Materiały źródłowe

• #1 Diagnosis of Cirrhosis – NIDDK

  https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/diagnosis

  If your doctor suspects that you have cirrhosis, they may make a diagnosis based on your medical history, a physical exam, and the results of blood tests and imaging tests. […] Your doctor can use blood tests to tell how serious cirrhosis is. […] Based on the blood test results, your doctor may be able to diagnose certain causes of cirrhosis. […] Imaging tests can show the size, shape, and texture of the liver and show how much fat is in the liver. […] Your doctor may perform a liver biopsy to see how much scarring is in your liver. A liver biopsy can diagnose cirrhosis when the results of other tests are uncertain.

• #1 Cirrhosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492

  People with early-stage cirrhosis of the liver usually don’t have symptoms. Often, cirrhosis is first found through a routine blood test or checkup. To help confirm a diagnosis, a combination of laboratory and imaging tests is usually done. […] A healthcare professional may order one or more tests to check liver function, including: Lab tests. A healthcare professional may order blood tests to check for signs of liver malfunction, such as high bilirubin levels or certain enzymes. To evaluate kidney function, the blood is checked for creatinine. A blood count would be measured and blood is screened for hepatitis viruses. An international normalized ratio (INR) also is checked for the blood’s ability to clot. Based on history and blood test results, a medical professional may be able to diagnose the underlying cause of cirrhosis. Blood tests also can help identify the stage of cirrhosis.

• #1 How to Diagnose Cirrhosis – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/background/how-to-diagnose.asp

  Identifying the presence of cirrhosis is essential in any patient with chronic liver disease. Making the diagnosis of cirrhosis will affect management and follow-up. […] Cirrhosis should be investigated in patients with chronic (6 months in duration) abnormalities in liver enzymes and/or in patients in whom risk factors for cirrhosis are present: alcohol use disorder, hepatitis C, hepatitis B, obesity, and metabolic syndrome (even in the absence of liver enzyme abnormalities). […] The diagnosis of decompensated cirrhosis is usually easy and straightforward. However, for compensated cirrhosis, a combination of clinical judgement, laboratory tests (e.g. FIB-4, imaging finding) should be used. Finally, elastography is the best non-invasive assessment of fibrosis. […] Liver biopsy (an invasive method) is required to establish (or exclude) the diagnosis of cirrhosis when there is high suspicion but absence of non-invasive findings.

• #1 Cirrhosis of the Liver: Signs & Symptoms, Causes, Stages

  https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

  Cirrhosis of the liver is late stage liver disease, in which healthy liver tissue has been gradually replaced with scar tissue. This is a result of long-term, chronic hepatitis. […] A healthcare provider will begin by physically examining you for signs and symptoms of cirrhosis of the liver. Theyll ask you about when your symptoms began and whether theyve changed over time. Theyll also ask questions about your medical history, what medications, herbs or supplements you take, and your diet and lifestyle. Theyll look for clues that might suggest a history of liver disease or liver damage. […] Tests may include: Blood tests. A panel of liver function tests can show signs of liver disease and liver failure. These measure liver products like liver enzymes, proteins and bilirubin levels in your blood.

• #1 Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0901/p756.html

  Cirrhosis often is an indolent disease; most patients remain asymptomatic until the occurrence of decompensation, characterized by ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, or variceal bleeding from portal hypertension. […] No serologic or radiographic test can accurately diagnose cirrhosis. […] A significant correlation has been demonstrated between persistently elevated liver function tests and biopsy-proven underlying hepatic disease; thus, a more targeted serologic work-up is indicated in patients whose liver function test results are persistently abnormal. […] Referral for liver biopsy should be considered only after a thorough, non-invasive serologic and radiographic evaluation has failed to confirm a diagnosis of cirrhosis; the benefit of biopsy outweighs the risk; and it is postulated that biopsy will have a favorable impact on the treatment of chronic liver disease.

• #1 Cirrhosis (End Stage Liver Disease) | Doctor

  https://patient.info/doctor/cirrhosis-pro

  Diagnosing cirrhosis (investigations)1 […] These will depend to a considerable extent upon clinical suspicion of the aetiology. […] Blood tests […] LFTs: should include aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, gamma-glutamyltransferase (gamma-GT); AST and ALT are raised due to hepatocyte damage; gamma-GT is high in active alcoholics. […] Albumin: there is hypoalbuminaemia in advanced cirrhosis. […] FBC: occult bleeding may produce anaemia; hypersplenism may cause thrombocytopenia; macrocytosis can suggest alcohol abuse. […] Renal function tests and electrolytes: hyponatraemia may be present (due to increased activity of antidiuretic hormone). Poor renal function may represent hepatorenal syndrome. […] Red cell folate: alcohol abuse is often associated with a diet inadequate in folate.

• #1 Cirrhosis (End Stage Liver Disease) | Doctor

  https://patient.info/doctor/cirrhosis-pro

  Coagulation screen: abnormalities of coagulation are a sensitive test of liver function; prothrombin time is reduced in advanced cirrhosis. […] Ferritin: low ferritin may indicate iron deficiency from diet or blood loss; ferritin is raised in haemochromatosis. […] Viral antibody screen: to look for evidence of hepatitis B or C infection. […] Fasting glucose/insulin/triglycerides and uric acid levels: these should be measured if NASH is suspected. […] Autoantibody screen: anti-mitochondrial antibodies are a very strong indicator of primary biliary cirrhosis.11 […] Alpha-1-antitrypsin level: to assess for alpha-1-antitrypsin deficiency. […] Ceruloplasmin and urinary copper: to look for Wilson’s disease.12 […] Fasting transferrin saturation and HFE (haemochromatosis C282Y) mutation: along with a raised ferritin, these tests can screen for haemochromatosis.

• #1 Testing for cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8671021/

  Cirrhosis can be suspected by a thorough clinical assessment, but compensated liver disease is often asymptomatic. Select investigations are therefore critical for identifying patients with advanced liver disease and cirrhosis. […] Biomarkers and validated serum tests can evaluate liver damage and synthetic function. The ratio of the concentration of aspartate aminotransferase to the platelet count can predict the presence of cirrhosis. […] The gold standard test for diagnosis of cirrhosis has been liver biopsy, however, due to its invasiveness, rare but serious complications and cost, it is now used less frequently. Nowadays, careful clinical assessment, biochemical markers and imaging can provide a reliable evaluation of a patient with cirrhosis. […] Once the diagnosis of cirrhosis is made, monitoring for deteriorating liver function or complications is important.

