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Make the Diagnosis: Cirrhosis

Prior Probability

The probability of cirrhosis depends on the underlying etiology causing liver disease. Among all patients with liver disease undergoing a liver biopsy, the prevalence of cirrhosis is 24% (95% CI, 20-28%). Hepatitis C has been the most frequently studied liver disease, and 19% (95% CI, 15-23%) of affected patients who undergo biopsy will have cirrhosis.

Population in Whom Cirrhosis Should Be Considered

The presence of liver disease is usually first manifested by abnormal liver enzymes (aminotransferases) or function results (prothrombin time, serum albumin, total bilirubin). These laboratory findings typically occur before the physical examination manifestations of cirrhosis. Thus, cirrhosis should be considered in patients with liver disease who have either abnormal laboratory tests or clinical features compatible with the morphological changes of cirrhosis that disturb hepatic function.

Assessing the Likelihood of Cirrhosis

Among patients with liver disease, many findings are useful for assessing the likelihood of cirrhosis (Table 86-1). The overall clinical impression of cirrhosis (LR 4.8, 95% CI, 2.5-7.2) or the absence of cirrhosis (LR 0.52, 95% CI, 0.33-0.71) works similarly to most of the individual findings shown in Table 86-1. A combination of findings in the Bonacini score or Lok index

Table 86-1.Useful Findings for Assessing the Likelihood of Cirrhosis Among Patients With Liver Disease

Reference Standard Tests

The reference standard for diagnosing cirrhosis is a liver biopsy. However, the liver biopsy can be affected by sampling error, estimation of fibrosis, and interobserver variability in interpretation.

Original Article: Does This Patient With Liver Disease Have Cirrhosis?

Clinical Scenarios

Case 1

A 50-year-old man is referred for evaluation of fatigue, weakness, and abdominal swelling that has been present for 3 months. He ...

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