Routine Investigations for Liver Disease a guide

fighting childhood liver disease Routine Investigations for Liver Disease a guide Medical Information Series

Welcome This leaflet has been written specifically for: Parents/carers of a child with a liver condition Young people with a liver condition Others who may find this leaflet helpful are: Relatives and friends Healthcare and allied professionals, school, college, university and nursery teams This leaflet aims to: Explain the common investigations carried out to assess how the liver is working Explain how the tests are used to monitor a liver problem You may find it helpful to also read the following CLDF leaflets: Guide to the liver Glossary of terms Children s Liver Disease Foundation (CLDF) also has leaflets in its support series which are available to download from our website childliverdisease.org. Leaflets can be mailed to UK patients free of charge, our contact details are on this leaflet. You may find it helpful to have a copy of CLDF s making the most of an appointment leaflet which will help you prepare for appointments and meetings following discharge. We also have the following information packs available, free of charge: Essential 5 CLDF s starter kit of vital information Education a pack supporting children and young people under 18 in an educational setting GP Practice a pack for families to give to their GP providing a range of information on childhood liver disease Friends and Relatives Yellow Alert a pack to support CLDF s Yellow Alert Campaign for early diagnosis of liver disease in new bornbabies All are available on request to UK families and young adults. Overseas Routine Investigations families should for Liver Disease contact a guide CLDF to discuss their literature needs.

Introduction Each test result is like putting a piece into a jigsaw puzzle. On its own it will give some information but put together with other test results, the history taken by the doctor and from examination, it will be much more useful. What is likely to be the first set of tests? A blood test is often one of the first things which will be needed if a liver problem is indicated. The blood sample, once taken, will usually be split into several different bottles so that many different tests can be carried out. A group of 7 particular tests together are called the liver function tests (see later). Where will I/my child go to have a blood test? It may be possible for a blood test to be done at your local surgery. However, a sample of blood will usually need to be taken from a vein and in young children this may be quite tricky. Your doctor may think that it would be best for someone used to taking blood from a child to do this and so this may mean a trip to your local hospital. It will usually be done at the same time as you visit the hospital doctor. Some blood tests can be done by a heel prick for babies and a finger prick for older children. What will the blood tests look at? A number of things will be looked at. Each of these has a normal range, but the range may vary according to age. If the blood result shows that some or all of the liver function tests are outside the normal range it may (and only may) indicate a liver problem or a problem with the bile drainage system (biliary system). Liver function tests only give limited information and won t give a diagnosis so normally further investigations are needed such as additional blood tests, special scans e.g. ultrasound scan and possibly a liver biopsy (see further on in this leaflet). However, liver function tests are a very useful way to monitor you or your child s condition once they are known to have a liver problem. Routine Investigations for Liver Disease a guide 01

Which tests make up the liver function tests and what does an abnormal result mean? Name and normal range * Abbreviation What it suggests if result is abnormal 1 Bilirubin If raised the bilirubin level gives a precise a) total SBR measurement of the amount of jaundice total 3 20 mmol/l present. Comparing the total and the conjugated levels can help to indicate whether b) conjugated the jaundice is due to: conjugated less than n Red blood cells breaking up too quickly 7 mmol/l (and not a liver disease) n 02 Routine Investigations for Liver Disease a guide Reduced production or flow of bile out of the liver 2 Aspartate Aminotransferase AST A raised level of this enzyme indicates 10 50 IU/l generalised liver cell inflammation (irritation). The extent to which it is raised can help to tell whether it is an acute (sudden) problem or one which is more chronic (one which develops over time). 3 Alanine Aminotransferase ALT A raised level of this enzyme indicates 10 50 IU/l generalised liver cell inflammation (irritation). The extent to which it is raised can help to tell whether it is an acute (sudden) problem or one which is more chronic (one which develops over time). 4 Gamma-Glutamyl Transferase GGT or ggt A raised level suggests bile duct inflammation 5 55 IU/l or Gamma GT (irritation) or obstruction. A high or low level can also give useful information about bile production in some cases. 5 Alkaline Phosphatase ALP A raised level may suggest bile duct Less than 350 IU/l inflammation (irritation) but ALP is not liver specific and can indicate changes elsewhere in the body e.g. normal bone development. 6 Total Protein Measures albumin and all other proteins in the 60 80 g/l blood including antibodies. High and low levels when considered with other results give further information about the type of liver problem. 7 Albumin Albumin is a protein which is only made in the 35 50 g/l liver it is a useful measure of how well the liver is able to do its job as a manufacturer. If the level is low it suggests that the problem has been present for some time i.e. it is chronic. Albumin levels can also be low when nutrition is affected or there is an abnormal loss of albumin from the body. An additional important test in assessing liver function is: Name and normal range * Abbreviation What it suggests if result is abnormal Blood Clotting (Coagulation) PT, PPT, INR The liver produces substances which are essential INR 0.9 1.2 for normal control of blood clotting. Raised (prolonged) PT 12 15 seconds, levels may indicate a shortage of Vitamin K due to depends on level for control reduced flow of bile. If the level remains high after adequate Vitamin K has been given this can indicate liver cell damage. * The normal ranges are given as a guide only and may alter with different laboratories and/or the age of the child. A child with a known liver disease may not be expected to have some measurements within the normal range.

