| Pivotal Assessment | Findings | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| History | African descent | Cancer, History of | Change in menstrual cycle, if female | Cold Intolerance | Constipation, dry skin, and weight gain | Dyspnea and Malaise | Nausea with vomiting | Weakness, thirst, and postural dizziness | Weight Gain | Weight Loss | ||||
| Physical Exam | Jaundice | |||||||||||||
| Lab Test | Elevated TSH | Hemoglobin_Hematocrit, Low | ||||||||||||
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Diagnosing liver failure involves a combination of clinical evaluation, laboratory tests, imaging studies, and sometimes, a liver biopsy. Here are the main steps:
### 1. **Clinical Evaluation**
- **Symptoms**: Early symptoms may include fatigue, nausea, vomiting, loss of appetite, and jaundice (yellowing of the skin and eyes). As liver failure progresses, symptoms can worsen to include confusion, bleeding, swelling in the abdomen (ascites), and altered mental status (hepatic encephalopathy).
- **Medical History**: Risk factors, such as history of alcohol use, hepatitis infections, medications, and family history of liver disease, are considered.
### 2. **Laboratory Tests**
- **Liver Function Tests (LFTs)**: Elevated levels of liver enzymes (AST, ALT, ALP), bilirubin, and low levels of albumin and total protein may indicate liver dysfunction.
- **Coagulation Tests**: The liver produces clotting factors, so liver failure can result in an increased prothrombin time (PT) and INR, indicating poor clotting ability.
- **Serum Ammonia**: Elevated levels are seen in liver failure, especially if hepatic encephalopathy is present.
- **Other Blood Tests**: These may include kidney function tests, electrolytes, complete blood count (CBC), and blood glucose levels, as liver failure can affect other organs and systems.
### 3. **Imaging Studies**
- **Ultrasound**: This is often the first imaging test used to evaluate liver size, shape, blood flow, and any structural abnormalities.
- **CT or MRI**: These provide a more detailed view if the ultrasound is inconclusive. They can detect masses, lesions, and other structural liver abnormalities.
- **Elastography**: A special type of ultrasound or MRI that measures liver stiffness, which can help assess fibrosis or cirrhosis.
### 4. **Liver Biopsy**
- In some cases, a liver biopsy may be necessary to confirm the diagnosis and determine the extent of liver damage. This is generally only done when other tests are inconclusive or when a specific diagnosis is required to guide treatment.
### 5. **Assessment of Liver Failure Type**
- **Acute Liver Failure**: Rapid onset of liver dysfunction in a previously healthy liver, often due to toxins (like acetaminophen), infections, or autoimmune hepatitis.
- **Chronic Liver Failure (End-stage Liver Disease)**: Progressive liver damage often associated with chronic liver diseases such as cirrhosis, hepatitis B or C, or alcoholic liver disease.
### 6. **Additional Tests for Etiology**
- Depending on suspected causes, further tests might include viral hepatitis panels, autoimmune markers, genetic testing, and toxicology screens.
### 7. **Assessment of Complications**
- Tests for complications like ascites (paracentesis), hepatic encephalopathy, and hepatorenal syndrome may also help in assessing the severity of liver failure.
Early detection and management are critical, especially in acute liver failure, as it can progress quickly and may require intensive care or even liver transplantation.