• Diagnosis of Cirrhosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Up to 60% of patients with cirrhosis have no symptoms. The symptoms of cirrhosis include:
    • Gastrointestinal: lack of appetite, diarrhea, nausea, vomiting
    • Fever
    • Muscle weakness
    • Disturbed sleep
    • Weight loss
    • Muscle cramps
    • Abdominal pain
    • Loss of libido
    • Tremor
    • Slurring of speech
    • Severe itch
    • Confusion
    Signs associated with cirrhosis include:
    • Yellow skin or eyeballs
    • Dilated abdomen
    • Breast in men
    • Bruises
    • Bronze appearance
    • Small testicles
    • Swelling in legs
    • Sweet and strong breath odor
    Other tests to confirm the diagnosis may include.
    Blood Tests—there is no blood test to diagnose cirrhosis. Blood tests can only detect signs of liver function problems, such as:
    • Elevated liver enzymes aspartate transaminase (AST), alanine transaminase (ALT) alkaline phosphatase, g-glutamyltransferase (GGT) (an indicator of liver damage)
    • Elevated bilirubin (the pigment that produces jaundice and is usually cleared from the body by the liver)
    • Low serum albumin (a protein made by the liver)
    • Blood clotting abnormalities detected by measuring the prothrombin time
    • Anemia
    Special tests are ordered to confirm various causative factors including tests for:
    • Viral hepatitis B and C serologies
    • Autoimmune hepatitis with antinuclear antibodies or anti-smooth muscle antibody
    • Hemochromatosis with transferring saturation, unsaturated iron-binding capacity, ferritin
    • Wilson disease with serum copper and ceruloplasmin
    • Alpha 1 antitrypsin deficiency with serum alpha 1 antitrypsin plus genetic screening
    • Primary biliary cirrhosis with antimitochondrial antibody
    • Primary sclerosing cholangitis with antineutrophil cytoplasmic antibody
    Imaging Tests—These tests help the physician visualize the liver in various ways to determine whether the size and shape are normal or if the liver shows any signs of cirrhosis. Imaging tests may include:
    • CT Scan—a type of x-ray that uses a computer to make pictures of the liver
    • Ultrasound—a test that uses echoes of ultrasound waves to examine internal organs.
    • Liver/Spleen Scan
    • Abdominal X-ray—a test that uses radiation to take a picture of structures inside the body
    • MRI—test that provides detailed images of internal organs
    Laparoscopy—A tube with a tiny video camera mounted on it is inserted through a small incision in the abdomen. It relays pictures back to a computer screen. This also allows the doctor to see the liver and determine whether the size and shape appear normal.
    Liver Biopsy—This is the only definite way to diagnose cirrhosis. A needle is used to obtain a small sample of tissue from the liver. The tissue sample is then examined under a microscope to determine whether it shows scarring or other signs of disease.

    References

    American Liver Foundation website. Available at: http://www.liverfoundation.org. Accessed March 8, 2006.

    Heidelbaugh JJ, Bruderly M. Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation. Am Fam Phys. 2006;74:756-81

    National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov . Accessed March 7, 2006.

    National Library of Medicine website. Available at: http://www.nlm.nih.gov. Accessed March 8, 2006.

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