• #1 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  Cirrhosis is the 12th leading cause of death in the United States. Newer research has established that liver fibrosis is a dynamic process and that early cirrhosis may be reversible. Only one in three people with cirrhosis knows they have it. Most patients with cirrhosis remain asymptomatic until the onset of decompensation. When clinical signs, symptoms, or abnormal liver function tests are discovered, further evaluation should be pursued promptly. The most common causes of cirrhosis are viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. Initial workup includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio, if not already ordered. Additional testing is based on demographics and risk factors. Common serum and ultrasound-based screening tests to assess fibrosis include the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, FibroTest/FibroSure, nonalcoholic fatty liver fibrosis score, standard ultrasonography, and transient elastography. Generally, noninvasive tests are most useful in identifying patients with no to minimal fibrosis or advanced fibrosis.

• #1

  https://link.springer.com/article/10.1007/s00261-024-04225-8

  A diagnosis of cirrhosis initiates a shift in the management of chronic liver disease and affects the diagnostic workflow and treatment decision of primary liver cancer. […] Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability. […] Various qualitative and quantitative imaging biomarkers based on ultrasound, CT and MRI have been proposed for noninvasive diagnosis of cirrhosis. […] Elastography techniques allow quantitative assessment of liver stiffness and are highly accurate for cirrhosis diagnosis. […] Ultrasound elastography are widely used in clinical practice, while MR elastography has narrower availability. […] Although not applicable in clinical practice yet, other quantitative imaging features, including liver surface nodularity, linear and volumetric measurement, extracellular volume fraction, liver enhancement on hepatobiliary phase, and parameters derived from diffusion-weighted imaging, can provide additional information of liver morphology, perfusion, and function, thus may increase diagnosis performance.

• #1 Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0901/p756.html

  Although no laboratory test can diagnose cirrhosis accurately, liver function tests, a complete blood count with platelets, and a prothrombin time test should be performed if a liver abnormality is suspected. […] If clinical, laboratory, and radiographic data are inconclusive, but suspicion of cirrhosis remains, a diagnostic liver biopsy should be performed. […] Abdominal ultrasonography is a specific, reliable, noninvasive, fast, and cost-effective test that should be used as a first-line radiographic study for diagnosing cirrhosis. […] No serologic test can diagnose cirrhosis accurately. […] The major use of radiographic studies is to detect ascites, hepatosplenomegaly, hepatic or portal vein thromboses, and hepatocellular carcinoma, all of which strongly suggest cirrhosis. […] Ultrasonography should be the first radiographic study performed in the evaluation of cirrhosis because it is the least expensive and does not pose a radiation exposure risk or involve intravenous contrast with the potential for nephrotoxicity as does computed tomography (CT).

• #1 Cirrhosis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/cirrhosis

  Cirrhosis may be diagnosed based on your symptoms, medical history, physical examination and results of laboratory tests. Tests to confirm a diagnosis of cirrhosis include a complete blood count (CBC), liver enzyme, liver function and electrolyte testing as well as screening for other health conditions such as hepatitis B and C viruses, liver cancer or gallstones. […] In most cases, a liver biopsy is used to confirm the diagnosis. During a biopsy, the doctor uses a needle to take a small sample of tissue from your liver so that it can be examined for scarring or other signs of disease. […] Imaging tests may also be recommended to obtain a closer look at your liver. These include a computerized tomography (CT) scan, ultrasound or a scan of the liver using a radioisotope a harmless radioactive substance that highlights the liver. The doctor also might examine your liver using a laparoscope, an instrument that is inserted through the abdomen that relays images onto a computer screen.

• #1 Cirrhosis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/366426-overview

  The guidelines recommend that if the appearances are typical of HCC (ie, hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC. […] MRI with gadolinium (or other contrast agents) is not recommended by the AASLD as an initial screening modality. […] The American College of Radiology (ACR) appropriateness criteria for chronic liver disease includes the following recommendations for the diagnosis of cirrhosis; although ultrasonography (grayscale and Doppler) can diagnose cirrhosis, it does so unreliably using morphologic and sonographic features, and it cannot diagnose earlier stages of fibrosis. […] 1-D transient elastography (TE) can more reliably diagnose cirrhosis compared with grayscale and Doppler US but is unreliable in patients with obesity and ascites, which is a significant portion of cirrhotic patients living in the United States. […] Acoustic radiation force impulse (ARFI) elastography can reliably diagnose cirrhosis and can stage hepatic fibrosis as well. […] MR elastography is the most accurate method for diagnosing liver fibrosis noninvasively because it assesses the whole liver and can stage liver fibrosis.

• #1 What will your health care provider do about cirrhosis? – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/cirrhosis/patient/what-provider-will-do.asp

  Cirrhosis […] People with cirrhosis need to see a health care provider regularly. If you have compensated cirrhosis, these visits may be scheduled as often as every 3 to 6 months. These visits allow your provider to watch for complications. Your provider may order the screening tests that can catch these complications early. Then they can be treated or even delayed. […] If you have decompensated cirrhosis, you may need to see your provider more often so the complications that have developed can be managed. […] An important step for all patients with cirrhosis is to reduce or prevent more liver damage by controlling the underlying cause. Patients who drink alcohol should stop all alcohol intake. It often takes support from friends, family and even a medical professional who specializes in helping individuals quit drinking. Patients with chronic viral hepatitis B or hepatitis C should receive treatment that can control or cure the virus. Patients with non-alcoholic fatty liver disease should reduce calorie intake. Consultation with a dietitian or with the MOVE! Weight Management Program is often recommended. […] Some people with cirrhosis should have an upper endoscopy (pronounced en-dahs-cup-ee) procedure. This is a test in which a thin tube with a camera is passed down your esophagus (food tube) so that your provider can look for varices. If you have no varices, the endoscopy will be repeated every few years or you may be given a type of medication called a beta-blocker instead of endoscopy. If you have large varices, you will get treatment or medication to reduce the chance of bleeding. […] You also will have a blood test and an ultrasound (or sometimes a CAT scan or an MRI) to look for signs of liver cancer and ascites. It is important for your health care provider to look for cancer on a regular basis, usually every 6 months. If the cancer is caught early, there are often ways to treat it. […] If you have developed decompensated cirrhosis, your provider may discuss liver transplant with you. Your provider can answer questions and help you to decide if a transplant is right for you. Your provider will help you find out if your body can tolerate this operation, and, if it can, help you and your loved ones get ready for transplant surgery.

• #1 Cirrhosis: Causes, Signs, & Treatment

  https://www.medicinenet.com/cirrhosis/article.htm

  Liver cancer (hepatocellular carcinoma) may be detected by CT and MRI scans or ultrasound of the abdomen. […] If there is an accumulation of fluid in the abdomen, a sample of the fluid can be removed to be tested (paracentesis). The results of testing may suggest the presence of cirrhosis as the cause of the fluid.

