Cirrhosis – Laboratory Diagnosis

Routine tests of liver function may be quite normal in cirrhosis. A decreased serum albumin and a prolonged prothrombin time directly reflect impaired hepatic function in the truest sense. An increased serum gamma globulin accompanies many forms of chronic liver disease. AST and ALT are often moderately elevated, while alkaline phosphatase may be normal or increased, particularly with biliary obstruction. Bilirubin is usually normal. Increased total serum globulin is common. A normochromic normocytic (occasionally macrocytic) anemia, thrombocytopenia, and leukopenia may be present. With alcohol-related liver disease, the anemia is occasionally macrocytic.

Isotopic scintiscans show an irregular pattern of liver uptake and an increased uptake in the spleen and bone marrow. Ultrasound examination of the abdomen is useful to confirm hepatosplenomegaly and may also reveal enlargement or venous obstruction of the portal or splenic veins with portal hypertension. Cavernous transformation of the portal vein can also be identified and the presence of esophageal varices is suggested. New ultrasound modalities are beginning to estimate portal vein flow.

Source: Merck Manual