What are the steps involved in diagnosing cirrhosis?

From the Guidelines

Diagnosing cirrhosis involves a combination of medical history, physical examination, blood tests, imaging studies, and non-invasive tests for fibrosis assessment, with liver biopsy remaining the gold standard for definitive diagnosis. The diagnostic process typically begins with a thorough medical history and physical examination to identify risk factors and symptoms, followed by blood tests including liver function tests (ALT, AST, alkaline phosphatase, bilirubin), complete blood count, and coagulation studies to assess liver damage and function 1. Specific tests like albumin levels and prothrombin time help evaluate the liver's synthetic capacity. Imaging studies are crucial, with ultrasound often being the first choice, followed by CT or MRI scans if needed to visualize liver texture, size, and potential complications like portal hypertension. Non-invasive tests for fibrosis assessment include FibroScan (transient elastography) and serum biomarker panels like FibroTest or APRI.

Some key points to consider in the diagnosis of cirrhosis include:

• The use of a VCTE cutoff of 12.5 kPa to detect cirrhosis in patients with chronic alcoholic liver disease, as suggested by the American Gastroenterological Association institute guideline 1.
• The importance of liver biopsy in confirming cirrhosis, determining its severity, and identifying the underlying cause, despite the availability of non-invasive tests 1.
• The role of imaging studies, such as multiphasic CT and MRI, in the diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis 1.
• The need for regular screening for hepatocellular carcinoma in patients with cirrhosis, using non-invasive tests such as liver ultrasound, CT, or MRI 1.

In terms of specific diagnostic criteria, the AASLD guidelines suggest that a diagnosis of cirrhosis can be made based on a combination of clinical, laboratory, and imaging findings, including:

• A liver stiffness measurement of 12.5 kPa or higher on VCTE 1.
• A platelet count of less than 100,000/μL, which is suggestive of portal hypertension 1.
• The presence of varices or other signs of portal hypertension on endoscopy or imaging studies 1.
• A liver biopsy showing cirrhosis, which is the gold standard for diagnosis 1.

Overall, the diagnosis of cirrhosis requires a comprehensive approach that takes into account the patient's medical history, physical examination, laboratory results, and imaging findings. A liver biopsy is recommended for definitive diagnosis, especially in cases where the diagnosis is uncertain or the patient has a high risk of complications.

From the Research

Diagnosis of Cirrhosis

The diagnosis of cirrhosis involves a combination of physical examination, laboratory tests, and imaging studies. The following are the steps involved in diagnosing cirrhosis:

• History and physical examination to identify signs and symptoms of liver disease, such as jaundice, ascites, and hepatic encephalopathy 2, 3
• Laboratory tests, including liver function tests, complete blood count, and prothrombin time/international normalized ratio 2, 4
• Imaging studies, such as ultrasonography, transient elastography, and liver biopsy 2, 4, 5
• Noninvasive tests, such as the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, and FibroTest/FibroSure, to assess fibrosis 4, 5
• Calculation of the Child-Pugh and Model for End-stage Liver Disease (MELD) scores to assess the severity of liver disease 2

Diagnostic Criteria

The diagnostic criteria for cirrhosis include:

• Presence of liver fibrosis and scarring on liver biopsy 2, 5
• Elevated liver stiffness on elastography, typically greater than 15 kPa 5
• Presence of signs and symptoms of liver disease, such as jaundice, ascites, and hepatic encephalopathy 2, 3
• Abnormal laboratory test results, including liver function tests and complete blood count 2, 4

Screening and Early Detection

Screening for cirrhosis is recommended for patients at risk, including those with chronic liver disease, viral hepatitis, and nonalcoholic fatty liver disease 4, 6. Early detection and treatment of cirrhosis can improve outcomes and reduce the risk of complications 2, 5. Primary care physicians should be aware of the signs and symptoms of cirrhosis and its related complications and adopt a low threshold for referral to a specialist when the condition is suspected 6.