What other blood tests may be needed? The following blood tests may be needed: Name Full Blood Count Details n Haemoglobin (Hb): This measures the protein that enables oxygen to be carried in the blood to all parts of the body. Also measured are a number of different cells in the blood, such as: n White cell count (WBC): This measures the total amount of cells involved in fighting infection. It generally rises if infection is present. n Platelets (Plt): These are involved in blood clotting. The level can fall in chronic liver disease if the spleen is enlarged. Urea and electrolytes A number of other properties of the blood are measured with this test. Urea and creatinine are waste products excreted by the kidneys. Urea can become low in some types of liver disease. Electrolytes include sodium, chloride, potassium, bicarbonate and minerals such as phosphate, magnesium and calcium. They occasionally become abnormal in some cases of liver disease. Blood Glucose Ammonia A high or low sugar (glucose) in the absence of diabetes may indicate either a metabolic liver disease or poor function of the liver. This is a waste product which is usually cleared from the body by the liver. A rise in the blood ammonia level may indicate a specific type of liver disease, usually of a metabolic type. In some other types of liver disease, measuring the ammonia level over time may help to monitor the progress of a condition. Are there other tests which might be done? Yes. One or all of the following may be needed: Urine and Stools Looking at the colour of the urine and stools and sometimes sending samples to the laboratory for testing can provide further useful information about the liver. Abdominal Ultrasound An abdominal ultrasound scan is a simple way of looking at the organs in the tummy (abdomen). It does not hurt. The scan takes place in the X-ray department but does not involve using X-rays. You/Your child will need to lie on your/their back. A small probe covered in a jelly will be moved across your/ their tummy. The probe transmits high frequency sound waves (which can t be heard) which are converted to pictures on a screen as they bounce back off the structures in the tummy. Mothers will probably have had a similar scan to look at their baby when pregnant. An ultrasound can show the size and texture of the liver and other organs such as gall bladder, bile ducts, spleen and kidneys. It can also show the blood flow into and out of the liver. Liver Biopsy After preliminary tests your doctor may think that a liver biopsy could be helpful in making a diagnosis or in assessing any liver damage. Before this is done this will be fully explained and discussed. A liver biopsy involves passing a very fine needle through the tummy and into the liver and getting a tiny sample of the liver. The sample is then prepared before being examined under a microscope by a specialist. Routine Investigations for Liver Disease a guide 03