• #1 Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0901/p756.html

  Referral for liver biopsy should be considered after a thorough, noninvasive serologic and radiographic evaluation has failed to confirm a diagnosis of cirrhosis; the benefit of biopsy outweighs the risk; and it is postulated that biopsy will have a favorable impact on the treatment of chronic liver disease.

• #1 Core Concepts – Evaluation and Prognosis of Persons with Cirrhosis – Evaluation, Staging, and Monitoring of Chronic Hepatitis C – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-prognosis-cirrhosis/core-concept/all

  Once it has been established that an individual has cirrhosis, it is very important to determine whether they have compensated or decompensated cirrhosis. […] Prognosis and survival are markedly better in persons with compensated cirrhosis than in those with decompensated cirrhosis. […] A MELD score should be calculated for all persons with decompensated cirrhosis to better estimate the survival probability and to determine eligibility for transplantation. […] Decompensated cirrhosis is defined by a calculated CTP score of 7 to 15 (CTP Class B or C) and is often accompanied by the development of jaundice, ascites, variceal hemorrhage, and/or hepatic encephalopathy. […] Treatment of HCV in persons with decompensated cirrhosis has become possible with all-oral DAA therapy. […] The development of cirrhosis is the single most important risk factor for developing hepatocellular carcinoma (HCC).

• #1 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and conversion of the normal liver architecture into structurally abnormal nodules. The progression of liver injury to cirrhosis may occur over several weeks to years. […] Patients with compensated cirrhosis have a near 70% likelihood of survival 10 years after diagnosis. In contrast, patients with decompensated cirrhosis have only a 9% likelihood of survival 10 years after diagnosis. […] Relatively recent practice guidelines highlight the importance of making an early diagnosis of clinically significant portal hypertension (CSPH). […] The American Association for the Study of Liver Diseases (AASLD) classifies hepatic fibrosis as follows: Significant fibrosis: F2 fibrosis; Advanced fibrosis: F3 and F4 fibrosis; Cirrhosis: F4 fibrosis.

• #1 Cirrhosis of the Liver: Signs & Symptoms, Causes, Stages

  https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

  You might be able to prevent liver disease from progressing to cirrhosis by intervening earlier in the process. This depends on whether youre aware of it and whether there are steps you can take to prevent it. […] Healthcare providers use scoring methods like the Child-Turcotte-Pugh (CTP) system and the Model for End-Stage Liver Disease (MELD) to forecast your prognosis and determine your place on the liver transplant waiting list.

• #1 Cirrhosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492

  If you have cirrhosis, a healthcare professional is likely to recommend regular tests to see if liver disease has progressed or check for signs of complications, especially esophageal varices and liver cancer. Noninvasive tests are becoming more widely available for keeping an eye on liver disease. […] A tissue sample, called a biopsy, is not necessarily needed for diagnosis. However, it may be done to find out how severe liver damage is and what’s causing it.

• #1 Cirrhosis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/366426-overview

  Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and conversion of the normal liver architecture into structurally abnormal nodules. […] Diagnostic imaging offers diverse modalities for use in the noninvasive evaluation of the liver, as well as in interventional techniques; the latter may be used to treat such complications as portal hypertension and neoplasia. […] International guidelines for patients with cirrhosis suggest ultrasound examination every 6 months for early detection of HCC. The main goal is to detect neoplastic nodules less than 2cm. […] Imaging evaluation, initially ultrasound at 6-month intervals, is recommended based on evidence that increased frequency of examination leads to detection of hepatocellular carcinoma (HCC) at an earlier stage.

• #1 Physicians over-relying on a commonly used laboratory test can miss liver cirrhosis | MUSC | Charleston, SC

  https://web.musc.edu/about/news-center/2021/12/17/alcoholic-cirrhosis

  A recent study at the Medical University of South Carolinas (MUSC) Digestive Disease Research Core Center (DDRCC) provides insight into why physicians should be cautious when using a certain liver function test to diagnose alcoholic cirrhosis. […] A common method to diagnose patients with alcoholic cirrhosis is to look for elevated levels of enzymes known as aminotransferases in the liver. However, the MUSC study, published in The American Journal of Medical Sciences, found that patients with alcoholic cirrhosis have nearly normal levels of aminotransferases. […] The study’s findings are important because physicians who rely only on these tests can fail to diagnose alcoholic cirrhosis, said MUSC Health gastroenterologist and DDRCC director Don Rockey, M.D., who led the study. […] Often, patients may show subtle signs and symptoms in the early stages of alcoholic cirrhosis. However, if physicians look only at the laboratory results and not the patient, they are going to be faked out, said Rockey.

• #1 VA Study Finds Alarming Gaps in Cirrhosis Diagnosis

  https://www.gastroendonews.com/PRN/Article/08-21/VA-Study-Finds-Alarming-Gaps-in-Cirrhosis-Diagnosis/64221

  New research has found that nearly half of patients who receive care at Veterans Health Administration hospitals have risk factors for liver disease. Yet, fewer than 10% of patients with these risk factors and markedly abnormal fibrosis scoring or transient elastography receive a diagnosis of cirrhosis. […] Unfortunately, many of our patients with cirrhosis are discovered in the later stages of their disease process, said Lauren Beste, MD, the director of data and analytics for the VAs HIV, Hepatitis Related Conditions Program office, in Seattle. But when you look back, you often realize they had signs of cirrhosis that didnt get picked up, sometimes for years. Our motivation for the study was to see how many patients have risk factors for liver disease as well as other corroborating findings that might indicate they have undiagnosed cirrhosis.

• #1 VA Study Finds Alarming Gaps in Cirrhosis Diagnosis

  https://www.gastroendonews.com/PRN/Article/08-21/VA-Study-Finds-Alarming-Gaps-in-Cirrhosis-Diagnosis/64221

  Of the 3,023,074 patients with such risk factors, 87.5% (n=2,644,952) underwent liver-related testing. Of this group, 133,636 had markedly abnormal FIB-4 or transient elastography results. Despite these findings, only 9.7% of patients with risk factors and abnormal screening results received a diagnosis of cirrhosis. […] This is concerning to us because its likely that many of the patients who have these abnormal scores also have unrecognized cirrhosis. […] The findings point to the existence of a significant pool of patients who likely have cirrhosis and require further evaluation and referrals, said Dr. Beste, who added that population-level screening may help identify many of them. […] Timely recognition and referral of patients with cirrhosis is imperative in order to offer opportunity to impact disease progression and long-term outcomes, said Dr. Patton, who expressed dismay that so few patients received a diagnosis of cirrhosis. This, along with the high rate of decompensation in the year following diagnosis, indicates that we are routinely missing opportunities to treat liver disease before morbidity and mortality are imminent. […] The extremely high prevalence of risk factors for liver disease in our veterans should serve as a strong impetus to develop mechanisms for population-based screening to identify patients with advanced liver disease, she said.

