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Diagnosing Cirrhosis: Blood Tests, Ultrasound and Biopsy

Your doctor may suspect cirrhosis if a physical examination reveals that the liver is larger or harder than normal, or if it is tender to the touch. He or she will probably take a medical history to see if any previous illnesses or lifestyle factors could play a role. The doctor will also look for evidence of the common symptoms and determine your risk factors.

Blood Tests

A blood test is a quick method of determining the likelihood of cirrhosis. The blood test determines the levels of liver enzymes and proteins in the bloodstream. Although blood tests often suggest cirrhosis, results can be misleading. The liver is a resilient organ: even when badly damaged, it can often perform its functions well enough that blood tests appear normal.

Your doctor may order a number of blood tests. A liver panel is a group of tests designed to measure as many enzymes and protein levels as possible. Possible blood tests include the following:

AST (Aspartate Aminotransferase)and ALT (Alanine Aminotransferase): High levels of these enzymes suggest that the organ is damaged. As liver cells become injured, AST and ALT leak into the bloodstream causing their levels to rise sharply.
ALP (Alkaline Phosphatase): ALP enzymes increase in the blood when the bile ducts are obstructed.
albumin: This is an important protein produced by the liver; low levels of albumin suggest defective synthesis of the protein, as seen in cirrhosis.
bilirubin: High levels of the waste product bilirubin cause jaundice, and may indicate cirrhosis. A bilirubin test may measure total levels of bilirubin, or only the amount that has been processed by the liver (conjugated bilirubin).

In addition to blood work, your doctor may order a prothrombin time test, which determines whether liver damage is hindering the body's ability to coagulate blood.

Getting the Picture: Ultrasound, CAT Scans and Radioactive Isotopes

Blood tests can indicate only a possible problem. When a doctor suspects cirrhosis, he may use diagnostic imagery machines to see how much damage has been done to the liver. For instance, a CAT scan may be used to view the organ. A CAT scan (short for computed axial tomography scan) uses x-rays and computer imagery to build a virtual model of an internal organ. The doctor can use the CAT scan model to look for scarring and abnormal growth.

Ultrasound uses high-frequency sound to construct a picture of organs, blood vessels and internal organs. Ultrasound is often used to look for gallstones, determine areas of scar tissue and show the size of an organ.

Cirrhosis can also be diagnosed by scanning the body with radioactive isotopes. The radioactive isotopes are harmless, and the scan constructs an image of the internal organs.

A laproscope is a small camera inserted through a surgical incision in the abdomen. It is very useful because doctors can actually see damage through the camera.

Biopsy: The Most Accurate Test

Despite all the blood tests and diagnostic imagery tools, only a liver biopsy can diagnose cirrhosis with 100 percent certainty. To perform a biopsy, the doctor uses a long needle to extract a sample of the organ's tissue. The sample of tissue is then examined for signs of disease, inflammation and scarring.

Resources

Beers, M. H., & Berkow, R., ed. (1999). The Merck Manual of Diagnosis and Therapy, 17th Edition. NJ: Merck Research Laboratories.

Gunter, J. A. (2002). Cirrhosis: Advanced liver disease. National AIDS Treatment Advocacy Project.

Haggerty, M. (updated 2005). Cirrhosis. Gale Encyclopedia of Medicine.

Lab Tests Online. (updated 2004). Liver panel.

Lab Tests Online. (updated 2005). Prothrombin time.

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