Cirrhosis - Diagnosis and Treatment

Diagnosis

Doctors often find cirrhosis when a person has no symptoms. They may spot it during a routine exam or while running blood tests for other reasons.

To know for sure if someone has cirrhosis, doctors order several tests. These tests check how well the liver works and if there is any scarring.

Blood Work to Check the Liver and More

Blood tests help doctors find cirrhosis and figure out how much damage there is.

Some key blood tests include:

Liver Function Panel: Measures enzymes and proteins like ALT, AST, ALP, bilirubin, and albumin. High enzyme or bilirubin levels can mean the liver is not working well.
Blood Clotting Test (INR): Shows if the liver helps blood clot normally.
Complete Blood Count (CBC): Checks for anemia or low platelets, which can happen when the liver is unhealthy.
Creatinine Test: Looks at kidney function, since advanced cirrhosis can affect the kidneys.
Viral Hepatitis Testing: Screens for hepatitis B and C, which often cause cirrhosis.

Table: Some Common Blood Tests Used in Cirrhosis Diagnosis

Test Name	What It Checks	What Result May Show
ALT, AST, ALP	Liver injury	High levels
Bilirubin	Liver ability to clear waste	High if liver damaged
Albumin	Protein the liver makes	Low if liver weak
INR	Blood clotting	High if liver not working well
Platelet count	Blood cell numbers	Low if liver is scarred
Creatinine	Kidney function	High if kidney affected

Blood tests alone may suggest cirrhosis, but doctors usually need more information to confirm it and find the cause.

Imaging to Look at the Liver

Imaging scans let doctors see if the liver looks healthy or scarred.

Common types include:

Ultrasound: Doctors often use this first. It can spot an enlarged liver, nodules, and other changes.
CT scan or MRI: These scans give more detailed pictures of the liver’s size and shape, and can find liver cancer or blood flow problems.
Elastography (Transient or Magnetic Resonance): These scans measure how stiff the liver is. Scar tissue makes the liver stiffer, so this test shows how bad the scarring is without a biopsy. Transient elastography uses sound waves and is quick and painless. Magnetic resonance elastography gives more detail but takes longer.

Doctors now use noninvasive scans like elastography more often. This makes it easier to track liver disease without hospital stays or surgery.

Tissue Sample Test (Biopsy)

Sometimes, doctors need a small sample of the liver to look for signs of cirrhosis. They call this a liver biopsy.

Liver biopsy: A thin needle removes a tiny piece of liver for checking under a microscope. This shows how much scarring (fibrosis) there is and can point to the cause. Doctors do not always need a biopsy, but it is the best way to see how much permanent damage has happened. Sometimes, imaging tests give enough information so a biopsy is not needed.

Ongoing Checks

When doctors know a person has cirrhosis, they often order regular follow-up tests.

These checks might include:

Blood tests to watch how the liver is working and catch new problems.
Imaging to look for liver cancer or blood flow changes.
Noninvasive tests to keep checking for more scarring.

Doctors recommend these repeated tests to catch complications early, such as esophageal varices or new liver tumors.

Summary Table: Tools Used to Find Cirrhosis

Tool	Purpose	Invasive?
Blood work	Checks how well the liver is working	No
Ultrasound, CT, MRI	See details about liver shape and texture	No
Transient and MR elastography	Finds out how stiff the liver has become	No
Liver biopsy	Samples tissue for scarring and cause	Yes

Treatment

Managing the Root Cause of Liver Scarring

The first step in treating cirrhosis is to slow or stop the process that harms the liver. Treatment depends on what caused the liver damage.

Cause	Main Treatment
Alcoholic liver disease	Complete alcohol abstinence
Nonalcoholic fatty liver disease/NASH	Weight loss, diabetes control
Viral hepatitis (B/C)	Antiviral medications
Hemochromatosis	Removal of excess iron
Primary biliary cholangitis	Specific medicines

Alcohol-Related Liver Disease: Stopping all alcohol is the most important step. Even small amounts can make liver damage worse. Programs like counseling or support groups can help with quitting.
Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: Weight loss and better blood sugar control through healthy eating and activity help. Weight loss can lessen fat buildup and slow scarring.
Viral Hepatitis (Hepatitis B or C): Medicines can control the viruses that harm the liver. Long-term medicine may prevent more injury to liver cells.
Other liver diseases: Some types, such as primary biliary cholangitis or hemochromatosis, may improve with specific medicines or treatments.
Nutrition and general health: Malnutrition is common with cirrhosis. Vitamin and mineral supplements and a healthy diet may help prevent weak bones and other problems.

Treating fatigue, itching, and pain can also help improve daily life.

Handling Problems Linked to Cirrhosis

As cirrhosis gets worse, new problems can appear. Treating these complications is an important part of care.

