From the Guidelines
Liver enzymes are often elevated in cirrhosis, reflecting ongoing liver damage and dysfunction, and the most recent guidelines recommend using non-invasive tests such as FIB-4 or NAFLD fibrosis score to determine the likelihood of liver fibrosis 1.
Key Points to Consider
- In cirrhosis, common elevated enzymes include AST (aspartate aminotransferase), ALT (alanine aminotransferase), ALP (alkaline phosphatase), and GGT (gamma-glutamyl transferase) 1.
- The pattern and degree of elevation can help determine the cause and severity of liver disease, with alcoholic cirrhosis typically showing an AST:ALT ratio greater than 2:1, while viral hepatitis causing cirrhosis often has higher ALT than AST 1.
- Regular monitoring of these enzymes is essential for patients with cirrhosis, typically every 3-6 months depending on disease stability, and treatment focuses on addressing the underlying cause, such as alcohol cessation for alcoholic cirrhosis, antiviral medications for hepatitis B or C, or weight loss for non-alcoholic steatohepatitis 1.
- Medications like ursodeoxycholic acid may help in certain types of cirrhosis, and patients should avoid hepatotoxic substances including alcohol, certain medications, and supplements that could further damage the liver 1.
- The management of ascites in cirrhosis involves a step-wise approach, starting with salt restriction and diuretics, and may require repeated paracentesis or transjugular intrahepatic portosystemic shunt (TIPSS) in refractory cases, with liver transplantation being the only curative option 1.
Management Strategies
- For patients with cirrhosis, it is essential to determine the likelihood of liver fibrosis using non-invasive tests such as FIB-4 or NAFLD fibrosis score, and to refer patients to a hepatology clinic for assessment and management of advanced fibrosis, screening and treatment of portal hypertension, and HCC screening and management 1.
- Patients with ascites should be managed according to the most recent guidelines, which recommend a step-wise approach starting with salt restriction and diuretics, and may require repeated paracentesis or TIPSS in refractory cases 1.
- Liver enzyme elevations in cirrhosis indicate ongoing inflammation and cell death, and persistent elevations may signal disease progression requiring adjustment of management strategies, and patients should be monitored regularly to adjust treatment as needed 1.
From the Research
Liver Enzymes and Cirrhosis
- Liver cirrhosis is a condition where the liver is scarred due to chronic inflammation, leading to impaired liver function 2.
- The management of liver cirrhosis involves treating the underlying cause and preventing complications, with liver transplantation being an option in some cases 2, 3.
- Non-selective beta-blockers (NSBBs) are commonly used to reduce portal pressure and prevent variceal bleeding in patients with cirrhosis 4, 5.
Diagnosis and Complications
- Cirrhosis can be diagnosed through a combination of laboratory tests, imaging, and liver biopsy, with liver biopsy being the reference standard for diagnosis 3.
- Patients with cirrhosis are at risk of developing complications such as ascites, hepatic encephalopathy, and variceal bleeding, which can significantly impact survival rates 6.
- The management of cirrhosis-related complications involves preventing and treating these complications, with the goal of improving patient outcomes and preventing decompensated cirrhosis 6.
Treatment Options
- NSBBs, such as propranolol and carvedilol, are effective in reducing portal pressure and preventing variceal bleeding, but their use should be individualized based on patient risk factors and response to treatment 4, 5.
- Liver transplantation is a curative option for patients with cirrhosis, particularly those with decompensated cirrhosis or hepatocellular carcinoma 3, 6.
- Emerging therapies, such as anti-fibrotic agents, may hold promise in potentially halting or reversing the progression of cirrhosis, even in patients with decompensated cirrhosis 6.