Cirrhosis creates scars that damage your liver. This damage can prevent this vital organ from doing important jobs like helping with digestion and removing toxins from your body. The sooner your doctor diagnoses cirrhosis, the faster you can get treated and put a stop to the damage. You might even be able to reverse some of the scarring.
In its early stages, cirrhosis usually doesn't cause symptoms. You might not realize you have it unless your doctor finds signs of liver damage on a blood test during a routine checkup.
If you do have symptoms like yellow skin (jaundice), fatigue, and easy bruising or bleeding, see your doctor right away. Blood tests and imaging scans can show whether you have cirrhosis.
First, your doctor will ask about your symptoms, your health, and your family's health history. They’ll also look for telltale signs of cirrhosis, like these:
If you have symptoms of cirrhosis or you're at risk for the disease, your doctor will take a sample of your blood. These help spot signs of cirrhosis liver damage. They may help your doctor learn what caused the disease.
Liver tests measure levels of enzymes and proteins your liver makes. These tests include:
- Alanine transaminase (ALT) and aspartate transaminase (AST). These help your body break down protein and amino acid. Levels of both ALT and AST in your blood are usually low. High levels can mean that your liver is leaking these enzymes because it's damaged from cirrhosis or another disease. However, levels can still be normal if you have cirrhosis.
- Albumin test. Albumin is a protein that’s made by the liver. When the liver is damaged, the level of albumin in the blood falls.
- Bilirubin level. This is a yellow pigment that’s left over when old blood cells are broken down. The liver normally removes bilirubin from the blood and gets rid of it in the stool. But when the liver isn’t working properly, bilirubin builds up in the blood and can cause the skin and eyes to become yellow. This is called jaundice.
- Creatinine. This is a waste product made by your muscles. Your kidneys normally filter it out of your blood. A high creatinine level is a sign of kidney damage, which can happen in the late stages of cirrhosis.
- Prothrombin time or international normalized ratio. Your liver makes substances that help your blood clot. This test checks to see how well your blood clots. If it clots too slowly, cirrhosis could be a possible cause.
- Sodium blood test. If the sodium level in your blood is low, it could be an indicator that you have cirrhosis. A low level of sodium in the blood is called hyponatremia.
Your doctor can use the results of these tests to give you a Model for End-Stage Liver Disease (MELD) score. This shows how much your liver has been damaged, and whether you need a liver transplant.
Other blood tests your doctor might order include:
- A complete blood count (CBC). This test checks your red and white blood cells, as well as platelets, to get a picture of your overall health.
- A viral hepatitis blood test. Viral hepatitis is caused by viruses that damage your liver and can lead to cirrhosis. These tests check your blood for hepatitis A, B, and C.
- Tests to check for autoimmune hepatitis, Wilson's disease, hemochromatosis and other diseases.
Your doctor might order one or more of these to see if you have scarring or other damage to your liver:
- CT scan. Using X-rays and a computer, it makes detailed pictures of your liver. You might get a contrast dye before the test to help your doctor see your liver more clearly.
- MRI. This uses powerful magnets and radio waves to make pictures of your liver. You might get contrast dye before the test.
- Ultrasound. It uses sound waves to make pictures of your liver.
- Endoscopy. It uses a flexible tube with a light and camera on one end. It can be used to look for abnormal blood vessels called varices. These form when cirrhosis scars block blood flow in the portal vein that carries blood to your liver. Over time, pressure builds up in this vein. Blood backs up into blood vessels in the stomach, intestines, or esophagus.
- Magnetic resonance elastography and transient elastography. These newer tests look for stiffness in your liver caused by cirrhosis scars. Your doctor might use them instead of a liver biopsy, because they're less invasive. But they’re not yet widely available.
During this procedure, your doctor first numbs the skin on your belly over your liver. Then, they place a thin needle through your belly into your liver and removes a small piece of tissue. They might use a CT scan, ultrasound, or other imaging method to guide the needle.
The tissue sample goes to a lab. A lab tech looks at it under a microscope for signs of damage. A biopsy can diagnose cirrhosis and help your doctor learn the cause.
Getting the Right Diagnosis
Other diseases can have some of the same symptoms as cirrhosis. Make sure you're comfortable with your doctor's diagnosis. If not, you always have the option to get a second opinion from another doctor.