Cirrhosis

Have you been experiencing pain, fatigue, and weight gain?

Find out with cirrhosis tests from Ulta Lab Tests to check for signs of liver damage and malfunction.

Cirrhosis is a condition in which the liver becomes inflamed or swollen and causes your liver to become damaged and scarred. This can lead to serious health problems, including jaundice, fatigue, weight loss, nausea, vomiting, and liver failure. If left untreated, it can lead to serious complications such as portal vein thrombosis and hepatocellular carcinoma. It can be caused by alcohol, hepatitis B and C, fatty liver disease, and other conditions. The lab tests for cirrhosis check for signs of liver malfunction, such as excess bilirubin, as well as for certain enzymes that may indicate liver damage.

The liver performs many functions, including blood clotting and breaking down toxins. When the organ becomes damaged or diseased, it may have trouble doing these jobs correctly, leading to life-threatening complications.

If you want to learn more about cirrhosis and lab testing that can help you, click on the title of the articles below.

Ulta Lab Tests takes the hassle and expense out of getting lab tests. We provide discounted lab tests online, with most tests returning results in as little as 24 to 48 hours. Plus, there's no need to pay an office fee or wait for a doctor; you can get your labs done locally and quickly at over 2,000 sites around the country. With our secure and confidential results, you'll be able to use dynamic charting to track changes in your health over time. Also, if you have an FSA or HSA card, you can use it to make your purchase.

We offer a range of lab tests to detect, diagnose and monitor cirrhosis. Take control of your health by ordering your blood tests from the list below. 


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Comprehensive Metabolic Panel


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A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Screening test for abnormalities of coagulation factors that are involved in the extrinsic pathway. Also used to monitor effects of Warfarin therapy and to study patients with hereditary and acquired clotting disorders.

PT-Screening test for deficiencies of plasma coagulation factors other than Factors VII and XIII. The test is also used to monitor patients on heparin therapy. PTT-Screening test for abnormalities of coagulation factors that are involved in the extrinsic pathway. Also used to monitor effects of Warfarin therapy and to study patients with hereditary and acquired clotting disorders.

Screening test for deficiencies of plasma coagulation factors other than Factors VII and XIII. The test is also used to monitor patients on heparin therapy.

Serum iron quantification is useful in confirming the diagnosis of iron-deficiency anemia or hemochromatosis. The measurement of total iron binding in the same specimen may facilitate the clinician''s ability to distinguish between low serum iron levels caused by iron deficiency from those related to inflammatory neoplastic disorders. The assay for iron measures the amount of iron which is bound to transferrin. The total iron binding capacity (TIBC) measures the amount of iron that would appear in blood if all the transferrin were saturated with iron. It is an indirect measurement of transferri


Actin is the major antigen to which smooth muscle antibodies react in autoimmune hepatitis. F-Actin IgG antibodies are found in 52-85% of patients with autoimmune hepatitis (AIH) or chronic active hepatitis and in 22% of patients with primary biliary cirrhosis (PBC). Anti-actin antibodies have been reported in 3-18% of sera from normal healthy controls.

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Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions and during the third trimester of pregnancy. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Urinary copper concentrations are also useful to monitor patients on chealation therapy

Clinical Significance

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.



A high Anti-Mitochondrial Antibody (AMA) titer supports the diagnosis of primary biliary cirrhosis (PBC). Low titers of AMA may be detected in other liver disorders, which include chronic active hepatitis and cryptogenic cirrhosis. Mitochondrial M2 Antibody has an even higher specificity for PBC.

If Mitochondrial Antibody Screen is positive, Mitochondrial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).


This assay is intended for use in the assessment of risk for the development of hepatocellular carcinoma (HCC) in patients with chronic liver disease.

IMPORTANT - The specimen for this test must be collected at a patient service center that can collect, store and transport frozen samples as outlined below.  

IMPORTANT: Before ordering this lab test, check and confirm with the selected patient service center to ensure that they can collect, store and transport frozen samples as outlined below.

Preferred Specimen(s) 

2 mL frozen plasma collected in an EDTA (lavender-top) tube

Collection Instructions 

Collect blood from stasis-free vein of patient (e.g., no tourniquet). Patient should not clench fist during collection, as muscular exertion often increases venous ammonia levels. Patient should avoid smoking prior to phlebotomy since smoking increases plasma ammonia levels. Tubes should be filled completely and kept tightly stoppered at all times. Place immediately on ice. Separate plasma from cells within 20 minutes and freeze plasma immediately.

