Exams and Tests

Your doctor will do a physical exam and ask about your medical history to see if you have symptoms of liver disease and to help find out possible causes of liver damage.

If your doctor thinks you may have cirrhosis, you may have blood and imaging tests. You also may have a liver biopsy. This test can show for sure if you have cirrhosis.

Blood tests to check liver function

Measuring the levels of certain chemicals produced by the liver can show how well your liver is working. Blood tests may be used to measure:

• Albumin and total serum protein. Albumin is a type of protein. Liver disease can cause a decrease in protein levels in the blood.
• Partial thromboplastin time or prothrombin time/INR. These tests measure blood-clotting factors that are produced in the liver.
• Bilirubin. This is produced when the liver breaks down hemoglobin, the oxygen-carrying substance in red blood cells. Cirrhosis may cause high bilirubin levels, which causes jaundice.

Blood tests to check for inflammation of the liver

You may have blood tests to check your liver enzymes. These can help show whether you have had liver inflammation for a long time. These blood tests include:

• Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH). An increased level of these enzymes may mean injury to the liver and the death of liver cells.
• Alkaline phosphatase (ALP). An increased ALP level may mean blockage of bile ducts.
• Gamma-glutamyl transpeptidase (GGT). An increased level can happen because of alcohol use or diseases of the bile ducts.

Some people with cirrhosis have normal liver enzymes.

Blood tests to diagnose a cause of cirrhosis

Tests to check for conditions that may cause cirrhosis include:

• Antinuclear antibodies (ANA). ANA testing and anti-smooth-muscle antibody (ASMA) testing may help find autoimmune chronic hepatitis.
• Antimitochondrial antibody test (AMA), which may help find primary biliary cirrhosis.
• Ferritin and iron tests. These may help diagnose iron overload, or hemochromatosis.
• Tests for hepatitis B and hepatitis C or tests for infection with hepatitis viruses. These tests may help diagnose infection with certain hepatitis viruses.
• Blood alcohol level (BAL) tests. These tests may show alcohol use, which can cause alcoholic cirrhosis.
• Serum ceruloplasmin testing, which may help diagnose Wilson's disease.
• Alpha1-antitrypsin level. This may diagnose a condition in which people lack this protein (alpha1-antitrypsin deficiency).

Tests that show an image of the liver

Imaging tests can check for tumors and blocked bile ducts. They also can be used to look at liver size and blood flow through the liver. These tests include:

• Abdominal ultrasound.
• CT scan of the abdomen (including the liver, gallbladder, and spleen).
• MRI scan of the abdomen.
• Liver and spleen scan (rarely done).

Other tests

Other tests also may be done to confirm cirrhosis or to look for possible complications. These include:

• Liver biopsy. This is the only test that can confirm cirrhosis. Looking at liver tissue also may reveal signs of inflammation.
• Paracentesis. This test can help diagnose the cause of fluid buildup in the belly or to look for infection in the fluid (spontaneous bacterial peritonitis).
• Endoscopy. It looks for enlarged veins (varices) and bleeding (variceal bleeding) in the digestive tract.
• Endoscopic retrograde cholangiopancreatogram (ERCP), to look inside the tubes (bile ducts) that drain the liver, pancreas, and gallbladder. ERCP may be done if your doctor thinks that a condition called primary sclerosing cholangitis (PSC) might be leading to your liver problems.
• Alpha-fetoprotein (AFP) testing, to screen for cancer of the liver. This is a blood test.
• Ammonia testing. This test looks for excess ammonia in the blood, which can cause altered brain function (encephalopathy).