Evaluation of the Patient with cirrhosis
Disease Tests and findings
Alcoholic liver disease History of alcohol abuse
AST/ALT > 2 with both being less than 500 IU/mL if alcoholic hepatitis is present.
Chronic hepatitis C Second generation assay for anti-HCV
PCR for HCV RNA if confirmatory test is necessary.
Primary biliary cirrhosis Antimitochondrial antibodies as an isolated finding
Primary sclerosing cholangitis Strong association with inflammatory bowel disease
Contrast cholangiography to establish the diagnosis
Antinuclear and antismooth muscle antibodies
ANCA; these are not diagnostic
Autoimmune hepatitis Hypergammaglobulinemia
Chronic hepatitis B HBsAg and HBeAg and, in some cases, HBV DNA by hybridization or bDNA assay.
Hereditary hemochromatosis Family history of cirrhosis
Transferrin saturation and plasma ferritin should be performed but may be elevated by liver disease itself.
Diagnosis established by liver biopsy and calculation of hepatic iron index or by genetic testing.
Wilson's disease Family or personal history of cirrhosis at a young age
Serum ceruloplasmin reduced in 95 percent of patients.
Liver biopsy shows increased copper content which may also be seen in cholestatic liver diseases.
Alpha-1-antitrypsin deficiency Family or personal history of cirrhosis at a young age
Serum AAT; phenotyping if low or border line values.
