Should I Be Tested for Cirrhosis?

The liver is different from many other organs because it can repair itself. When the liver is damaged, its cells can regrow. But the liver cannot do this forever.^1-3

As the liver gets more and more damage, it cannot keep up with repairing itself. If the liver is constantly being damaged, its ability to repair will eventually be unable to keep up. When this happens, the liver starts developing scar tissue. Scarring that is reversible is called fibrosis. Over time, this damage becomes permanent and is called cirrhosis.1-3

Cirrhosis can cause many serious health issues. There are two kinds of cirrhosis: compensated and decompensated. The liver works fairly well in compensated cirrhosis, and symptoms are less severe. In decompensated cirrhosis, symptoms may be life-threatening. The liver is not able to work well at all.^1-3

Cirrhosis and hepatitis C

A major cause of cirrhosis in the United States is the hepatitis C virus (HCV). HCV reproduces in the liver and causes damage along the way. This damage can build up for decades. At some point, the liver develops cirrhosis. As many as 50 percent of people with chronic (long-term) HCV will develop cirrhosis. Treating HCV reduces the risk of cirrhosis and its complications.^4,5

Complications of cirrhosis

Cirrhosis can lead to many complications. These include:^1-3

• Liver cancer (hepatocellular carcinoma is most common)
• Liver failure
• Hepatic encephalopathy (a buildup of toxins that can lead to problems with concentration and memory)

In addition, most of the body’s blood flows through the liver. When scar tissue increases, blood cannot flow as smoothly. This causes a backup of blood called “portal hypertension.” Portal hypertension can lead to many different issues, including:^1-3

• Abnormal veins in the esophagus
• Severe bleeding
• Swelling of the belly (ascites)
• Swelling of the limbs (peripheral edema)
• Breathing problems
• Kidney failure

Since many of these complications are life-threatening, doctors will monitor people at high risk to look for signs of cirrhosis or its progression. There is no specific cure for cirrhosis. But treating its underlying causes in the early stages may prevent severe symptoms later on.^2,6

Risk factors for cirrhosis

Risk factors for cirrhosis that may require a person to be tested include:^1-3

• Heavy, long-term alcohol use
• Being overweight or obese
• Having a hepatitis virus (like HCV or hepatitis B)
• Eating a high-fat diet
• Having a personal history of liver-related health conditions
• Having a family history of liver issues

Testing for cirrhosis

You and your doctor can determine which, if any, risk factors you might have for cirrhosis. If you are at higher risk or have symptoms, you may need testing. The greater the symptoms or more risk factors present, the more likely you will be monitored. Common testing options are:^1-3

• Blood tests
• Liver imaging
• Liver biopsy

Blood tests can be used to get a general idea of liver function. Your doctor may test for specific proteins made in the liver or kidneys. They may also test to see how well your blood clots. That is because proteins that clot blood are made in the liver. But many blood tests are not very specific. Further testing is often needed.1,2

Imaging tests help give an idea about the state of the liver. Imaging can also help track changes over time. Types of imaging that are used to look for cirrhosis include:^1-3

• Ultrasound
• Transient elastography (FibroScan)
• Magnetic resonance elastography (MRE)
• Computed tomography (CT) scans

A liver biopsy is the next step if imaging is insufficient to tell whether you have cirrhosis. A biopsy is the standard for confirming cirrhosis. A small sample of liver cells is taken using a needle during a liver biopsy. These cells are looked at under the microscope. Not everyone will need a biopsy. It depends on what your blood and imaging test results show.^1-3

Fibrosis and cirrhosis staging

Fibrosis is scored using the Metavir scoring system. This system starts at F0 (no scarring), progresses through stages F1, F2, and F3, and goes up to F4 (cirrhosis). Once cirrhosis is diagnosed, doctors will use systems like the Child-Pugh or Model for End-Stage Liver Disease (MELD) scores. These systems help the doctor understand the stage of cirrhosis a person has and their risk of dying.^3,6