Cirrhosis Of The Liver - Diagnosis

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How is cirrhosis diagnosed and evaluated?

The single best test for diagnosing cirrhosis is biopsy of the liver. Liver biopsies, however, carry a small risk for serious complications, and, therefore, biopsy often is reserved for those patients in whom the diagnosis of the type of liver disease or the presence of cirrhosis is not clear. The possibility of cirrhosis may be suggested by the history, physical examination, or routine testing. If cirrhosis is present, other tests can be used to determine the severity of the cirrhosis and the presence of complications. Tests also may be used to diagnose the underlying disease that is causing the cirrhosis. The following are some examples of how doctors discover, diagnose and evaluate cirrhosis:

  • In taking a patient's history, the physician may uncover a history of excessive and prolonged intake of alcohol, a history of intravenous drug abuse, or a history of hepatitis. These pieces of information suggest the possibility of liver disease and cirrhosis.
  • Patients who are known to have chronic viral hepatitis B or C have a higher probability of having cirrhosis.
  • Some patients with cirrhosis have enlarged livers and/or spleens. A doctor can often feel (palpate) the lower edge of an enlarged liver below the right rib cage and feel the tip of the enlarged spleen below the left rib cage. A cirrhotic liver also feels firmer and more irregular than a normal liver.
  • Some patients with cirrhosis, particularly alcoholic cirrhosis, have small red spider-like markings (telangiectasias) on the skin, particularly on the chest, that are made up of enlarged, radiating blood vessels. However, these spider telangiectasias also can be seen in individuals without liver disease.
  • Jaundice (yellowness of the skin and of the whites of the eyes due to elevated bilirubin in the blood) is common among patients with cirrhosis, but jaundice can occur in patients with liver diseases without cirrhosis and other conditions such as hemolysis (excessive break down of red blood cells).
  • Swelling of the abdomen (ascites) and/or the lower extremities (edema) due to retention of fluid is common among patients with cirrhosis, although other diseases can cause them commonly, for example, congestive heart failure.
  • Patients with abnormal copper deposits in their eyes or certain types of neurologic disease may have Wilson's disease, a genetic disease in which there is abnormal handling and accumulation of copper throughout the body, including the liver, which can lead to cirrhosis.
  • Esophageal varices may be found unexpectedly during upper endoscopy (EGD), strongly suggests cirrhosis.
  • Computerized tomography (CT or CAT) or magnetic resonance imaging (MRI) scans and ultrasound examinations of the abdomen done for reasons other than evaluating the possibility of liver disease may unexpectedly detect enlarged livers, abnormally nodular livers, enlarged spleens, and fluid in the abdomen, which suggest cirrhosis.
  • Advanced cirrhosis leads to a reduced level of albumin in the blood and reduced blood clotting factors due to the loss of the liver's ability to produce these proteins. Thus, reduced levels of albumin in the blood or abnormal bleeding suggest cirrhosis.
  • Abnormal elevation of liver enzymes in the blood (such as ALT and AST) that are obtained routinely as part of yearly health examinations suggests inflammation or injury to the liver from many causes as well as cirrhosis.
  • Patients with elevated levels of iron in their blood may have hemochromatosis, a genetic disease of the liver in which iron is handled abnormally and which leads to cirrhosis.
  • Auto-antibodies (antinuclear antibody, anti-smooth muscle antibody and anti-mitochondrial antibody) sometimes are detected in the blood and may be a clue to the presence of autoimmune hepatitis or primary biliary cirrhosis, both of which can lead to cirrhosis.
  • Liver cancer (hepatocellular carcinoma) may be detected by CT and MRI scans or ultrasound of the abdomen. Liver cancer most commonly develops in individuals with underlying cirrhosis.
  • If there is an accumulation of fluid in the abdomen, a sample of the fluid can be removed using a long needle. The fluid then can be examined and tested. The results of testing may suggest the presence of cirrhosis as the cause of the fluid.
Return to Cirrhosis (Liver)

See what others are saying

Comment from: janet, 55-64 Female (Patient) Published: May 10

I was diagnosed last month with cirrhosis. I had a distended abdomen, and because I had been learning the signs to look for, because of my drinking habits, I knew it was my liver. I was given tests and was told I have cirrhosis. I quit drinking as soon as my abdomen was swelling. That has been seven weeks ago. So far, I have remained stable because of cutting out the alcohol and following my diet and meds. I have faith that the part of my liver that is still functioning will carry me through. I refuse to give up. My journey has just begun and I will do whatever it takes to prolong the inevitable. I look forward to sharing my experiences. I am 60 and my cirrhosis was caused from alcohol abuse for the last eight years or so.

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Comment from: jdwrites, 45-54 Female (Patient) Published: December 30

In 2009, I went in for a Lap-Band surgery. When the doctors were in, they saw that my liver looked poorly and took a biopsy. Afterward, they sat me down and told me I had stage 3 cirrhosis (autoimmune type) from my untreated diabetes. (I was recently also diagnosed with type 1 diabetes.) I was never a heavy drinker or drug user! I have a good liver doctor now who does ultrasounds and blood work every six months and advises me and watches everything. So far, he says, all is ok. Still, I worry.

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