Cirrhosis in the early stages causes minimal and non-specific symptoms. It may be diagnosed accidentally during tests done for an unrelated illness. If the doctor suspects cirrhosis based on medical history and physical examination, he or she will recommend tests to confirm the diagnosis, the extent of liver damage and the probable cause/s of cirrhosis.
Medical history: During examination of medical history, the doctor may ask questions, such as:
Physical examination: During physical examination, the doctor will look for findings suggestive of cirrhosis, such as prominent tiny red lines (blood capillaries) on the skin above the waist, swelling of legs and ankles, swelling of abdomen, tenderness over liver, etc. If your symptoms or physical examination suggest liver cirrhosis, the doctor will do several tests to confirm the diagnosis.
Tests: Tests will be done to determine your liver function, the extent of damage caused and the cause of cirrhosis. Some of the tests that may be done include the following:
Blood test: It is done to assess the liver function and extent of liver damage. In this test, the levels of the liver enzymes alanine transaminase (ALT) and aspartate aminotransferase (AST) are measured. The enzymes are raised in people with liver damage due to hepatitis. Blood tests are also done to diagnose the cause of liver damage, such as viral hepatitis and an excess of iron or copper in the blood.
Imaging tests: Ultrasound scan, computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan is often done in people with liver disease.
Ultrasound: It is a painless and non-invasive test that uses high-frequency sound waves to produce a picture of the inside of your body. A trained doctor may look at the images formed and detect normal and abnormal structures in the abdomen. When sonography is done for liver, the doctor will look for changes, such as scarring of liver, size of liver, accumulation of fat, any cysts or nodules. It is often performed first as it is a safe test, has no risk of radiation exposure and is widely available.
CT scan: It is a painless and non-invasive test, which produces a series of images of the part of the body that is being examined. In this case, the liver and other structures in your abdomen. It can detect abnormalities that may not be seen on an ultrasound. It can provide details, such as scarring of liver, size of liver, accumulation of fat, any cysts or nodules. If the findings of the CT scan are not conclusive, the MRI scan may be done as it can show abnormalities that cannot be visualised on a CT scan.
Liver biopsy: Biopsy is an invasive medical test in which a fine needle is inserted into the body (usually between your ribs) to take a sample of a tissue from the liver. It is usually done after the patient is given local anaesthesia as a day care procedure. The tissue sample is examined under a microscope in the lab to determine what's causing the liver problems. The examination of the sample of liver tissue under microscope in the lab can confirm if there is cirrhosis and what the underlying cause of liver disease is.
Endoscopy: Endoscope is a special medical instrument, which has a thin, flexible tube that has a light and a camera at one end. It is inserted through the mouth into the oesophagus (food pipe) and then to your stomach. Endoscopy is done in cirrhosis to look for varices (swollen vessels). Presence of varices is a sign of cirrhosis. They are big and a person may experience bleeding from the varices.
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