Common complications and how doctors manage them:

Complication	Treatment Options
Ascites and swelling	Low-salt diet, diuretics, fluid drainage
Portal hypertension/varices	Blood pressure meds, endoscopy, banding, shunt procedure
Infection	Antibiotics, vaccines
Liver cancer risk	Regular blood tests and ultrasounds
Hepatic encephalopathy	Medicines to reduce toxins

Fluid Buildup (Ascites and Swelling):
- A low-sodium diet helps reduce fluid.
- Diuretics remove extra fluid.
- Sometimes, doctors drain fluid from the belly.
High Blood Pressure in the Liver (Portal Hypertension):
- Special medicines lower pressure in the veins.
- Regular checks (endoscopy) look for swollen veins (esophageal varices) that might bleed.
- Doctors may prescribe medicines if varices are present.
- Banding or shunt procedures may prevent or control bleeding.
Infections:
- Doctors treat infections quickly with antibiotics.
- Vaccines help avoid infections like flu, pneumonia, and hepatitis.
Greater Risk of Liver Cancer:
- Regular blood tests and liver scans help detect cancer early.
Trouble with Brain Function (Hepatic Encephalopathy):
- Medicines lower the amount of toxins in the blood.

Transplant Options

If the liver stops working, a transplant may be needed. Surgeons replace the damaged liver with a healthy one from a donor. Doctors consider a liver transplant after careful tests to check if the person is healthy enough for surgery.

People with alcoholic liver disease must avoid alcohol for life. Some programs accept people with a history of alcohol use if they meet the requirements.

The new liver can come from a person who has died or, sometimes, from a living donor who gives part of their liver. After transplant, following medical advice and taking medicines are important for success.

New Directions and Promising Treatments

Researchers are working to find better ways to treat cirrhosis and its causes.

Some areas of focus include:

Medicines for Liver Fibrosis: Scientists are studying drugs that may stop, slow, or reverse scar tissue buildup.
Earlier Detection and Prevention: Screening people at risk could help start treatment sooner.
New Approaches for Metabolic and Viral Causes: Experimental drugs aim to control or fix the underlying diseases.
Potential Role for Regenerative Medicine: Researchers are looking into stem cells or growth factors to rebuild liver tissue, but these treatments are not yet available.

Areas being researched:

Targeted antifibrotic therapies
Improved medicines for nonalcoholic fatty liver disease
Better antiviral drugs for hepatitis
New strategies to manage complications

People with cirrhosis may benefit from these treatments once proven safe and effective.

At-Home Steps and Daily Choices

Healthy lifestyle choices help protect the liver when living with cirrhosis. People should avoid alcohol completely, even if their liver problem was not caused by drinking.

Managing salt intake is important. Foods high in sodium make swelling worse, especially in the belly and legs. Choosing fresh foods and seasoning meals with herbs helps cut salt.

Food Group	Best Choices	To Avoid
Protein	Poultry, fish, legumes	Red or processed meats
Sodium	Fresh produce, low-salt	Canned, salty snacks
Seafood	Cooked fish, shellfish	Raw seafood

Eating well matters because cirrhosis increases the risk for malnutrition. Meals should include fruits, vegetables, and lean protein. Cooking food thoroughly helps lower infection risks.

Frequent handwashing and avoiding sick people help prevent illness, since the body fights infections less well. Staying up to date with vaccines for hepatitis A and B, flu, and pneumonia is also helpful.

Check with a healthcare provider before using any medicines, including those bought without a prescription. Some, like aspirin and ibuprofen, can harm the liver. Even acetaminophen should only be taken in small amounts if approved by a doctor.

Getting Ready for Your Visit

Steps to Take Before Your Medical Visit

Follow Any Special Instructions: Some appointments may require you to avoid eating or drinking for a set time. Check for any restrictions before your visit.
Track Your Symptoms: Note when your symptoms began and how often they occur. Write down any changes to discuss with your doctor.
Prepare a Medication List: Bring an updated list of all prescription drugs, over-the-counter medicines, vitamins, and supplements you use.
Collect Important Medical Details: Add information about other health conditions and recent hospital stays or treatments.
Gather Test Results: Bring copies of recent blood tests and imaging records, such as CT, MRI, or ultrasound. Include liver biopsy results if you have them.
Include Personal Background: Write notes about recent life changes, major stress, or personal details that may affect your care.
Ask Someone To Join You: Bring a family member or friend for support. They can help you remember important information.
Write Your Main Concerns: List the topics or symptoms you most want to discuss with your doctor.

Sample Table:

What to Bring	Why It’s Helpful
List of medicines	Ensures safe care
Medical test results	Gives complete history
Symptom timeline	Helps track progress

Helpful Questions for Your Specialist

What is likely causing my liver issues?
Are there ways to slow or stop further damage to my liver?
What treatment options do I have?
Should I stop or change any current medicines or supplements?
What signs or symptoms should make me call for help?
How do I manage my other health conditions while treating my liver disease?

Ask about diet, activities, or lifestyle changes. Request clear instructions if anything is unclear.

Information and Questions You May Hear from the Doctor

The doctor needs details to understand your health.

Be ready to answer questions such as:

When did your symptoms begin?
Have your symptoms stayed the same or changed?
How severe are your symptoms?
What makes your symptoms better or worse?
How often do you drink alcohol?
Have you used any drugs that can harm your liver?
Does your family have a history of liver problems?
Have you ever had hepatitis or yellowing of the skin (jaundice)?
Have you ever had a blood transfusion or used injected drugs?
Do you have any tattoos?

Cirrhosis – Diagnosis and Treatment