It is not always easy to diagnose cirrhosis. A doctor will take a careful medical history, carry out a physical examination and make plans for further tests.
The tests for cirrhosis include:
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blood tests, which among other things measure the liver function and damage. These
are most commonly liver function tests (LFTs). These are used to gain an idea of how the different parts of your liver are functioning.
The liver function test is made up of a number of separate examinations, each looking at
different properties of your blood. It is used to gain an indication of how much your liver is inflamed or unable to work properly. The test will measure, for example, levels of the liver enzymes ALT and AST as these are increased during inflammation (hepatitis).
It will also look at how well your blood clots (referred to as INR time) and how well your kidneys remove a product called creatinine. These are good indicators for how well your liver is working, and how this is affecting the rest of your body.
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imaging tests in which your liver may be scanned using ultrasound, computerised tomography (CT) or magnetic resonance imaging (MRI).
Ultrasound, the same technology used to confi rm all is well in pregnancy, sends sound waves into your body. The echoes are picked up and used to build a picture of the condition of the liver.
MRI and CT provide a detailed view of your internal organs and are able to generate very detailed cross-sectioned images (or ‘slices’) of your body area.
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liver biopsy in which a tiny piece of the liver is taken to be looked at under a microscope. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn. The test is usually done under local anaesthetic and may mean an overnight stay in hospital, although most people are allowed home later the same day if they live close by.
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endoscopy in which, following sedation, a thin flexible tube with a light and a tiny camera on the end (endoscope) is passed down your oesophagus and into your stomach. This is to check for varices in the oesophagus or stomach which may rupture and suddenly bleed.
Cirrhosis is sometimes called end stage liver disease. This simply means it comes after the other stages of liver damage which can include infl ammation (hepatitis), fatty deposits (steatosis) and increased stiffness and mild-scarring of your liver (fibrosis).
Many people with cirrhosis can feel quite well and live for many years without needing a liver transplant. This is because the liver can function relatively well even when it is quite severely damaged.
Cirrhosis is classified as compensated or decompensated. Compensated cirrhosis is where the liver is coping with the damage and maintaining its important functions. In decompensated cirrhosis, the liver is not able to perform all its functions adequately. People with decompensated liver disease or cirrhosis often have serious symptoms and complications such as portal hypertension, bleeding varices, ascites and encephalopathy.
There are also systems for grading cirrhosis according to its severity. One of these is the Childs Pugh Score, which uses symptoms including encephalopathy and ascites together with blood test results for bilirubin, albumin and clotting, to grade cirrhosis from A (relatively mild) to C (severe). There are other systems including MELD (model of end-stage liver disease) which are used to help decide which patients most urgently need liver transplants. It uses blood test results for bilirubin, creatinine and clotting (INR).