It is important to detect cirrhosis as soon as possible since significant liver damage may occur with few or no symptoms. If the cause of liver damage can be eliminated or controlled, further scarring will stop and some existing scars may actually resolve. While blood tests can detect liver injury, there is no single test that can be used to diagnose cirrhosis. A liver biopsy is considered the "gold standard" for diagnosing cirrhosis, but the procedure is invasive and will not detect every case.
Routine laboratory tests may be done to detect liver damage and/or scarring and to evaluate its severity, particularly if the individual has some risk factor for developing cirrhosis. Additional tests may be performed to help diagnose the underlying cause and to monitor the affected person's health over time. This can include monitoring for the possible development of hepatocellular carcinoma.
- Alanine aminotransferase (ALT) – an enzyme found mainly in the liver. Values are increased with all types of liver injury, including cirrhosis.
- Aspartate aminotransferase (AST) – an enzyme found in the liver and other organs. AST is elevated in people with liver injury, including cirrhosis.
- Alkaline phosphatase (ALP) – an enzyme found along bile ducts. ALP is usually normal or mildly elevated in cirrhosis.
- Total bilirubin – a substance produced exclusively in the liver. It is increased with many liver diseases. Bilirubin is usually normal or slightly elevated until cirrhosis becomes far advanced.
- Albumin – a protein made by the liver that is often decreased in cirrhosis.
If any of these tests are abnormal, then they will be further investigated. The pattern of results is more informative than the result of any single test.
Other routine testing may include:
- Complete blood count (CBC) – may be ordered to evaluate a person's red and white blood cells and platelets; anemia may be present if bleeding has occurred, and platelets are often decreased with cirrhosis.
- Prothrombin time (PT/INR) – most clotting factors are produced by the liver. This test evaluates clotting function and results may be prolonged with cirrhosis.
Many of the tests listed above are used to monitor the progression of cirrhosis. As the condition worsens, results may become increasingly abnormal.
- Hepatitis B and hepatitis C testing may be ordered to help diagnose the underlying cause of chronic liver disease.
- If ascites is present, peritoneal fluid analysis may be performed.
- Liver biopsy involves taking a sample of liver tissue to evaluate the structure and cells of the liver. It can clearly indicate the presence of cirrhosis, but since the sample is tiny, a negative result may not rule cirrhosis out.
Depending on the suspected cause, one or more specialized tests may be performed:
- Iron tests – when hemochromatosis is suspected
- Copper and ceruloplasmin – when Wilson disease is suspected
- Antimitochondrial antibody (AMA) – to help diagnose primary biliary cirrhosis
- Alpha-1 antitrypsin – to help diagnose a deficiency of this protein
- Genetic tests for inherited liver diseases (hemochromatosis, Wilson disease)
- Hyaluronic acid – associated with fibrosis; if low, then extensive fibrosis is unlikely
Some tests may be ordered to monitor for the development of complications:
- Alpha-fetoprotein (AFP) – often mildly elevated with cirrhosis; may be markedly elevated with liver cancer
- Des-gamma-carboxy prothrombin (DCP) – may be elevated with liver cancer
- Ammonia – values rise in late-stage cirrhosis with liver failure
Calculations based upon panels of specific tests may be used to evaluate prognosis or likely cirrhosis:
- Child-Turcotte-Pugh (CTP) scoring system for cirrhosis – may be used to help evaluate life expectancy in those with advanced cirrhosis
- MELD (model of end-stage liver disease) – used to help determine those who are at a high risk of mortality, to consider for liver transplant
- Several commercially developed calculations (algorithms) are available to help recognize the presence and severity of scarring in the liver.
Other procedures and imaging tests may be useful:
- Ultrasound – sometimes ordered to help diagnose nonalcoholic fatty liver disease (NAFLD). Periodic ultrasounds are done for some patients to monitor for development of hepatocellular carcinoma.
- Magnetic or transient elastography – to evaluate degree of liver fibrosis by measuring liver stiffness
For more on these tests, visit RadiologyInfo.org.