How is cirrhosis diagnosed?
Jun 30, 2021
Source: Cainiu Health
Dr. Mou Dongpo
Introduction
1. Complete blood count (CBC): In early-stage liver cirrhosis, CBC results are typically normal; however, patients in the decompensated stage may develop anemia, and leukocytosis may occur during infection.
2. Urinalysis: Usually normal; however, in patients with hepatitis B virus (HBV)-related cirrhosis complicated by HBV-associated glomerulonephritis, urine protein testing yields a positive result.
3. Liver function tests: For example, serum bilirubin levels—both conjugated and total bilirubin may be elevated in the decompensated stage.
Cirrhosis is a diffuse hepatic injury resulting from prolonged or repeated exposure to one or more etiological factors and represents a common chronic liver disease in clinical practice. In China, most cases are post-hepatitis cirrhosis; a smaller proportion are alcoholic cirrhosis or schistosomal cirrhosis. So, how is cirrhosis diagnosed? The following section addresses this question.
How Is Cirrhosis Diagnosed?
1. Complete Blood Count (CBC)
In early-stage cirrhosis, the CBC may be normal. During the decompensated phase, patients may develop anemia; leukocytosis may occur during infection. In cases of hypersplenism, both white blood cell and platelet counts decrease. Additionally, alpha-fetoprotein (AFP) testing is performed: AFP levels rise during active cirrhosis; persistently elevated AFP with normal transaminase levels suggests concomitant hepatocellular carcinoma. Viral hepatitis serological testing helps identify the underlying cause—such as hepatitis B, C, or D virus infection—and aids in etiological diagnosis.
2. Urinalysis
Urinalysis is typically normal. However, in patients with hepatitis B-related cirrhosis complicated by hepatitis B-associated nephritis, urine protein may be positive. In cholestatic jaundice, urine bilirubin is positive while urobilinogen is negative. In hepatocellular jaundice, urobilinogen excretion increases. Patients with ascites should routinely undergo 24-hour urinary sodium and potassium measurements. Stool analysis is usually normal; however, melena, tarry stools, or even dark red bloody stools may appear in cases of esophageal or gastric variceal bleeding or portal hypertensive gastropathy, with positive fecal occult blood tests.
3. Liver Function Tests
Serum bilirubin levels—particularly conjugated and total bilirubin—may increase during the decompensated phase. Persistent hyperbilirubinemia is an important indicator of poor prognosis. Protein metabolism assessment is also critical: the liver is the sole site of albumin synthesis. In the absence of protein loss, serum albumin concentration often reflects hepatic functional reserve; decreased albumin synthesis occurs when liver function is significantly impaired. Prothrombin time (PT) is another key prognostic indicator of hepatic reserve function; it is markedly prolonged in advanced cirrhosis and severe hepatocellular injury.
The above outlines the diagnostic approaches used to detect cirrhosis. We hope this information is helpful to you.
