As an experiment, let's say that you are a person who cares about your health. Assume you know that liver disease is commonly asymptomatic or silent. It gives you no clue that it is dying until it is in bad shape. As an advocate for your own health, can you look at your own medical history and decide how likely it is that you need in depth diagnosis for the silent killer of cirrhosis?
There has been a lot of recent research on blood based screeners and the field is advancing rapidly. It is still early and the broad practice of primary care medicine has not yet started using the best information available routinely. However, we now know that we can look at something more than just whether AST and ALT are elevated as guides to advancing liver disease. It is important to understand that high levels of these tests indicate that a lot of liver damage is occurring. What you want to know is are you at risk of being in that situation even though you have no symptoms.
I'll discuss how you can apply this information below, but if you are interested in how a number of the largest medical facilities in the nation are encouraging changes in the way the primary care physicians decide how to refer patients quickly to the specialists you can take a look at an effort called
NASHNET is a project by a number of the heavyweights of medicine and they advocate that your primary care physician should use a combination of blood tests called FIB-4 and NFS to help determine if patients should have a FibroScan prior to being referred to a hepatologist.
This is very interesting from the perspective of an educated patient who is engaged in their own medical care and who is not interested in getting sick before finding out about potential problems. The blood tests that they are advocating at NASHNET are ones that you, as a patient can use yourself. They are based upon routine blood tests and there are online calculators that you can use to determine your score. From that you can gain a sense of the general condition of your liver and that will be useful to you in discussions about possible next steps with your physician.
As a patient you need to be aware that not all physicians feel comfortable with patients bringing in diagnostic information. These screens are not proof of anything and are just tools to help guide a diagnosis so understand and treat it that way. If your doctor needs more information you might direct him to the page below at NASHNET
it discusses their approach from the clinic point of view and is advocated by many of the liver disease profession's leaders. Just remember, your primary care doctor may not be aware of this movement.
That's enough of me telling you I'm not a doctor and can't give medical advice. Here is a chart that shows you what these two screeners are and how they are interpreted. Click on it and it will take you to a page on our website with some additional information and links to the online screeners.