Transport Temperature 

Frozen

Specimen Stability 

Room temperature: Unstable
Refrigerated: Unstable
Frozen -20° C: 72 hours
Frozen -70° C: 7 days

Reject Criteria 

Hemolysis • Lipemia • Received thawed • PPT Potassium EDTA (white-top) tube

Clinical Significance

Ammonia is one of the by-products of protein metabolism. Elevated blood ammonia levels have been associated with severe liver dysfunction such as hepatic encephalopathy, coma resulting from cirrhosis, severe hepatitis, Reye's syndrome, and drug hepatotoxicity. Also, elevated blood ammonia has been reported in cardiac failure, azotemia, and pulmonary emphysema. Correlation between plasma ammonia and the degree of encephalopathy can be erratic.


Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving those related to nutrition and pathology particularly in the liver and kidney. Serum albumin is valuable when following response to therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may be a loss of albumin in the gastrointestinal tract, in the urine secondary to renal damage or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia

Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.


AST is widely distributed throughout the tissues with significant amounts being in the heart and liver. Lesser amounts are found in skeletal muscles, kidneys, pancreas, spleen, lungs, and brain. Injury to these tissues results in the release of the AST enzyme to general circulation. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peak within two days and return to normal by the fourth or fifth day post infarction. An increase in serum AST is also found with hepatitis, liver necrosis, cirrhosis, and liver metastasis.

BNP is increased in congestive heart failure, left ventricular hypertrophy, acute myocardial infarction, coronary angioplasty, and hypertension. Elevations are also observed in pulmonary hypertension (indicating right ventricular dysfunction), acute lung injury, hypervolemic states, chronic renal failure and cirrhosis. Decreasing levels indicate therapeutic response to anti-hypertensive therapy.

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Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstruction. The assessment of direct bilirubin is helpful in the differentiation of hepatic disorders. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubin are increased in the serum with hepatitis.

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstructive disease

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gallbladder obstructive disease.

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Decreased levels of ceruloplasmin are found in Wilson''s Disease, fulminant liver failure, intestinal malabsorption, renal failure resulting in proteinuria, chronic active hepatitis and malnutrition. Elevated levels are found in primary biliary cirrhosis, pregnancy (first trimester), oral contraceptive use and in acute inflammatory conditions since ceruloplasmin is an acute phase reactant


Cirrhosis occurs when healthy liver tissue gets damaged over a long period of time. Chronic liver disease leads to scarring of liver tissue, which affects the structure and functionality of the liver. Cirrhosis is linked to over 32,000 annual deaths in the United States alone.  

A wide variety of chronic liver conditions could be responsible for cirrhosis. It takes years or even decades to develop the condition. Compared to scars that occur in most of the other parts of the body, liver scarring is reversible – even in patients with cirrhosis. The liver is located on the upper right-hand side of your abdomen and is a vital organ in the body. It converts nutrients from food into vital blood components, metabolizes, detoxifies, and produces many factors that are necessary for blood clotting. The liver also produces bile for the digestion of fats. 

Liver disease can affect all these functions. Liver disease can occur due to a wide variety of causes such as physical injuries, infections, autoimmune conditions, exposure to toxins, and genetic conditions that lead to the build-up of iron and copper. Liver disease can lead to inflammation, clotting abnormalities, obstruction of bile flow, and many other conditions. Persistent or prolonged damage to the liver results in accumulating excess connective tissue or fibrosis of the liver – which can lead to cirrhosis at a later stage.  

When one has cirrhosis, the structure of his/her liver will change – forming nodules of cells that are surrounded by fibrous tissue. Fibrous tissue won’t function like healthy liver tissue. It will interfere with the flow of bile and blood through the liver. Cirrhosis begins to affect many other organs and tissues throughout the body as the condition progresses. Some examples of cirrhosis complications include: 

  • Portal Hypertension – The pressure increases in the vein that carries blood to the liver.  
  • Swelling and bleeding of veins in the esophagus or stomach – this happens because of the increased pressure due to portal hypertension and the redirection of blood into the smaller veins. 
  • Increasing of blood toxins – which can lead to confusion and many other mental changes. 
  • Kidney disfunction 
  • Fluid build-up in the abdomen – Ascites 
  • Easy bleeding and bruising due to the decline in the production of clotting factor. 
  • Patients who suffer from cirrhosis are at a higher risk of developing liver cancer over time – about 3-5% of cirrhosis patients are supposed to get multiple cancers, including liver cancer in the long run. 