• #1

  https://link.springer.com/article/10.1007/s00261-024-04225-8

  The introduction of radiomics and deep learning has further improved diagnostic accuracy while reducing subjectivity. […] Several imaging features may also help to assess liver function and outcomes in patients with cirrhosis. […] In this review, we summarize the qualitative and quantitative imaging biomarkers for noninvasive cirrhosis diagnosis, and the assessment of liver function and outcomes, and discuss the challenges and future directions in this field.

• #1 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  The sequential algorithm and risk prediction charts we developed and validated represent a significant progress for the patient management in clinical practice. As they use the same fibrosis tests and sequence of tests use, these tools represent an extension and improvement of the current guidelines.

• #1 Testing for cirrhosis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/testing-for-cirrhosis.html

  Cirrhosis can be suspected by a thorough clinical assessment, but compensated liver disease is often asymptomatic. Select investigations are therefore critical for identifying patients with advanced liver disease and cirrhosis. […] The diagnosis of cirrhosis is important to guide treatment, determine prognosis, and to monitor for complications in patients with chronic liver disease. […] The gold standard test for diagnosis of cirrhosis has been liver biopsy, however, due to its invasiveness, rare but serious complications and cost, it is now used less frequently. Nowadays, careful clinical assessment, biochemical markers and imaging can provide a reliable evaluation of a patient with cirrhosis. […] Once the diagnosis of cirrhosis is made, monitoring for deteriorating liver function or complications is important.

• #2 Cirrhosis of the Liver: Signs & Symptoms, Causes, Stages

  https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver

  Cirrhosis of the liver is late stage liver disease, in which healthy liver tissue has been gradually replaced with scar tissue. This is a result of long-term, chronic hepatitis. […] A healthcare provider will begin by physically examining you for signs and symptoms of cirrhosis of the liver. Theyll ask you about when your symptoms began and whether theyve changed over time. Theyll also ask questions about your medical history, what medications, herbs or supplements you take, and your diet and lifestyle. Theyll look for clues that might suggest a history of liver disease or liver damage. […] Tests may include: Blood tests. A panel of liver function tests can show signs of liver disease and liver failure. These measure liver products like liver enzymes, proteins and bilirubin levels in your blood.

• #2 Cirrhosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

  Cirrhosis is usually a result of liver damage from conditions such as hepatitis B or C, or chronic alcohol use. […] Cirrhosis is often detected through routine blood tests or checkups. If your doctor finds something suspicious, further blood tests may be necessary. […] Based on the results, your doctor maybe able to diagnose the underlying cause of cirrhosis. […] A biopsy may also be required to identify the severity, extent and cause of liver damage. […] The liver damage caused by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the underlying cause is treated, further damage can be limited. […] Cirrhosis may make it more difficult for the body to process nutrients, leading to weakness and weight loss.

• #2 Cirrhosis: Causes, Signs, & Treatment

  https://www.medicinenet.com/cirrhosis/article.htm

  Cirrhosis is the end complication of many liver diseases and is characterized by abnormal structure and function of the liver. […] How is cirrhosis diagnosed and evaluated? […] The single best test for diagnosing cirrhosis is a biopsy of the liver. […] If cirrhosis is present, other tests can be used to determine the severity of cirrhosis and the presence of complications. […] Examples of how doctors diagnose and evaluate cirrhosis are: The patient’s history. The doctor may uncover a history of excessive and prolonged intake of alcohol, a history of intravenous drug abuse, or a history of hepatitis. This can suggest the possibility of liver disease and cirrhosis. […] Patients who are known to have chronic viral hepatitis B or C have a higher probability of having cirrhosis. […] With cirrhosis, the liver may be enlarged, normal or smaller in size.

• #2 Diagnosis of Cirrhosis – NIDDK

  https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/diagnosis

  If your doctor suspects that you have cirrhosis, they may make a diagnosis based on your medical history, a physical exam, and the results of blood tests and imaging tests. […] Your doctor can use blood tests to tell how serious cirrhosis is. […] Based on the blood test results, your doctor may be able to diagnose certain causes of cirrhosis. […] Imaging tests can show the size, shape, and texture of the liver and show how much fat is in the liver. […] Your doctor may perform a liver biopsy to see how much scarring is in your liver. A liver biopsy can diagnose cirrhosis when the results of other tests are uncertain.

• #2 Testing for cirrhosis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/testing-for-cirrhosis.html

  Cirrhosis can be suspected by a thorough clinical assessment, but compensated liver disease is often asymptomatic. Select investigations are therefore critical for identifying patients with advanced liver disease and cirrhosis. […] The diagnosis of cirrhosis is important to guide treatment, determine prognosis, and to monitor for complications in patients with chronic liver disease. […] The gold standard test for diagnosis of cirrhosis has been liver biopsy, however, due to its invasiveness, rare but serious complications and cost, it is now used less frequently. Nowadays, careful clinical assessment, biochemical markers and imaging can provide a reliable evaluation of a patient with cirrhosis. […] Once the diagnosis of cirrhosis is made, monitoring for deteriorating liver function or complications is important.

• #2 Liver Cirrhosis Diagnosis

  https://www.clinicbarcelona.org/en/assistance/diseases/liver-cirrhosis/diagnosis

  Cirrhosis can be diagnosed when there are abnormalities in several tests: […] Blood analysis: an increase in bilirubin is usually seen, as well as a decrease in albumin and prothrombin time (markers that indicate liver damage). A decrease in the number of platelets is another feature. […] Transient elastography: for the assessment of the amount of fibrous tissue (scars) in the liver. Elevated values above 8 kPa suggest the patient has significant fibrosis. Above 15 kPa, cirrhosis is suspected so tests are necessary to rule it out. […] Abdominal ultrasound: evaluates the shape of the liver. If the patient has cirrhosis, the ultrasound will show irregular liver margins, fibrous liver tissue or a decrease in liver size. […] Liver biopsy: this test provides the definitive diagnosis of cirrhosis. This can be ultrasound guided or by insertion of a catheter into the liver. Performing liver catheterisation also makes it possible to measure the liver venous pressure, which is high in the case of cirrhosis and is useful for obtaining data on the prognosis of the disease.

• #2 Cirrhosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/278

  Key diagnostic factors include presence of risk factors, abdominal distension, jaundice and pruritus, blood in vomit (haematemesis) and black stool (melaena), hand and nail features (e.g., leukonychia, palmar erythema, spider naevi), facial features (e.g., telangiectasia, spider naevi, jaundiced sclera), abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension), and altered mental status. […] 1st investigations to order include liver function tests, gamma-glutamyl transferase (GGT), serum albumin, serum sodium, serum potassium, prothrombin time, platelet count, antibodies to hepatitis C virus, and hepatitis B surface antigen hepatitis B DNA assay. […] Investigations to consider include total iron, total iron binding capacity (TIBC), transferrin saturation, serum ferritin, antinuclear antibody, antismooth muscle antibody, liver kidney microsomal antibody, antimitochondrial antibody, serum immunoglobulins, serum ceruloplasmin, plasma alpha-1 antitrypsin, alpha-fetoprotein, abdominal ultrasound, abdominal CT, abdominal MRI, upper gastrointestinal endoscopy, liver biopsy, imaging-based non-invasive tests, blood-based non-invasive tests, and portal pressure assessment.

• #2 Work up the etiology – Cirrhosis Care

  https://cirrhosiscare.ca/cirrhosis-provider/work-up-the-etiology/

  The three most common causes of cirrhosis are Non-alcoholic fatty liver disease, Alcohol and Hepatitis C virus. […] In addition to a detailed history, examination and liver imaging such as an ultrasound doppler, basic testing in all patients with cirrhosis should include screening with the anti-HCV antibody (will require HCV PCR to confirm diagnosis if antibody is positive), HBsAg, quantitative immunoglobulins and iron studies. […] In addition to a detailed history and relevant physical examination, the following laboratory investigations can be done to determine the etiology in cases of confirmed cirrhosis.

• #2 Testing for cirrhosis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/testing-for-cirrhosis.html

  Referral to a hepatologist should be considered for the assessment of all patients with liver cirrhosis, when the diagnosis of chronic liver disease is uncertain and for the management of complications. […] Making the diagnosis requires a clinical suspicion of liver disease, particularly in at-risk populations. The initial investigations include biochemical tests and imaging. Serum markers and clinical features can be combined to predict the presence of liver fibrosis. Liver fibrosis can also be assessed by measuring the tissue stiffness with elastography. Biopsy is now rarely used for the diagnosis of cirrhosis.

• #2 Cirrhosis – Wikipedia

  https://en.wikipedia.org/wiki/Cirrhosis

  Diagnosis is based on blood tests, medical imaging, and liver biopsy. […] A liver biopsy will confirm the diagnosis; however, is generally not required. […] Ultrasound is routinely used in the evaluation of cirrhosis. […] Other scans include CT of the abdomen and MRI. […] Cirrhosis is also diagnosable through a variety of new elastography techniques. […] The best predictors of cirrhosis are ascites, platelet count 160,000/mm3, spider angiomata, and a Bonacini cirrhosis discriminant score greater than 7. […] FibroTest is a biomarker for fibrosis that may be used instead of a biopsy. […] The gold standard for diagnosis of cirrhosis is a liver biopsy. […] A biopsy is not necessary if the clinical, laboratory, and radiologic data suggest cirrhosis.

• #2 Cirrhosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/1215/p759.html

  Liver biopsy remains the reference standard; however, transient elastography has become more widely available and is rapidly replacing biopsy as the preferred method for liver fibrosis staging. […] Liver fibrosis is scored on a scale from F0 to F4. Differentiating between significant (F2 or greater) and advanced (F3 or greater) fibrosis and cirrhosis (F4) is difficult even with complete clinical, laboratory, and imaging data because findings are often nonspecific or insensitive. Liver biopsy remains the reference standard for assessing liver fibrosis; however, use of noninvasive methods has become increasingly common in clinical practice. […] After the diagnosis of cirrhosis is established, Child-Pugh and Model for End-Stage Liver Disease scores should be used to identify the stage of cirrhosis and mortality risk, respectively. A Child-Pugh grade B classification (seven to nine points) is consistent with early hepatic decompensation, whereas a Model for End-Stage Liver Disease score of 12 or more is predictive of increased risk for cirrhosis complications.

• #2 Cirrhosis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/366426-overview

  Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and conversion of the normal liver architecture into structurally abnormal nodules. […] Diagnostic imaging offers diverse modalities for use in the noninvasive evaluation of the liver, as well as in interventional techniques; the latter may be used to treat such complications as portal hypertension and neoplasia. […] International guidelines for patients with cirrhosis suggest ultrasound examination every 6 months for early detection of HCC. The main goal is to detect neoplastic nodules less than 2cm. […] Imaging evaluation, initially ultrasound at 6-month intervals, is recommended based on evidence that increased frequency of examination leads to detection of hepatocellular carcinoma (HCC) at an earlier stage.

• #2 Cirrhosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cirrhosis?lang=us

  Cirrhosis can be diagnosed with ultrasound, CT, and MRI, and these imaging modalities can also be used to evaluate for possible complications of cirrhosis, such as portal hypertension or hepatocellular carcinoma. […] The diagnosis is made either at screening for cirrhosis due to known risk factors, elevated liver enzymes, or discovered incidentally in an examination for non-specific symptoms (e.g. right upper quadrant pain). […] One of the key roles of diagnostic radiology is the detection of hepatocellular carcinoma (six-monthly ultrasound should be done for surveillance as per 2018 AASLD (American Association for the Study of Liver Diseases) guidelines in cirrhotic patients to screen for hepatocellular carcinoma development).

• #2 Cirrhosis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Cirrhosis_differential_diagnosis

  Abdominal MRI may also be helpful in the diagnosis of portal hypertension. Findings on MRI suggestive of cirrhosis with portal hypertension include: Cirrhotic liver, as shrinkage and atrophy in liver, Re-canalized umbilical vein–pathognomonic, Dilated portal vein and/or splanchnic veins, Esophageal varices, Collaterals in any abdominal organ, Splenomegaly, Ascites. […] Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in various liver diseases. […] The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score. […] Findings on transient elastography may show reasonable correlation with the severity of cirrhosis: Increasing scarring of the liver is associated with increasing „stiffness” of the tissue. […] Cirrhosis must be differentiated from other diseases that cause jaundice, abdominal pain, weight loss, and fever such as Gallbladder cancer, hepatocellular carcinoma, pancreatic cancer, cholecystitis, choledochitis and liver fluke infections.

