If your doctor thinks you may have cirrhosis, he or she will do a physical exam and ask about your medical history to see if you have symptoms of liver disease and to help find out possible causes of liver damage. The following are the tests that may be done to assist in diagnosis and treatment.

Blood Tests To Check Liver Function

Measuring the levels of certain chemicals produced by the liver can show how well your liver is working. Blood tests may be used to measure:

• Albumin and total serum protein. Albumin is a type of protein. Liver disease can cause a decrease in protein levels in the blood.
• Partial thromboplastin time or prothrombin time/INR. These tests measure blood-clotting factors that are produced in the liver.
• Bilirubin. This is produced when the liver breaks down hemoglobin, the oxygen-carrying substance in red blood cells. Cirrhosis may cause high bilirubin levels, which causes jaundice.

Blood Tests To Check For Inflammation Of The Liver

You may have blood tests to check your liver enzymes. These can help show whether you have had liver inflammation for a long time. These blood tests include:

• Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH). • An increased level of these enzymes may mean injury to the liver and the death of liver cells.
• Alkaline phosphatase (ALP). • An increased ALP level may mean blockage of bile ducts.
• Gamma glutamyl transferase (GGT), also called gamma-glutamyl transpeptidase (GGTP) • An increased level can happen because of alcohol use or diseases of the bile ducts.

SOME PEOPLE WITH CIRRHOSIS HAVE NORMAL LIVER ENZYMES.

Blood Tests To Diagnose A Cause Of Cirrhosis

Tests to check for conditions that may cause cirrhosis include:

• Antinuclear antibodies (ANA): ANA testing and anti-smooth-muscle antibody (ASMA) testing may help find autoimmune chronic hepatitis.
• Antimitochondrial antibody test (AMA): This test may help find primary biliary cirrhosis.
• Ferritin and iron tests: These may help diagnose iron overload, or hemochromatosis.
• Tests for hepatitis B and hepatitis C or tests for infection with hepatitis viruses: These tests may help diagnose infection with certain hepatitis viruses.
• Blood alcohol level (BAL) tests: These tests may show alcohol use, which can cause alcoholic cirrhosis.
• Serum ceruloplasmin testing: These may help diagnose Wilson's disease.
• Alpha1-antitrypsin level: This may diagnose a condition in which people lack this protein (alpha1-antitrypsin deficiency).

Tests That Show An Image Of The Liver

Imaging tests can check for tumors and blocked bile ducts. They also can be used to look at liver size and blood flow through the liver. These tests include:

• ‍Abdominal ultrasound.
• CT scan of the abdomen (including the liver, gallbladder, and spleen).
• MRI scan of the abdomen.
• Liver and spleen scan (rarely done).

Other Tests

Other tests also may be done to confirm cirrhosis or to look for possible complications. These include:

• Liver biopsy: This is the only test that can confirm cirrhosis. Looking at liver tissue also may reveal signs of inflammation.
• Paracentesis: This test can help diagnose the cause of fluid buildup in the belly or to look for infection in the fluid (spontaneous bacterial peritonitis).
• Endoscopy: It looks for enlarged veins (varices) and bleeding (variceal bleeding) in the digestive tract.
• Endoscopic retrograde cholangiopancreatogram (ERCP): To look inside the tubes (bile ducts) that drain the liver, pancreas, and gallbladder. ERCP may be done if your doctor thinks that a condition called primary sclerosing cholangitis (PSC) might be leading to your liver problems.
• Alpha-fetoprotein (AFP) test: To screen for cancer of the liver. This is a blood test.
• Ammonia test: This test looks for excess ammonia in the blood, which can cause altered brain function (encephalopathy).

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I see misconceptions and misunderstandings about liver disease and Cirrhosis all the time and I just wanted to write down some things as I understand them, hopefully to clear some of the confusion. I kept this to a general overview, since getting into specific cases or situations would be huge and beyond my pay grade. I'm willing to clarify if needed.

Webster's Dictionary defines Cirrhosis as:

The widespread disruption of normal liver structure by fibrosis and the formation of regenerative nodules that is caused by any of various chronic progressive conditions affecting the liver (such as long-term alcohol abuse or hepatitis).

That's a technical sounding definition, which doesn't matter because, technically, it's wrong.

Hepatitis isn't something separate from long-term alcohol abuse. It's caused BY long-term alcohol abuse. And many other things. ALL Cirrhosis comes from years of Hepatitis. No matter the cause or type of hepatitis, they all end up at the same destination if steps aren't taken to stop their progression.

The following 4 sentences are a basic description of the process that transforms ahealthy liver into a cirrhotic liver:

1. Hepatitis is another name for liver inflammation
2. If the liver remains inflamed long enough, scar tissue, called fibrosis, forms in the liver
3. If fibrosis builds up long enough, the liver damage becomes cirrhosis
4. If cirrhosis continues long enough, it can become liver cancer and failure

HEPATITIS

Hepatitis is NOT a virus. Hepatitis is the irritation or swelling of liver cells from any "insult" to the liver which results in inflammation. A virus can be one of the infectious causes of hepatitis, but do not think "virus" when you hear hepatitis. Hepatitis = Liver Inflammation

Infectious causes of hepatitis:

• Cytomegalovirus (CMV)
• Epstein-Barr virus (EBV) - Commonly known as mononucleosis or "mono"
• Varicella - chickenpox virus
• Viral Hepatitis:
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• Hepatitis A is caused by consuming contaminated food or water
• Hepatitis B is a sexually transmitted disease
• Hepatitis C is commonly spread via direct contact with the blood of a person who has the disease
• Hepatitis D can only infect a person if they are already infected with hepatitis B
• Hepatitis E is from drinking contaminated water

Non-infectiouscauses of hepatitis:

• Heavy alcohol use
• Illicit drug use
• Certain medications (over-the-counter and prescription)
• Toxins (environmental, commercial, agricultural, etc.)
• Autoimmune disease
• Fat buildup in the liver
• Physical injury

ALL of the types of hepatitis listed above are also the causes of fibrosis in the liver.

CIRRHOSIS

Cirrhosis is severe fibrosis of the liver from an extended period (years) of hepatitis. A healthy liver might sustain one injury, develop hepatitis, rebuild itself, diminish the hepatitis, and then continue on, strong as ever. Two thirds of a healthy liver can be cut away, and that liver will rebuild itself entirely. BUT, when a liver is continually injured over an extended period of years (a chronic viral infection, ongoing alcohol consumption, autoimmune injury, etc),the hepatitis never goes away. The hepatitis remains, never subsiding, forming fibrosis all along the way. Fibrosis replaces healthy liver tissue and partially blocks the flow of blood through the liver. And the fibrosis will continue to replace healthy liver tissue as long as the injury and hepatitis continue.

Fibrosis in the liver is similar to scar tissue anywhere else on or in the body. Scar tissue no longer functions like the healthy tissue it has replaced. The scar from a severe burn or cut won't tan or sweat or grow hair like the surrounding skin. Fibrotic liver tissue doesn't filter blood, or create and distribute nutrients, or clear the blood of drugs and other poisonous substances, or regulate blood clotting,or resist infections by making immune factors, or remove bacteria from the bloodstream. And the severe accumulation of fibrosis called Cirrhosis never will regenerate and perform those functions again. Scar tissue is tough. A scar from a traumatic laceration can grow through a healthy muscle, rendering it useless. I know this. ALL the classic cirrhosis symptoms that we know and experience result from the loss of functioning liver cells and increased resistance to blood flow through the liver (portal hypertension).

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