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 individual's health over time. This can include monitoring for the possible development of hepatocellular carcinoma.
- Liver injury may be first detected in those who do not have symptoms during general health screening using a comprehensive metabolic panel (CMP).
- A liver panel may be performed when someone has symptoms that may be due to liver injury.
These panels include several liver tests:
- Alanine aminotransferase (ALT) – an enzyme found mainly in the liver; may be moderately elevated with liver injury, including in cirrhosis.
- Aspartate aminotransferase (AST) – an enzyme found in the liver and other places; may be moderately elevated with liver injury, including in cirrhosis.
- Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often normal
- Gamma-glutamyl transferase (GGT) – an enzyme found mainly in the liver; often normal
- Total bilirubin – measures all the bilirubin in the blood; increased with many liver diseases but may be normal in cirrhosis until it is far advanced
- Albumin – a protein made by the liver, may be decreased
If any of these tests are abnormal, then they will be further investigated. Typically, the pattern of results is more significant than the result from one or a few of these tests. A doctor may repeat them over a few days or weeks to determine if a pattern is present and to help gain clues to the underlying cause.
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 tests evaluates clotting function and results may be prolonged with cirrhosis.
Many of the tests listed above may be 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 a sample of liver tissue taken 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 PBC (primary biliary cirrhosis)
- Alpha-1 antitrypsin – to help diagnose a deficiency
- Genetic tests for inherited liver diseases (hemochromatosis, Wilson disease)
- Hyaluronic acid – associated with fibrosis; if low, then extensive fibrosis 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 – occasionally ordered
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)
- Once diagnosed with cirrhosis, periodic ultrasounds to monitor for development of hepatocellular carcinoma (liver cancer)
- Magnetic or transient elastography – to evaluate degree of liver fibrosis by measuring liver stiffness
For more on these, visit Radiologyinfo.org tests for the abdomen.