• #2 Diagnosis of Cirrhosis: Imaging | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-13614-1_6

  Liver biopsy is an essential tool for the hepatologist in the diagnosis and management of patients with cirrhosis. However, a pathological diagnosis is not always necessary to diagnose cirrhosis. Often clinical assessment with a complete history and physical examination, analysis of patterns of abnormalities in serum markers, and examination of common diagnostic radiologic modalities in totality allow for the diagnosis of cirrhosis. Abdominal imaging, namely computed tomography, ultrasound (US) with Doppler evaluation, and magnetic resonance imaging (MRI), serves as a useful crutch in this regard for both diagnostic and prognostic purposes. This chapter reviews the strengths and weaknesses of each of the modalities as it pertains to diagnosis of cirrhosis. Further, novel applications of elastography (both US and MRI-based) as another noninvasive tool to diagnose cirrhosis are discussed.

• #2 Cirrhosis | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/cirrhosis/

  These scans can produce detailed images of your liver or check liver stiffness to identify any scarring. […] A liver biopsy is where a fine needle is inserted into your body (usually between your ribs) to remove a small sample of liver cells. The sample is sent to a laboratory so it can be examined under a microscope. […] The biopsy is usually carried out under local anaesthetic, as a day case or with an overnight stay in hospital. The outcome of the biopsy will confirm a diagnosis of cirrhosis and may provide more information about the cause. However, transient elastography is increasingly being used as an alternative to a biopsy in the diagnosis of cirrhosis. […] An endoscopy is where an endoscope (a thin, long, flexible tube with a light and video camera at the end) is passed down your throat and into your stomach.

• #2 Testing for cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8671021/

  Cirrhosis can be suspected by a thorough clinical assessment, but compensated liver disease is often asymptomatic. Select investigations are therefore critical for identifying patients with advanced liver disease and cirrhosis. […] Biomarkers and validated serum tests can evaluate liver damage and synthetic function. The ratio of the concentration of aspartate aminotransferase to the platelet count can predict the presence of cirrhosis. […] The gold standard test for diagnosis of cirrhosis has been liver biopsy, however, due to its invasiveness, rare but serious complications and cost, it is now used less frequently. Nowadays, careful clinical assessment, biochemical markers and imaging can provide a reliable evaluation of a patient with cirrhosis. […] Once the diagnosis of cirrhosis is made, monitoring for deteriorating liver function or complications is important.

• #2 Liver Cirrhosis – American College of Gastroenterology

  https://gi.org/topics/liver-cirrhosis/

  Cirrhosis is best determined by examining a sample of liver tissue under the microscope, a procedure which is called a liver biopsy. In this relatively simple procedure a thin needle is inserted, usually under local anesthesia, into the liver and removes a small piece of liver tissue. Liver biopsy not only confirms the presence of cirrhosis, but can often provide information as to its cause. […] A liver biopsy is not always necessary to diagnose cirrhosis. Frequently, your physician may be able to diagnose cirrhosis by the presence of changes noted during physical examination (such as enlargement of the spleen, enlargement of the breast tissue in men, and certain skin findings) together with the results from blood tests, imaging studies (such as ultrasound, CT or MRI scans) and/or endoscopy. There are several new tests that use ultrasound or MRI to directly measure the stiffness of the liver which may help in diagnosing cirrhosis but these tests are not widely available.

• #2 Non-invasive diagnosis of advanced fibrosis and cirrhosis

  https://www.wjgnet.com/1007-9327/full/v20/i45/16820.htm

  The diagnosis of cirrhosis also portends an increased risk of liver related morbidity as well as mortality. […] Therefore, an accurate and timely diagnosis of liver cirrhosis is critical to identify patients in need of close monitoring, management of complications and treatment of the underlying liver disease. […] Despite its universal use in the staging of fibrosis, liver biopsy is an invasive and inaccurate gold standard with numerous drawbacks. In order overcome the limitations of liver biopsy, a number of non-invasive techniques have been investigated for the assessment of fibrosis. This review will focus on the non-invasive diagnosis of cirrhosis using these modalities. […] The non-invasive assessment of fibrosis and cirrhosis attempts to overcome some of the drawbacks of liver biopsy – by eliminating the risk of peri-procedural complications. On the whole, radiologic and serum markers of fibrosis correlate well with biopsy scores, especially when excluding cirrhosis (F4 or F 4) or excluding fibrosis (F0 vs F 0). This feature is certainly clinically useful, and avoids liver biopsy in many cases. However, the accurate distinction of stage of fibrosis is less reliable with these modalities.

• #2 Core Concepts – Evaluation and Prognosis of Persons with Cirrhosis – Evaluation, Staging, and Monitoring of Chronic Hepatitis C – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-prognosis-cirrhosis/core-concept/all

  Once it has been established that an individual has cirrhosis, it is very important to determine whether they have compensated or decompensated cirrhosis. […] Prognosis and survival are markedly better in persons with compensated cirrhosis than in those with decompensated cirrhosis. […] A MELD score should be calculated for all persons with decompensated cirrhosis to better estimate the survival probability and to determine eligibility for transplantation. […] Decompensated cirrhosis is defined by a calculated CTP score of 7 to 15 (CTP Class B or C) and is often accompanied by the development of jaundice, ascites, variceal hemorrhage, and/or hepatic encephalopathy. […] Treatment of HCV in persons with decompensated cirrhosis has become possible with all-oral DAA therapy. […] The development of cirrhosis is the single most important risk factor for developing hepatocellular carcinoma (HCC).

• #2 Core Concepts – Evaluation and Prognosis of Persons with Cirrhosis – Evaluation, Staging, and Monitoring of Chronic Hepatitis C – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-prognosis-cirrhosis/core-concept/all

  All persons with cirrhosis (compensated or decompensated) should undergo surveillance for HCC with hepatic ultrasound, with or without serum alpha-fetoprotein (AFP), every 6 months. […] The CTP scoring system is based on five parameters (serum bilirubin, serum albumin, prothrombin time, severity of ascites, and grade of encephalopathy); it is easy to calculate and provides valuable prognostic information. […] Individuals with cirrhosis and a MELD 3.0 score of 15 or greater should be referred for a liver transplantation evaluation.

• #2 Cirrhosis: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/cirrhosis/?srsltid=AfmBOoo6VktyJYYUtziMr5f0C4rbpALIJLwIOM_B9EkV8m5DtEtwWZQe

  Cirrhosis is diagnosed by symptoms, physical exam, and blood tests. Radiology exams such as ultrasound, CT, MRI, or transient elastography may be performed. A liver biopsy may also be performed to see how much of the liver is damaged (American Liver Foundation, 2021). […] During the early stages of cirrhosis there may not be any symptoms. This is called compensated cirrhosis. As more liver damage occurs, the individual may experience decompensated cirrhosis including symptoms such as: […] Follow up with the healthcare provider is an important part in the management of cirrhosis. The individual should have periodic upper endoscopies to assess for varices. Screening for ascites and liver cancer should also be completed. […] There are many appropriate nursing diagnoses for the individual with cirrhosis. Some possible nursing diagnoses include: […] Nursing intervention will vary based on an individuals symptoms. Some of the most common nursing interventions include: […] Expected Outcomes […] Patient/Caregiver Education

• #2 Cirrhosis in Children: Diagnosis and Treatment

  https://www.massgeneral.org/children/cirrhosis/diagnosis-treatment

  There are many tests to diagnose cirrhosis. One of these tests is a liver biopsy. This is when a doctor takes a small sample of your childs liver and checks it for signs of scarring under a microscope. […] After the doctor diagnoses your child with cirrhosis, your child might need one or more of the following tests to check the condition regularly: Blood tests to check your childs liver, kidney and oxygen levels, Ultrasound or other imaging tests of the liver, Physical exam.

