Cirrhosis - Complications

Diagnosis

A physical examination may reveal the following in a patient with cirrhosis:

• The cirrhotic liver is firm and often enlarged in early stages of the disease. The liver may feel rock-hard. (In advanced stages of cirrhosis, the liver may become small and shriveled.)
• If the abdomen is swollen, the doctor will check for ascites by tapping the flanks and listening for a dull thud and feeling the abdomen for a shifting wave of fluid.
• The doctor will also check for signs of jaundice, muscle wasting, and (in male patients) breast enlargement.

A patient’s medical history is another indicator of the risk for cirrhosis. Patients with a history of alcoholism, hepatitis B or C, or certain other medical conditions are at high risk.

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Other tests (blood tests, imaging tests, liver biopsy) may also be performed. The results of these tests along with the presence of specific complications (ascites and encephalopathy) are used for calculating the Child-Pugh Classification. This is a staging system (A to C) that helps doctors determine the severity of cirrhosis and predict the development of future complications.

Blood Tests

A patient’s medical history can reveal risk factors (such as alcoholism) that warrant screening for conditions such as hepatitis. Blood tests are also performed to measure liver enzymes associated with liver function. Enzymes known as aminotransferases, including aspartate (AST) and alanine (ALT), are released when the liver is damaged. Blood tests may also measure:

• Serum albumin concentration. Serum albumin measures protein in the blood (low levels indicate poor liver function).
• Prothrombin time (PT). The PT test measures in seconds the time it takes for blood clots to form (the longer it takes the greater the risk for bleeding).
• Alkaline phosphatase (ALP). High ALP levels can indicate bile duct blockage.
• Bilirubin. One of the most important factors indicative of liver damage is bilirubin, a red-yellow pigment that is normally metabolized in the liver and then excreted in the bile. In patients with hepatitis, the liver cannot process bilirubin, and blood levels of this substance rise, sometimes causing jaundice.