What Is Cirrhosis?
Cirrhosis is a slowly progressive, irreversible scarring and nodularity of the liver. The liver is the only organ in the body that can regenerate itself. Liver cells have a natural tendency to regenerate and maintain liver cell mass and function. Nevertheless, if there is chronic injury to the liver cells (such as from alcohol, viruses, bile obstruction), liver cells will die and scar tissue is formed. If this process continues faster than the regenerative nature of liver cells and scar tissue accumulates, then this can progress to circular nodules termed cirrhosis.

What is Compensated and Decompensated Cirrhosis?
Compensated or decompensated cirrhosis are terms used to describe the clinical condition of a patient with cirrhosis. Compensated cirrhosis is sometimes called early cirrhosis and decompensated cirrhosis is sometimes termed late cirrhosis. A patient with no clinical evidence of cirrhosis is said to have compensated cirrhosis. A patient with clinical evidence of cirrhosis such as yellowing of the eyes and skin (jaundice), confusion (hepatic encephalopathy), fluid in the abdomen (ascites) or legs, an episode of bleeding from dilated blood vessels in the esophagus or stomach (variceal bleeding), or cancer of the liver is said to have decompensated cirrhosis. These terms are useful in evaluating the severity of liver disease and as a general rule when a patient develops decompensated cirrhosis they should be referred for a liver transplant evaluation.

How is Cirrhosis Diagnosed?
Compensated cirrhosis might have no symptoms, since the liver can lose three-quarters of its cells before clinical signs of liver failure become apparent. The definitive diagnosis of cirrhosis can only be made by liver biopsy (tissue from the liver is obtained and evaluated by a physician). However, less invasive laboratory and imaging tests can suggest the presence of cirrhosis:

• Blood tests that are abnormal in patients with cirrhosis:
  • Elevated bilirubin (a breakdown product of hemoglobulin) that is normally excreted by the liver in the bile, which accumulates resulting in jaundice.
  • Alanine aminotransferases (ALT) and aspartate aminotransferases (AST) may be elevated if there is active liver cell damage.
  • Elevated prothrombin time (PT) reflecting a deficiency in proteins necessary to clot blood.
  • Low serum albumin (protein produced by the liver) which is needed to build muscles.
  • Elevated serum ammonia levels as a result of muscle wasting and the inability of the liver to metabolize ammonia.
  • Decreased red blood cells, white blood cells and platelets.
• Abdominal imaging studies that are abnormal in patients with cirrhosis:
  • Ultrasound can show a nodular liver, an enlarged spleen, and fluid in the abdomen.
  • CT scan can show greater detail than an ultrasound of the abdomen including cancer of the liver.
  • MRI can show similar detail as a CT scan of the abdomen including cancer of the liver, but requires more time and is more expensive.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technique to image the bile ducts, gall bladder, and pancreatic duct.