• #2 VA Study Finds Alarming Gaps in Cirrhosis Diagnosis

  https://www.gastroendonews.com/PRN/Article/08-21/VA-Study-Finds-Alarming-Gaps-in-Cirrhosis-Diagnosis/64221

  New research has found that nearly half of patients who receive care at Veterans Health Administration hospitals have risk factors for liver disease. Yet, fewer than 10% of patients with these risk factors and markedly abnormal fibrosis scoring or transient elastography receive a diagnosis of cirrhosis. […] Unfortunately, many of our patients with cirrhosis are discovered in the later stages of their disease process, said Lauren Beste, MD, the director of data and analytics for the VAs HIV, Hepatitis Related Conditions Program office, in Seattle. But when you look back, you often realize they had signs of cirrhosis that didnt get picked up, sometimes for years. Our motivation for the study was to see how many patients have risk factors for liver disease as well as other corroborating findings that might indicate they have undiagnosed cirrhosis.

• #2 Physicians over-relying on a commonly used laboratory test can miss liver cirrhosis | MUSC | Charleston, SC

  https://web.musc.edu/about/news-center/2021/12/17/alcoholic-cirrhosis

  A recent study at the Medical University of South Carolinas (MUSC) Digestive Disease Research Core Center (DDRCC) provides insight into why physicians should be cautious when using a certain liver function test to diagnose alcoholic cirrhosis. […] A common method to diagnose patients with alcoholic cirrhosis is to look for elevated levels of enzymes known as aminotransferases in the liver. However, the MUSC study, published in The American Journal of Medical Sciences, found that patients with alcoholic cirrhosis have nearly normal levels of aminotransferases. […] The study’s findings are important because physicians who rely only on these tests can fail to diagnose alcoholic cirrhosis, said MUSC Health gastroenterologist and DDRCC director Don Rockey, M.D., who led the study. […] Often, patients may show subtle signs and symptoms in the early stages of alcoholic cirrhosis. However, if physicians look only at the laboratory results and not the patient, they are going to be faked out, said Rockey.

• #2 VA Study Finds Alarming Gaps in Cirrhosis Diagnosis

  https://www.gastroendonews.com/PRN/Article/08-21/VA-Study-Finds-Alarming-Gaps-in-Cirrhosis-Diagnosis/64221

  Of the 3,023,074 patients with such risk factors, 87.5% (n=2,644,952) underwent liver-related testing. Of this group, 133,636 had markedly abnormal FIB-4 or transient elastography results. Despite these findings, only 9.7% of patients with risk factors and abnormal screening results received a diagnosis of cirrhosis. […] This is concerning to us because its likely that many of the patients who have these abnormal scores also have unrecognized cirrhosis. […] The findings point to the existence of a significant pool of patients who likely have cirrhosis and require further evaluation and referrals, said Dr. Beste, who added that population-level screening may help identify many of them. […] Timely recognition and referral of patients with cirrhosis is imperative in order to offer opportunity to impact disease progression and long-term outcomes, said Dr. Patton, who expressed dismay that so few patients received a diagnosis of cirrhosis. This, along with the high rate of decompensation in the year following diagnosis, indicates that we are routinely missing opportunities to treat liver disease before morbidity and mortality are imminent. […] The extremely high prevalence of risk factors for liver disease in our veterans should serve as a strong impetus to develop mechanisms for population-based screening to identify patients with advanced liver disease, she said.

• #2 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  Unlike for advanced liver fibrosis, the practical rules for the early non-invasive diagnosis of cirrhosis in NAFLD remain not well defined. Here, we report the derivation and validation of a stepwise diagnostic algorithm in 1568 patients with NAFLD and liver biopsy coming from four independent cohorts. The study algorithm, using first the elastography-based tests Agile3+ and Agile4 and then the specialized blood tests FibroMeterV3G and CirrhoMeterV3G, provides stratification in four groups, the last of which is enriched in cirrhosis (71% prevalence in the validation set). A risk prediction chart is also derived to allow estimation of the individual probability of cirrhosis. The predicted risk shows excellent calibration in the validation set, and mean difference with perfect prediction is only 2.9%. These tools improve the personalized non-invasive diagnosis of cirrhosis in NAFLD.

• #2 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  In this work, we used the best performing non-invasive tests currently available to liver specialists to develop and validate an accurate diagnosis of cirrhosis in patients with NAFLD, which translated in a cirrhosis category in the diagnostic algorithms currently recommended. […] Our results confirmed the very good to excellent areas under the receiver operating characteristic (AUROC) of non-invasive tests for the diagnosis of cirrhosis with results reaching 0.90 for the best tests. […] Diagnostic accuracy of these thresholds was consistent between the derivation and the validation sets. […] The study algorithm correctly diagnosed 86% of the patients and required liver biopsy in only 20% of the patients. Importantly, 88% of the misclassified patients in the validation set were by only one fibrosis stage. All these results were robust and did not differ between the derivation and the validation set.

• #2 Testing for cirrhosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8671021/

  The prevalence of cirrhosis is increasing. Patients are likely to have a better prognosis if there is an early diagnosis. […] Making the diagnosis requires a clinical suspicion of liver disease, particularly in at-risk populations. The initial investigations include biochemical tests and imaging. Serum markers and clinical features can be combined to predict the presence of liver fibrosis. Liver fibrosis can also be assessed by measuring the tissue stiffness with elastography. Biopsy is now rarely used for the diagnosis of cirrhosis.

• #2 The Stages of Liver Disease – American Liver Foundation

  https://liverfoundation.org/about-your-liver/how-liver-diseases-progress/

  Cirrhosis is where your liver is severely scarred and permanently damaged. While the word cirrhosis is most commonly heard when people discuss alcohol-induced liver disease, cirrhosis is caused by many forms of liver disease. […] Early diagnosis may prevent damage from occurring in your liver. Your liver is an incredible organ. If you’re diagnosed when some scar tissue has already formed, your liver can repair and even regenerate itself. Because of this, damage from liver disease can often be reversed with a well-managed treatment plan.

