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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
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
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
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