Cirrhosis Diagnosis and Evaluation

Routine blood tests provide the foundational data for assessing liver injury and function.

• Aminotransferases (AST and ALT):
  These liver enzymes indicate inflammation and cell death. In cirrhosis, they may be elevated, but paradoxically, they can also be normal or low because there is not enough healthy liver tissue left to release enzymes. An AST level that is higher than the ALT level often suggests an alcohol-related cause.
• Alkaline Phosphatase (ALP) and GGT:
  Elevations in these enzymes suggest blockage of the bile ducts or cholestasis, common in conditions like Primary Biliary Cholangitis (PBC).
• Bilirubin:
  This measures the liver’s ability to clear waste. Elevated total and conjugated bilirubin levels indicate hepatocellular dysfunction and lead to jaundice.
• Albumin:
  Albumin is a protein made exclusively by the liver. Low levels (hypoalbuminemia) are a specific marker of reduced synthetic capability and contribute to edema.
• Prothrombin Time (PT) and INR:
  The liver produces clotting factors. A prolonged PT or elevated INR (International Normalized Ratio) indicates that the liver is failing to synthesize these factors efficiently. This is a critical marker of disease severity.
• Platelet Count:
  Thrombocytopenia (low platelet count) is often the earliest and most sensitive blood indicator of cirrhosis. It is caused by hypersplenism, where the enlarged spleen sequesters and destroys platelets due to portal hypertension.
• Hyponatremia: Low sodium levels are common in advanced cirrhosis due to fluid retention and hemodynamic changes, serving as a poor prognostic sign.