Screening for Diffuse and Focal Liver Disease: A Gastroenterologist's Viewpoint

✍ Scribed by Charles J. Lightdale

• Book ID: 102332202
• Publisher: John Wiley and Sons
• Year: 1984
• Tongue: English
• Weight: 218 KB
• Volume: 12
• Category: Article
• ISSN: 0091-2751
• DOI: 10.1002/jcu.1870120206

✦ Synopsis

The development of new techniques for imaging the liver and rapid improvements in this technology have created a good deal of confusion among internists and gastroenterologists. Increasing pressure to control costs discourages ordering multiple tests at once, yet the guidance provided by a diagnostic image will often be crucial to further management. The imaging test that is or- dered first will ideally be decisive and sufficient.

This symposium presents arguments for initial imaging tests in patients with liver disease. The authors do a superb job defending their theses, but I have not been convinced that I would always choose one or another of these tests first.

In patients with liver disease, it should not seem remarkable that a careful medical history and thorough physical examination will suggest the correct diagnosis more than 90% of the time. In addition, commonly available blood tests help to characterize the nature of the liver ailment. Blood chemistry patterns can indicate the probability of biliary obstruction, cholestasis, infiltration, or primarily hepatocellular disease.

Imaging tests are used to add specificity to the history, physical examination, and blood tests, and may at times provide the final information needed for diagnosis. More often, however, imaging tests serve as guides to more invasive procedures, including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous cholangiography (PTC), liver biopsy, and surgery.

Until modern imaging techniques became available, distinguishing extrahepatic biliary obstruction (surgical jaundice) from intrahepatic cholestasis was nearly impossible in some patients. A period of observation could lead to com-

From the Gastroenterology