Ongoing monitoring By repeating the same blood tests and/ or scans at intervals it is possible to see the progress of your child s condition and monitor the response to any treatment given. Is there a charity taking action against the effects of childhood liver disease? Yes. Started by families in 1980, Children s Liver Disease Foundation (CLDF) leads the way in fighting all childhood liver disease. CLDF funds vital research, develops information and awareness programmes and supports families, young people and adults diagnosed in childhood who are living day in, day out with a liver condition or transplant. And its work has made a big difference and continues to help save lives. CLDF has so much to offer you: information, the opportunity to meet other families, events and regular updates. To find out more, call, email or write today: Children s Liver Disease Foundation, 36 Great Charles Street, Birmingham, B3 3JY 0121 212 3839 Main site: childliverdisease.org Young people site: cldf-focus.org info@childliverdisease.org What are the roles of CLDF s Family and Young People s teams? CLDF s Family and Young People s teams are here for you, whether you want to talk about issues affecting you, meet and share with others or just belong to a group which cares, knows what it s like and is fighting to make a difference. You are not alone. Our parents say...... We don t know how we would have coped without CLDF s care and support. They have been just fantastic from the outset tremendous people, who are compassionate and so positive. They really care about families and children struggling with liver disease. When Emily was very ill we felt we were on the sidelines, knowing we couldn t influence the outcome and not in control. Getting involved in fundraising is something you can control and achieve a positive result. I really took comfort from that. Our young people say... Knowing CLDF is there is what I need. I can call whenever I want. Whatever I think and feel is listened to. Even when I called to tell them it was my birthday! I feel really well. It s great that CLDF has given us the chance to meet other young people outside of the hospital and have a fun time. I want them to do more things like this. Families Team families@childliverdisease.org 0121 212 6023 Young People s Team youngpeople@childliverdisease.org 0121 212 6023 Children s Liver Disease Foundation: April 2005 Updated: September 2006; January, August 2008; February 2011; April 2012; October 2013 04 Routine Investigations for Liver Disease a guide

# Donation, Regular Gift & Gift Aid Declaration Form To make a one-off gift or set up a direct debit gift online, go to childliverdisease.org I d like to make a gift to CLDF How much? 10 20 Other... I enclose a cheque made payable to Children s Liver Disease Foundation I wish to pay by card MASTERCARD / VISA / DEBIT CARD (delete as appropriate) Card No. Expiry Date... /... /... Name on Card... Security Number:... (back of card) I d like to make a regular gift by direct debit to CLDF How much? 5 10 20 25 50 other... How often? monthly quarterly half-yearly annually My bank details: Bank name:... Branch name:... My bank address:...... Postcode:... My bank sort code: My bank account number:... Please pay to Children s Liver Disease Foundation, account no. 00181442, sort code: 12-05-65 Starting on... /... /... until further notice. My signature:... Are you a UK taxpayer? Yes / No If yes, please give your gift under Gift Aid. This means that CLDF can claim the basic rate of tax you have already paid on the amount you are donating. It will not cost you anything. In order to qualify you must have paid enough UK income or capital gains tax to cover all your charitable donations. Other taxes such as Council Tax or VAT do not apply. We will confirm all Gift Aid details in your acknowledgement letter. Yes, please treat this and any future donations as given under Gift Aid. Date:... About you: First name:... Surname:...Title: Mr / Mrs / Ms / Miss /... My address is:...... Postcode:... Home telephone:... Mobile:... Home email:... Work email:... To claim Gift Aid we are required to have your full name and address including postcode. Please return your completed form to CLDF, address below. Thank you. Children s Liver Disease Foundation, 36 Great Charles Street, Birmingham B3 3JY

Children s Liver Disease Foundation is the UK s leading organisation dedicated to taking action against the effects of childhood liver disease. It provides free of charge: A huge selection of literature and online animations on the working of the liver available in print and online Information packs for a wide range of audiences, including young people, parents/carers, GP practices, schools and nurseries, friends and relatives Families and young people s teams providing services in person, online, facebook, text and phone Developing services for adults diagnosed with a liver disease in childhood Website childliverdisease.org Young people s website cldf-focus.org National event programme for families and young people to meet, share and have fun Secure online message board childliverdisease.org/forum Around 75% of CLDF s annual income is derived from voluntary donations. Please help us to continue to support young people, families and adults diagnosed in childhood by making a donation. You can do this online or by completing the donation form in this leaflet. Even better, a regular direct debit gift will enable us to plan our work more fully. Thank you. Children s Liver Disease Foundation 36 Great Charles Street Birmingham B3 3JY 0121 212 3839 info@childliverdisease.org Join the conversation Follow @tweetcldf Find us on Facebook search CLDF Scan with your smartphone to visit CLDF s website Scan with your smartphone and visit CLDF s Young People s website fighting childhood liver disease Registered charity number 1067331