Liver Ultrasound Scan: Here’s What You Need to Know

What is a liver ultrasound?

A liver ultrasound is a non-invasive imaging technique that uses high-frequency sound waves to produce detailed images of the liver and surrounding tissues. It's commonly performed to screen for various liver conditions, monitor liver health, or check your condition if you are showing symptoms of liver disease.

However, a liver ultrasound scan isn't a definitive diagnostic tool and is usually accompanied by additional tests, such as a liver biopsy, for further evaluation. In Singapore, liver ultrasound is widely available and can be done at private clinics, polyclinics, or hospitals.

Conditions that a liver ultrasound can detect

A liver ultrasound is often the first test performed when a liver condition is suspected, as it can provide clear images of the liver and surrounding tissues. It is also commonly used to monitor the progression of chronic liver disease over time.

Here are some medical conditions that can be detected by this imaging test, such as:

Chronic liver disease

1. Fatty liver disease (steatosis)

   • This phase is the early stage of chronic liver disease, where fat accumulates in the liver cells.

2. Inflammation of liver tissue (hepatitis)

   • Hepatitis, the second stage of liver disease, is the liver's attempt to heal itself in response to autoimmune conditions, toxic substances like alcohol, or infections like the hepatitis B virus.

3. Scarring of the liver tissue (fibrosis)

   • The third stage of a liver disease is caused by ongoing liver damage, where the liver is repeatedly injured and attempts to repair itself by producing collagen. Over time, excess collagen is deposited and stiffened in the liver tissue, leading to the formation of scarring.

4. Cirrhosis

   • This fourth stage of liver disease is marked by severe scarring and permanent damage. Over time, cirrhosis can lead to liver failure, where the liver can no longer function. Cirrhosis also increases the risk of hepatocellular carcinoma (HCC), a type of liver cancer.

Other liver condition

• Portal hypertension, which is an increased blood pressure in the portal vein.

• Ischaemia, where the blood flow to the liver is reduced, impairing its function.

• Ischaemia, which are fluid-filled sacs that can develop within the liver tissue.

• Liver haemangioma, which is a noncancerous tumour inside the liver that's made up of tangled blood vessels.

In Singapore, chronic liver disease is a common health problem, with hepatitis B being responsible for about 63% of cirrhosis cases. Fortunately, liver ultrasound is widely available and easily accessible, allowing for early detection and timely intervention before the disease progresses to an advanced stage.

When do I need a liver ultrasound?

A liver ultrasound scan may be recommended by your healthcare provider if you:

• Show symptoms of liver disease, such as unexplained abdominal pain or jaundice (yellowing of the skin and eyes).

• Have abnormal results from blood tests that indicate a potential liver condition.

• Have been diagnosed with liver disease to monitor the progression of the condition or treatment response.

If you are experiencing any of the mentioned symptoms, request an appointment with Thomson Medical. Our specialists can assist with further diagnosis, including a liver ultrasound scan, to determine the cause of your symptoms and provide an appropriate treatment plan.

How does a liver ultrasound work?

A liver ultrasound works by using a handheld device called an ultrasound probe (transducer) that emits high-frequency soundwaves to generate detailed images of your liver and surrounding tissues.

During the procedure, an ultrasound technician (sonographer) applies a clear gel to the skin over the liver area, usually on the right side of your abdomen. This gel helps the transducer move smoothly over your skin and improve the transmission of sound waves.

As the sonographer gently moves the probe over your abdomen, sound waves bounce off the liver and other tissue around it and return to the probe at varying speeds. These reflected sound waves are then converted by a computer into real-time images (sonograms) that can be displayed on a screen for assessment.

Types of liver ultrasound

Depending on your medical needs, several types of liver ultrasounds may be performed to focus on a specific organ or condition, such as:

Standard liver ultrasound

• A standard liver ultrasound is similar to a regular abdominal ultrasound scan but focuses on the upper right part of your abdomen. This type of ultrasound helps the healthcare provider assess your liver and nearby organs, such as gallbladder, right kidney, and part of your pancreas

• These organs are examined due to their connection to the hepatobiliary system, which produces and transports bile to aid in digestion. A medical issue in any of these organs may be related to or affect the liver.

Vascular liver ultrasound

• A vascular liver ultrasound is used to assess the liver's blood vessels, allowing healthcare providers to evaluate the quality of blood flow. To achieve it, this test combines a standard liver ultrasound with a Doppler ultrasound, which are used to image the blood flow in the blood vessels.

Elastography ultrasound

• An elastography ultrasound, or transient elastography, measures how stiff your liver tissue is. Liver stiffness often means the existence of scar tissue (fibrosis), which can result from chronic liver disease and may lead to cirrhosis over time.

• During this test, the sonographer uses a special probe that measures how quickly vibrations travel through your liver. The faster the vibrations travel, the stiffer your liver is. Your healthcare provider then can use this information to check for early liver damage or track how your liver changes over time.

Contrast-enhanced ultrasound of the liver

• If your doctor spots an abnormal growth in the liver on a regular liver ultrasound, a contrast-enhanced ultrasound helps them see it more clearly. It uses tiny gas bubbles (instead of dye) that reflect sound waves, creating clearer images.

• Before the scan, your doctor injects these gas bubbles from your vein. It then travels through your bloodstream to your liver, helping to highlight and enhance any abnormalities found.

Unsure which type of liver ultrasound scan is suitable for your condition? Request an appointment with Thomson Medical to consult your healthcare provider and determine the most suitable scanning method for you.

What to prepare before a liver ultrasound scan

This ultrasound scan is a simple and non-invasive procedure, but your healthcare provider may ask you to make some preparations, including:

• Wear loose-fitting, comfortable clothing, as you will need to undress from the waist up to allow the transducer to make contact with your skin.

