Cirrhosis – pronounced suh-ROH-sis

The diagnosis of cirrhosis is usually based on the presence of a risk factor for cirrhosis, such as alcohol use or obesity, and is confirmed by physical examination, blood tests, and imaging. The doctor will ask about the person’s medical history and symptoms and perform a thorough physical examination to observe for clinical signs of the disease. For example, on abdominal examination, the liver may feel hard or enlarged with signs of ascites. The doctor will order blood tests that may be helpful in evaluating the liver and increasing the suspicion of cirrhosis.

To view the liver for signs of enlargement, reduced blood flow, or ascites, the doctor may order a computerized tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), or liver scan. The doctor may look at the liver directly by inserting a laparoscope into the abdomen. A laparoscope is an instrument with a camera that relays pictures to a computer screen.

A liver biopsy can confirm the diagnosis of cirrhosis but is not always necessary. A biopsy is usually done if the result might have an impact on treatment. The biopsy is performed with a needle inserted between the ribs or into a vein in the neck. Precautions are taken to minimize discomfort. A tiny sample of liver tissue is examined with a microscope for scarring or other signs of cirrhosis. Sometimes a cause of liver damage other than cirrhosis is found during biopsy.

How is the Severity of Cirrhosis Measured?

The model for end-stage liver disease (MELD) score measures the severity of cirrhosis. The MELD score was developed to predict the 90 day survival of people with advanced cirrhosis. The MELD score is based on three blood tests:

• International Normalized Ratio (INR) – Tests the clotting tendency of blood.
• Bilirubin – Tests the amount of bile pigment in the blood.
• Creatinine – Tests kidney function.

MELD scores usually range between 6 and 40, with a score of 6 indicating the best likelihood of 90 day survival.