An internal medicine service that includes the diagnosis, treatment, and long-term monitoring of liver diseases through liver enzyme tests, imaging, and viral hepatitis testing.
Indication
- Patients with elevated liver enzymes (increased ALT/AST)
- Monitoring of chronic viral hepatitis B and C and antiviral treatment management
- Non-alcoholic fatty liver disease (NAFLD/MASLD) and steatohepatitis (NASH)
- Follow-up of cirrhosis and decompensation findings (ascites, encephalopathy, variceal bleeding)
- Autoimmune liver diseases (autoimmune hepatitis, primary biliary cholangitis)
- Evaluation of drug- or toxin-induced liver injury
- Unexplained fatigue, jaundice, or itching
Preparation
- 8-12 hours of fasting before blood tests (for lipid and glucose values)
- List of medications and herbal products being used
- Previous liver tests, hepatitis serologies, and imaging reports
- Overnight fasting and not voiding the morning urine for abdominal ultrasonography (USG)
How it's performed
- The physician takes a detailed history; alcohol, medications, and hepatitis risk factors are reviewed
- Abdominal examination evaluates liver-spleen size and jaundice
- ALT, AST, GGT, ALP, bilirubin, albumin, INR, and complete blood count are ordered
- Hepatitis B surface antigen (HBsAg), anti-HCV, and HBV-DNA / HCV-RNA when indicated
- Abdominal ultrasonography or elastography (FibroScan) is used to measure the degree of fibrosis
- Antiviral, immunosuppressive, or lifestyle recommendations are planned according to findings
Post-procedure
- Blood test follow-up every 3-6 months according to diagnosis and treatment
- Liver cancer screening with USG every 6 months in patients with cirrhosis and chronic hepatitis
- Recommendation of healthy weight, balanced diet, and avoiding alcohol
- Hepatitis (A and B), influenza, and pneumococcal vaccination planning
- Referral to a hepatology or transplantation center when necessary
Risks
- Transient bruising or tenderness after blood draw
- The disease may progress despite treatment
- Side effects related to medications used (nausea, fatigue, kidney/liver effects)
- Risk of developing cirrhosis or liver cancer in case of late diagnosis
FAQ
My liver enzymes are high. Does this mean cirrhosis?
No. Elevated enzymes can result from many causes such as fatty liver, drug effects, or viral infection. Additional tests and imaging are required to diagnose cirrhosis.
Is it possible to avoid liver transplantation with hepatitis B or C?
With early diagnosis and regular antiviral treatment, the progression of the disease can be slowed or stopped in most patients; regular follow-up is critical.
Is there medication for fatty liver?
The mainstay of treatment is weight loss, healthy nutrition, and exercise. In some patients, medication may be planned for accompanying conditions.
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