Prothrombin is a protein that the liver produces as one of the clotting factors that stop bleeding. Prothrombin time (PT) is the time the body needs to begin clotting-—-normally between 9 and
10 seconds—and vitamin K must be present for clotting to happen. When vitamin K is deficient (which is often the case with certain cholestatic liver diseases) or the liver has suffered extensive damage, the PT will be abnormally long, compromising the patients ability to stop bleeding. Injections of vitamin K or oral supplementation sometimes help; when an injection returns the PT to normal, doctors know that the liver is working. If clotting does not improve after the vitamin K injection, the coagulopathy (inability to stop bleeding) might indicate liver disease.
The immunoglobulins are another group of liver-related proteins connected with the immune system. They are produced partly by the liver itself, but mostly by the immune system outside the liver. Many patients with chronic liver diseases display high levels of immunoglobulins. Specific immunoglobulins, such as IgA, IgG, and IgM, are possible indicators of liver disease, particularly primary biliary cirrhosis and autoimmune hepatitis.
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During the clotting process, platelets are the blood cells that form clots; they are stored in the spleen. In cirrhotic patients, the spleen becomes enlarged because of portal hypertension (the blood backs up behind the scarred liver) and causes a condition known as splenomegaly, which traps the platelets. Low platelet levels are known as thrombocytopenia. When the spleen is enlarged and platelets are low, cirrhosis is a likely diagnosis.
After a first round of liver function tests, doctors may order more blood tests (see the table on page 161) to confirm a specific diagnosis. Depending on the hospital, the laboratory, and the test itself, it take as little as wo days or as long as two weeks before the results of a given test are known.
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Imaging Studies and the Liver
After the medical team has collected the chemical information from various blood tests, it is helpful for the doctors to be able to view the entire liver. They will look at its size, noting whether it has shrunk with scarring or grown larger, its location, and any possible growths. They will also check for gallstones in the gallbladder.
The imaging studies performed on liver patients are sonograms (ultrasounds), computerized axial tomography scans (CT or CAT scans), and magnetic resonance imaging (MRIs). None of these procedures involves surgery, and all are performed while the patient is awake, often in a doctor’s office.
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