• #2 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  The sequential algorithm and risk prediction charts we developed and validated represent a significant progress for the patient management in clinical practice. As they use the same fibrosis tests and sequence of tests use, these tools represent an extension and improvement of the current guidelines.

• #3 Cirrhosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/278

  Cirrhosis is the pathological end-stage of any chronic liver disease and most commonly results from chronic hepatitis B and C, alcohol-related liver disease, and metabolic dysfunction-associated steatotic liver disease. […] Management of cirrhosis includes treating underlying liver disease, avoiding superimposed injury, and managing complications. Timely referral for liver transplantation may be the only curative treatment option for patients with decompensated cirrhosis. […] Cirrhosis is a diffuse pathological process, characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules. […] It can lead to portal hypertension, liver failure, and hepatocellular carcinoma. […] In general, it is considered to be irreversible in its advanced stages, although there can be significant recovery if the underlying cause is treated.

• #3 Cirrhosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/278

  Key diagnostic factors include presence of risk factors, abdominal distension, jaundice and pruritus, blood in vomit (haematemesis) and black stool (melaena), hand and nail features (e.g., leukonychia, palmar erythema, spider naevi), facial features (e.g., telangiectasia, spider naevi, jaundiced sclera), abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension), and altered mental status. […] 1st investigations to order include liver function tests, gamma-glutamyl transferase (GGT), serum albumin, serum sodium, serum potassium, prothrombin time, platelet count, antibodies to hepatitis C virus, and hepatitis B surface antigen hepatitis B DNA assay. […] Investigations to consider include total iron, total iron binding capacity (TIBC), transferrin saturation, serum ferritin, antinuclear antibody, antismooth muscle antibody, liver kidney microsomal antibody, antimitochondrial antibody, serum immunoglobulins, serum ceruloplasmin, plasma alpha-1 antitrypsin, alpha-fetoprotein, abdominal ultrasound, abdominal CT, abdominal MRI, upper gastrointestinal endoscopy, liver biopsy, imaging-based non-invasive tests, blood-based non-invasive tests, and portal pressure assessment.

• #3 Cirrhosis of the Liver – Diagnosis, Evaluation & Treatment

  https://www.radiologyinfo.org/en/info/cirrhosisliver

  Cirrhosis can be diagnosed by radiology testing such as computed tomography (CT), ultrasound or magnetic resonance imaging (MRI) or via a needle biopsy of the liver. […] Elastography can detect stiffness of the liver caused by liver fibrosis earlier than other imaging tests. […] Other tests include: Biopsy: Part of the liver tissue is sampled and examined by a pathology doctor to analyze the extent of liver damage. […] Liver function test: This test involves analyzing the blood for particular enzymes that signal that liver damage is present.

• #3 Liver Cirrhosis Diagnosis

  https://www.clinicbarcelona.org/en/assistance/diseases/liver-cirrhosis/diagnosis

  Cirrhosis can be diagnosed when there are abnormalities in several tests: […] Blood analysis: an increase in bilirubin is usually seen, as well as a decrease in albumin and prothrombin time (markers that indicate liver damage). A decrease in the number of platelets is another feature. […] Transient elastography: for the assessment of the amount of fibrous tissue (scars) in the liver. Elevated values above 8 kPa suggest the patient has significant fibrosis. Above 15 kPa, cirrhosis is suspected so tests are necessary to rule it out. […] Abdominal ultrasound: evaluates the shape of the liver. If the patient has cirrhosis, the ultrasound will show irregular liver margins, fibrous liver tissue or a decrease in liver size. […] Liver biopsy: this test provides the definitive diagnosis of cirrhosis. This can be ultrasound guided or by insertion of a catheter into the liver. Performing liver catheterisation also makes it possible to measure the liver venous pressure, which is high in the case of cirrhosis and is useful for obtaining data on the prognosis of the disease.

• #3 Cirrhosis – Hepatic and Biliary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/hepatic-and-biliary-disorders/fibrosis-and-cirrhosis/cirrhosis

  Conventional imaging tests are not highly sensitive or specific for the diagnosis of cirrhosis by themselves, but they can often detect its complications. Noninvasive imaging studies are useful in detection of early cirrhosis when conventional imaging findings are equivocal and portal hypertension is not evident. […] Liver biopsy is invasive and is subject to sampling error, but it remains the gold standard for the diagnosis of cirrhosis. […] If clinical criteria and noninvasive testing are inconclusive for diagnosis of cirrhosis or its etiology, liver biopsy is required. […] Do liver biopsy if a clear diagnosis would lead to better management and outcome.

• #3 Cirrhosis (End Stage Liver Disease) | Doctor

  https://patient.info/doctor/cirrhosis-pro

  Retesting8 […] Offer retesting for cirrhosis every 2 years for: […] People diagnosed with alcohol-related liver disease. […] People with hepatitis C virus infection who have not shown a sustained virological response to antiviral therapy. […] People with NAFLD and advanced liver fibrosis. […] Classification systems for cirrhosis […] The Child-Pugh (also known as the Child-Pugh-Turcotte (CPT)) classification system is a widely used and validated way to estimate prognosis in those with cirrhosis.14 […] A score of 5-6 is class A (life expectancy 15-20 years); a score of 7-9 is class B (life expectancy 4-14 years); a score of 10-15 is class C (life expectancy 1-3 years). This aligns with a perioperative mortality (for abdominal surgery) of 10%, 30%, and 80% respectively. […] A statistical model for end-stage liver disease (MELD) has also been developed to help to predict survival in cirrhosis and to help with timing and allocation of liver transplantation.

• #3 Cirrhosis of the liver life expectancy: Stages, outlook, and more

  https://www.medicalnewstoday.com/articles/cirrhosis-of-the-liver-life-expectancy

  Cirrhosis of the liver is a severe condition, causing scarring and permanent damage to the liver. Life expectancy depends on the stage and type of liver cirrhosis, but it may vary between roughly 2 to 12 years. […] Physicians use diagnostic tests and scoring to determine a persons stage of cirrhosis, which will help project their life expectancy. […] Healthcare professionals will project the life expectancy of people with cirrhosis using CTP scores in the following chart: […] Physicians use the Model for End-Stage Liver Disease (MELD) to estimate the life expectancy for people with cirrhosis, setting priorities for liver transplants. […] The life expectancy of a person with liver cirrhosis will depend on the stage of cirrhosis and other factors, such as how they are managing the condition. Typically, the life expectancy for a person with cirrhosis of the liver is around 2 to 12 years.

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