Modern Principles of Liver Fibrosis Diagnosis in Patients With Chronic Diffuse Liver Lesions: Literature Review and Clinical Case Description

Abstract

Introduction. Chronic diffuse liver lesions, which is at a certain stage and phase of the disease characterized by excessive accumulation of components of the extracellular matrix, namely fibrosis, – are a heterogeneous multi etiological group of diseases that are characterized by the high prevalence, subclinical course in the initial stages, low curability and reversibility of the pathological process in the late stages, and therefore cause considerable clinical, epidemiological and socio-economic problem of our time. The main way of progression of chronic diffuse liver lesions, regardless of the etiological factor that led to its damage – is the process of fibrogenesis. Quantitative indicators of the severity and rate of fibrosis progression are the most important clinical parameter, the determination of which is crucial for choosing the right treatment and for monitoring its effectiveness. Today, there is no universal method and only a combination of different laboratory and instrumental methods of examination can significantly increase their diagnostic value for early detection of liver fibrosis in the case of chronic diffuse liver diseases. However, the range of possibilities of certain diagnostic methods is constantly expanding and recently the elastographic method has become increasingly important. The aim of the study. To make the literature review concerning the modern principles of liver fibrosis diagnosis in patients with chronic diffuse liver lesions, to describe the clinical case. Materials and methods. The content analysis, method of the system and comparative analysis, the bibliosemantic method of study of the actual scientific studies concerning modern principles of diagnosis of patients with diffuse liver disease, a clinical case is described. Results. The literature review demonstrates the importance and relevance of early and comprehensive diagnosis of chronic diffuse liver disease. Hepatic fibrosis is the basis for portal hypertension, varicose veins, ascites and liver failure. Decompensated cirrhosis is associated with high mortality and the only effective treatment is liver transplantation. Assessment of the degree of liver fibrosis is important for several reasons: to determine the prognosis of chronic liver damage, to select patients for specific (etiotropic) treatment and possible liver transplantation. Therefore, the problem of diagnosis and detection of early initial stages of liver fibrosis for the timely appointment of therapeutic agents, which are aimed at reducing the rate of its progression and prevent cirrhosis and liver cancer, is extremely important for modern medicine. It is known that the “gold standard” for the diagnosis of liver fibrosis is a liver biopsy, but the method has many limitations and contraindications. Elastography is one of the most promising non-invasive methods to diagnose liver fibrosis and steatosis in the case of chronic diffuse liver lesions, which can be used as an alternative to biopsy. Given its widespread implementation in clinical practice, groups of scientists from around the world are paying more and more attention to the study of factors that may affect the results of elastometry and its diagnostic effectiveness. The advantages of the method of liver elastography include: non-invasive, no contraindications, simplicity, fast execution and interpretation; the ability to determine the stage of fibrosis in patients who can not perform a liver biopsy (coagulopathy, thrombocytopenia); the possibility of repeated procedures to assess the increase in severity. Conclusions. Thanks to modern scientific achievements, the latest technologies have been introduced into clinical practice, with the help of which clinicians successfully improve the diagnosis of chronic diffuse liver diseases, in particular, through the use of quantitative detection of fibrotic changes in it, establishing the nature of abdominal fluid (serous or mucinous), assessment of hepatic venous pressure due to safe non-invasive and informative method of shear wave elastography of the liver, a method that not only allows to objectify the verification of the diagnosis, but also to dynamically assess the efficiency of treatment.