Causes:

When injury or damage to the liver is limited, it can repair itself. But when injury or damage is repeated over many years, it will result in liver cirrhosis.

There are many causes of liver cirrhosis, but they fall into one of these categories: 

  • Excessive use of alcohol over time can lead to alcoholic liver cirrhosis in the long run. 
  • Hepatitis conditions such as viral hepatitis, nonalcoholic fatty liver disease (NAFLD), and autoimmune hepatitis 
  • Damage to bile ducts or biliary obstruction 
  • Congestive heart failure can result in liver damage and cirrhosis in the long run. 
  • Drug and toxin-related conditions 
  • Metabolic or inherited conditions such as hemochromatosis, cystic fibrosis, and Wilson disease 
  • In about 10% of cirrhosis cases, the actual cause is unknown. 

The causes of liver cirrhosis may vary by population or geographic region. Over 50% of the cases in the United States are caused due to alcoholism or chronic hepatitis C infection. Chronic hepatitis B infection coupled with hepatitis D co-infection leads to a significant number of cirrhosis cases in other parts of the world. Nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) are two of the most common causes of non-infectious cirrhosis. The frequency of this cause is increasing across the globe. 

Symptoms of Liver Cirrhosis 

Most people who suffer from the condition don’t have or have little clinical evidence of the disease. Symptoms don’t usually occur until significant scarring of the liver has occurred. Some of the symptoms of the condition include: 

  • Weakness 
  • Fatigue 
  • Confusion and difficulty in concentrating 
  • Itching 
  • Abdominal discomfort 
  • Jaundice 
  • Abdominal swelling due to ascites or build-up of fluid in the abdomen 
  • Leg swelling 
  • Easy bruising and bleeding 
  • Nausea 
  • Loss of appetite and weight loss 

Tests 

Cirrhosis needs to be diagnosed as soon as possible to have a chance of saving the life of the patient. If not, significant liver damage could occur with little or no clinical evidence of the condition. When the cause of the liver disease is controlled or eliminated, the scarring will stop, and some existing scars may resolve. There isn’t a specific test to diagnose liver cirrhosis. But blood tests can help detect liver injury. A liver biopsy is the best test to diagnose cirrhosis. But the procedure is invasive and won’t detect every case. 

Routine laboratory tests can help detect liver damage or scarring. These tests can help evaluate the severity of the condition in case the patient has some risk factors of developing cirrhosis. The patient may need additional tests to diagnose the underlying cause of the condition and monitor his or her health in the long run. It includes monitoring the development of hepatocellular carcinoma. 

Routine Tests 

Liver injury is usually diagnosed by a liver panel or a comprehensive metabolic panel (CMP).

Here are some tests included in these panels: 

  • Aspartate aminotransferase (AST) – AST is an enzyme found in the liver and many other organs in the body. AST will be elevated if a person has a liver injury or cirrhosis. 
  • Alanine aminotransferase (ALT) – This enzyme is found mainly in the liver. The values will be increased when a person has a liver disease or cirrhosis. 
  • Alkaline phosphatase (ALP) – ALP is an enzyme found in the bile ducts. When one has cirrhosis, ALP can be normal or mildly elevated.  
  • Total bilirubin – Bilirubin is produced exclusively in the liver. It increases with most liver conditions. Bilirubin is either normal or slightly increased until cirrhosis becomes advanced. 
  • Albumin – This is a protein made by the liver and decreases when one has cirrhosis. 

If any of these test results are abnormal, one needs to further investigate the cause of it. The pattern of results will be more informative than any single test. 

Complete Blood Count or CBC – This test is ordered to evaluate the red and white blood cells and platelets. Anemia can occur if bleeding has occurred. Platelets become decreased when one has cirrhosis. 

Prothrombin Time (PT/INR) – Most of the clotting factors are produced in the liver. This test is important to evaluate the clotting function. The results can be prolonged with cirrhosis. 

These tests are used to monitor the progression of cirrhosis. As the condition progresses, the results can become increasingly abnormal.  

Additional Testing 

If a patient has chronic liver disease, the healthcare provider will order hepatitis C and B testing to determine the underlying cause of the condition. If ascites is present, your healthcare provider will order a peritoneal fluid analysis test. A liver biopsy is done to diagnose the cause of the condition. It involves taking a sample of liver tissue to evaluate the structure and cells of the liver. A biopsy will clearly indicate the presence of cirrhosis. But since the sample is tiny, a negative result cannot rule out cirrhosis. Depending on the situation, one or more of these specialized tests may be performed: