How is cirrhosis of the liver diagnosed?

How is cirrhosis of the liver diagnosed?

Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. They will also ask about any supplements or herbal products you may take. Your provider may suspect you have cirrhosis if you have a long history of alcohol abuse, injectable drug abuse or have had hepatitis B or C and have the symptoms listed in this article.

To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:

• Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin; yellowing of your skin or whites of your eyes; bruises on your skin; redness on your palms; swelling, tenderness or pain in your abdomen; enlarged firmer-feeling, bumpy texture to the lower edge of your liver (the part of your liver below the rib cage that can be felt).
• Blood tests: If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include:
  • Lower than normal levels of albumin and blood clotting factors (lower levels means your liver has lost its ability to make these proteins).
  • Raised levels of liver enzymes (suggests inflammation).
  • Higher level of iron (may indicate hemochromatosis).
  • Presence of autoantibodies (may indicate autoimmune hepatitis or primary biliary cirrhosis).
  • Raised bilirubin level (suggests liver isn’t working properly to remove bilirubin from the blood).
  • High white blood cell count (indicates an infection).
  • High creatinine level (a sign of kidney disease that suggests late-stage cirrhosis).
  • Lower levels of sodium (is an indicator of cirrhosis).
  • Raised level of alpha-fetoprotein (indicates presence of liver cancer).

In addition, other blood work will include a complete blood count to look for signs of infection and anemia caused by internal bleeding and a viral hepatitis test to check for hepatitis B or C.

• Imaging tests: Imaging test show the size, shape and texture of the liver. These tests can also determine the amount of scarring, the amount of fat you have in your liver and fluid in your abdomen. Imaging tests of your liver that could be ordered include computerized tomography (CT) scan, abdominal ultrasound and magnetic resonance imaging (MRI). A special ultrasound, called a transient elastography, measures the fat content and amount of stiffness in your liver. Two different types of endoscopies might be ordered: an endoscopic retrograde cholangiopancreatography to detect bile duct problems, and/or upper endoscopy to detect enlarged veins (varices) or bleeding in your esophagus, stomach or intestines.
• Biopsy: A sample of liver tissue (biopsy) is removed from your liver and examined under the microscope. A liver biopsy can confirm a diagnosis of cirrhosis, determine other causes or extent of liver damage or enlargement or diagnosis liver cancer.