The Liver in Systemic Disease

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There is no doubt that the prevalence of liver disease is rising globally and has a profound impact on patients, their family, and well as wider society. Liver diseases spans common problems (such as alcohol use disorders, metabolic syndrome, and viral hepatitis) as well as less frequent conditions such as autoimmune and inherited diseases. This parallels a reality that the delivery of modern health care is increasingly complex, with different professionals intervening to manage care. Patients, the public, as well as professionals, are now involved in increasing awareness and prevention by addressing the wider determinants of health. UK data from the Royal College of Pathologists suggest that around 95% of clinical pathways rely on patients having access to pathology services. Each year in England and Wales (population around 55million) there are 500million biochemistry and 130million hematology tests completed. 300 000 investigations are done each working day with around 50million reports sent to primary care doctors, meaning that an average of 14 tests are performed annually for each person in England and Wales [1]. Such a pattern of investigation is not exclusive to the UK but is mirrored globally. Of course, there are many types of blood tests and only a proportion will be liver tests. While liver tests are often requested in the knowledge of known liver disease, often abnormalities in liver tests are unexpected (and indeed sometimes unwanted).

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