 5 to 6 points: good liver function (stage A)
  • 7 to 9 points: moderate liver function (stage B)
  • > 10 points: low liver function (stage C)


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