Diagnosis of Cirrhosis

Jennifer Kong

Learning Objectives

By the end of this section you will be able to:

  • List blood tests which determine liver function
  • Describe the role of sonography in diagnosis of liver disease
  • Briefly explain the role of liver biopsy and histopathology of liver disease

The diagnosis of cirrhosis is mostly done through medical history, blood tests, and imaging.

Medical history will examine possible causes of liver injury.  A thorough history of medication/toxin exposure, liver infections, frequency of biliary obstructions, and inheritable infiltrative or autoimmune diseases will help to additionally determine the extent and frequency of liver damage.

Blood tests

Knowing the function of the liver, blood tests are used to ensure the hepatocytes are intact and able to make its products and perform its functions such as detoxification and bilirubin conjugation
Liver function tests (LFTs) a.k.a. liver panel
  • The following enzymes (GGT, AST, ALT, ALP, LDH) are in different cells in the body, but they are most concentrated inside hepatocytes.  Presence of these enzymes in high levels in the blood suggest hepatocyte leakage and lysis that has lead to the release of hepatic enzymes into the bloodstream.
  • Hepatic function is measured by the amount of albumin in reference to the levels of total protein consumed.  This is an excellent way to measure hepatocyte function, as albumin is only made by hepatocytes, using the proteins made available from diet (measured by total protein).  Hepatic function is also measured by the amount of total and conjugated bilirubin (direct bilirubin) in the blood as a functional liver will have low levels of hydrophobic unconjugated bilirubin (indirect bilirubin) in the blood.
  • Hepatic function is also assessed by how well ammonia is removed.  Low levels of ammonia in the blood suggests functional hepatocytes.

Coagulation panel

As mentioned, the liver produces many of the clotting factors, stores vitamin K, and stimulates platelet synthesis.
  • platelet number – the number of platelets indicates if there is a problem with either production (i.e. lack of the liver hormone thrombopoietin),  accumulation in the spleen due to spelnomegaly (i.e. due to portal hypertension), or due to destruction (i.e. tortuous path of platelet flow in fibrotic liver)
  • Clotting time:  a deficiency in any component of coagulation will result in a prolonged clotting time (PTT/INR)

Complete Blood Count (CBC)

Cirrhosis can cause reduced production of blood cells and sequestration in the spleen. Thus complete blood count (CBC) will determine if there are any signs of  anemia, leukopenia, and/or thrombocytopenia


Ultrasound uses sound waves to allow for visualization of tissue density based on echogenicity.  Abdominal ultrasound is used to evaluate the size and shape of the liver, as well as blood flow through the liver and surrounding abdomen. On ultrasound images, fluid accumulation in the peritoneum (ascites) can be visualized.   Presence of fatty changes can be detected, in addition to scar tissue in the liver.  Ultrasound can also detect blood flow, which is very useful in detecting portal hypertension.

Use of Ultrasound in liver disease by Ken Marken, interviewed by Jennifer Kong under a CC-BY-NC license

Liver biopsy

The definitive diagnosis for liver disease and cirrhosis is done with a liver biopsy.  Most commonly, this  is a CT or ultrasound-guided procedure using a fine needle to remove a sample of liver tissue (histopathology). The sample is then examined under a microscope for signs of fatty changes, inflammation, nodules, loss of hepatocytes, and fibrosis.

Section Summary

To assess the health of the liver, the liver can be both visualized and liver products & wastes measured to determine function.  The liver panel are blood tests which examine the extent of hepatocyte damage by measuring the presence of intra-hepatocyte enzymes floating around in the peripheral circulation:  an elevated presence of these hepatic enzymes leakiness or lysis of hepatoctyes.  Hepatocyte products such as albumin can be measured in the peripheral blood to determine the liver’s ability to synthesize plasma proteins.  As hepatocytes are responsible for most clotting factors and starting platelet synthesis, clotting times are also useful to determine liver function.  Similarly, the presence of undesired wastes such as ammonia or unconjugated (indirect) bilirubin will determine the liver’s function.   Liver can be visualized by ultrasound to determine size, shape, presence of nodules, and blood/bile flow.  Ultrasound is also used when obtaining a piece of liver for histopathological analysis (i.e. liver biopsy).  Liver biopsy is the definitive diagnostic test for liver disease and cirrhosis.

Review Questions


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Pathology by Jennifer Kong is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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