• Depending on the reason for your scan, you may be asked to fast for 6 to 8 hours beforehand, drinking only plain water. Fasting helps reduce gas and improve the clarity of the images.

• Avoid smoking, chewing gum, or drinking carbonated beverages before the scan, as these can cause excess gas in your abdomen and interfere with the ultrasound.

• If you are taking any medications, notify your healthcare provider. They will advise whether you need to adjust your routine before the scan.

Your healthcare provider may also give specific instructions based on the test's purpose, so make sure to follow their guidance for the best results and reach out to them if you have any questions or concerns.

What to expect during the scan

Once you’ve completed the preparation steps, the procedure will begin. Here’s what you can expect during the liver ultrasound scan:

1. You'll be asked to undress from the waist up.

2. Afterwards, you will lie on your back on the examination table, and the sonographer will apply a clear gel to your abdomen to help the transducer glide smoothly over your skin and make sound waves travel better.

3. The transducer is then gently pressed against your skin and moved to the area of interest.

4. The device will then transmit detailed images of the liver and other organs around it in real time, so you and your healthcare provider can observe them during the scan.

5. Depending on the findings during the scan, your healthcare provider may suggest additional procedures, such as a vascular liver, elastography, or contrast enhancement ultrasound. These extra steps are often performed during the same session.

6. After the ultrasound is completed, the sonographer will wipe away any remaining gel from your skin.

The entire procedure typically lasts between 15 and 30 minutes and is painless, allowing you to immediately resume normal activities afterward.

What do the results mean?

After the scan is finished, the sonographer will send the results to a radiologist, a specialist in medical imaging, for analysis. Once the radiologist has reviewed the images, they will share their findings with your healthcare provider.

Your healthcare provider will then contact you to discuss their findings, highlighting whether the ultrasound indicates a healthy liver or signs of liver abnormalities. Here are the differences between a normal liver and a liver that shows any abnormal signs:

Liver ultrasound scan costs in Singapore

In Singapore, a liver ultrasound can be performed at a hospital, clinic, or diagnostic centre. The cost of this imaging test usually depends on your choice of medical facility.

To help cover the cost, you can use up to SGD 300 annually from your MediSave account at select clinics. If you have private insurance, you may need to check with your individual provider to see if a liver ultrasound is covered by your policy.

For detailed fee information and payment options, please consult your healthcare provider directly. Request an appointment with our specialists at Thomson Medical today for a detailed price breakdown and a personalised care plan.

What are the risks of a liver ultrasound scan?A liver ultrasound is a safe, non-invasive imaging procedure because it uses sound waves instead of ionising radiation. There are no known risks associated with this procedure, although you may experience mild discomfort, such as:

• Discomfort when the transducer is being pressed against your skin by the sonographer during the procedure.

• If contrast-enhanced ultrasound is performed, a contrast material is used. You might feel a slight pain at the injection site or, in rare cases, an allergic reaction to the contrast material.

• Finally, patients who fast before the procedure may experience mild side effects like headache or lightheadedness due to low blood sugar or dehydration.

FAQ

What is a liver ultrasound looking for?

A liver ultrasound is looking for various liver conditions and abnormalities by producing detailed images of your liver and surrounding tissues. It can detect:

• Fatty liver disease (steatosis).

• Inflammation of liver tissue (hepatitis).

• Scarring of liver tissue (fibrosis).

• Cirrhosis (severe scarring and permanent damage).

• Portal hypertension (increased blood pressure in the portal vein).

• Cysts (fluid-filled sacs within the liver).

• Liver haemangioma (noncancerous tumours made of tangled blood vessels).

• Abnormal growths or masses that could indicate cancer.

This non-invasive imaging technique is often the first test performed when liver conditions are suspected, helping healthcare providers assess liver size, texture, and your overall kidney health.

How do I prepare for a liver ultrasound?

Here are some of the things you need to prepare before having a liver ultrasound, such as:

• Avoid eating or drinking anything other than water for 6-8 hours before your appointment to help reduce gas and improve the clarity of the images.

• Wear loose-fitting, comfortable clothing, as you'll need to undress from the waist up for the procedure.

• Avoid smoking, chewing gum, or drinking carbonated beverages before the scan

• Inform your healthcare provider about any medications you're taking

• Follow any specific instructions provided by your healthcare provider

What are the symptoms that would require me to have a liver ultrasound?

Your healthcare providers may order a liver ultrasound if you're experiencing:

• Unexplained abdominal pain, particularly in the upper right portion of your abdomen where your liver is located.

• Jaundice, which is the yellowing of your skin and eyes.

• Abnormal liver function indicated through blood test results.

Additionally, if you have a history of liver disease, hepatitis, or alcohol use, it may warrant a liver ultrasound to monitor liver health.

Why can't you drink water before a liver ultrasound?

You are often advised not to drink water before a liver scan because you may swallow air when you drink, especially if you drink too quickly. The air can put gas in your stomach and intestines and interfere with the ultrasound waves, making it harder to get clear images of your liver.

Additionally, drinking before the scan may cause your gallbladder to contract, making it more difficult to assess both the gallbladder and nearby structures during the exam. Always follow your healthcare provider’s specific preparation instructions, as recommendations may vary based on your health condition and the purpose of the test.

What is Stage 1 liver disease?

Stage 1 liver disease refers to fatty liver disease, also known as steatosis. This condition occurs when excess fat builds up in liver cells. While a small amount of fat in the liver is normal, it becomes a concern when it accounts for more than 5% of the liver’s weight.

Fatty liver is considered the earliest stage of chronic liver disease. If identified early, often through tests like a liver ultrasound, lifestyle changes and medical management can help reverse the condition and prevent it from progressing to more serious liver damage.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations based on your medical conditions, request an appointment with Thomson Medical.