3 The term liver function tests is a misnomer because the assays in most standard liver panels do not reflect the function of the liver correctly. No serologic test can diagnose cirrhosis accurately. Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) Granulomatous liver disease (e.g., sarcoidosis)Ĭhronic, passive hepatic congestion caused by right-sided heart failure, pericarditis Urea cycle defects (e.g., ornithine carbamoyltransferase deficiency) Lipid disorders (e.g., abetalipoproteinemia) NAFLD (10 percent)-most commonly resulting from obesity also can occur after jejunoileal bypassĪutoimmune chronic hepatitis types 1, 2, and 3Ĭarbohydrate disorders (e.g., fructose intolerance, galactosemia, glycogen storage diseases) Referral for liver biopsy should be considered only after a thorough, non-invasive serologic and radiographic evaluation has failed to confirm a diagnosis of cirrhosis the benefit of biopsy outweighs the risk and it is postulated that biopsy will have a favorable impact on the treatment of chronic liver disease. Unnecessary medications and surgical procedures should be avoided in patients with cirrhosis. A significant correlation has been demonstrated between persistently elevated liver function tests and biopsy-proven underlying hepatic disease thus, a more targeted serologic work-up is indicated in patients whose liver function test results are persistently abnormal.

No serologic or radiographic test can accurately diagnose cirrhosis. Some patients already may have had laboratory or radiographic tests that incidentally uncovered signs of cirrhosis and its comorbidities. Physical examination of patients with cirrhosis may reveal a variety of findings that necessitate a hepatic- or gastrointestinal-based work-up to determine the etiology. Cirrhosis often is an indolent disease most patients remain asymptomatic until the occurrence of decompensation, characterized by ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, or variceal bleeding from portal hypertension.

Cirrhosis and chronic liver failure are leading causes of morbidity and mortality in the United States, with the majority of preventable cases attributed to excessive alcohol consumption, viral hepatitis, or nonalcoholic fatty liver disease.

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