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When to seek medical advice

If you're experiencing any of the signs and symptoms of cirrhosis — weight loss, fatigue, jaundice and swelling in your legs or abdomen, especially if you drink alcohol or have had hepatitis — see your doctor. A physical exam and certain tests can help diagnose cirrhosis and rule out other reasons for your signs and symptoms.

Screening and diagnosis

Because cirrhosis seldom causes signs and symptoms in the early stages, your doctor may discover the disease during a routine medical examination. By gently pressing your abdomen, your doctor can often tell whether your liver is enlarged and firm, a sign of liver disease. As cirrhosis progresses, however, your liver often shrinks, leading to a backflow of blood and an enlarged spleen, which may also be detected in a physical exam.

If your doctor suspects cirrhosis, you're likely to have certain tests, including:

  • Liver blood tests. A damaged liver releases certain enzymes. Measuring these enzymes may help determine whether you have liver damage.

  • Bilirubin test. Bilirubin, a red-yellow pigment that results from the normal breakdown of red blood cells, is metabolized in your liver and excreted in your urine. But in advanced cirrhosis, your liver can't process bilirubin, leading to high blood levels of the pigment.

  • Ultrasound (ultrasonography). This noninvasive test uses sound waves to produce a picture of internal organs, including the liver. Ultrasound is painless and usually takes less than 30 minutes. While you lie on a bed or examining table, a wand-shaped device (transducer) is placed on your body. It emits sound waves that are reflected from your liver and transformed into a computer image.

  • Computerized tomography (CT) scan. This test uses X-rays to produce cross-sectional images of your body.

  • Magnetic resonance imaging (MRI). Instead of X-rays, MRI creates images using a magnetic field and radio waves. Sometimes a contrast dye also may be used. The test can take from 15 minutes to an hour. You may find an MRI more uncomfortable than a CT scan. That's because you'll likely be enclosed in a tube that's confining and because the machine generates a thumping noise some people find disturbing.

  • Liver biopsy. Although other tests can provide a great deal of information about the extent and type of liver damage, a biopsy is the only way to definitively diagnose cirrhosis. In this procedure, a small sample of tissue is removed from your liver and examined under a microscope. Your doctor is likely to use a thin cutting needle to obtain the sample. Needle biopsies are relatively simple procedures requiring only local anesthesia, but your doctor may choose not to do one if you have bleeding problems or severe abdominal swelling (ascites). Risks include bruising, bleeding and infection.


Because cirrhosis disrupts the normal function of your liver, it can cause a number of serious complications:

  • Increased pressure in the portal vein (portal hypertension). At any one time, your liver holds about 13 percent of your body's total blood, which enters the liver through two different vascular systems. Blood from your intestine, spleen and pancreas enters through a large blood vessel called the portal vein. Cirrhosis slows and blocks the normal flow of blood, increasing pressure within the portal vein and leading to widespread and serious complications such as enlarged veins (varices) and fluid retention (ascites).

  • Enlarged veins (varices). Portal hypertension often causes additional blood vessels to form — mainly in your stomach and esophagus. Sometimes other veins form around your navel and at the rectum. Similar to varicose veins, the blood vessels are thin-walled, twisted and engorged with blood. This makes them likely to bleed — a problem that occurs in about 30 percent of people with cirrhosis. Massive bleeding in the upper stomach or esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.

  • Fluid retention. Liver disease can cause large amounts of fluid to accumulate in your legs (edema) and abdominal cavity (ascites). Abdominal fluid is especially common in alcoholic cirrhosis. Several factors play a role, including portal hypertension, decreased ability of the blood vessels to retain fluid and changes in the hormones and chemicals that regulate fluids in your body. Ascites can be uncomfortable and may interfere with breathing. In addition, abdominal fluid may become infected (spontaneous bacterial peritonitis) and require treatment with antibiotics. Although not life-threatening in itself, ascites is usually a sign of advanced cirrhosis.

  • Bruising and bleeding. Cirrhosis interferes with the production of proteins that help your blood clot and with the absorption of vitamin K, which plays a role in synthesizing these proteins. As a result you may bruise and bleed more easily than normal. Bleeding in the gastrointestinal tract is particularly common.

  • Jaundice. This occurs when your liver isn't able to remove bilirubin — the residue of old red blood cells — from your blood. Eventually, bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color. Excreted bilirubin may turn your urine dark brown and your stools a pale clay color.

  • Itching. Bile salts deposited in your skin can cause intense itching.

  • Hepatic encephalopathy. A liver damaged by cirrhosis has trouble removing toxins from your body — normally one of the liver's key tasks. The buildup of toxins such as ammonia — a byproduct of protein digestion — can damage your brain, leading to changes in your mental state, behavior and personality (hepatic encephalopathy). Symptoms of hepatic encephalopathy include forgetfulness, confusion and mood changes, and in advanced cases, delirium and coma.

  • Weak bones (osteoporosis). Cirrhosis interferes with the liver's ability to process vitamin D and calcium, both of which are essential for bone growth and health. As a result, weak, brittle bones and bone loss are a common complication of the disease. Calcitriol, a form of vitamin D, may be particularly helpful in treating the problem.

  • Liver cancer. Cirrhosis from any cause greatly increases the risk of liver cancer, which occurs when malignant cells begin growing in the tissues of your liver. Unfortunately, liver cancer is rarely discovered early, and the prognosis is often poor. The outlook for people with liver cancer is further complicated because a liver transplant is seldom an option. In most cases, the cancer recurs outside the liver after the transplant.

  • Liver failure. This occurs when extensive damage to liver cells makes it impossible for your liver to function.

Cirrhosis > 1 > 2 > 3 > 4

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