Can a Doctor Diagnose Cirrhosis Without a Biopsy?

Question: Can a Doctor Diagnose Cirrhosis Without a Biopsy?

Answer: Yes, doctors can diagnose cirrhosis without a biopsy, but it is more of an educated guess than a certainty. Though the diagnosis of cirrhosis can only be made with complete certainty based on a liver biopsy, there are often other pieces of information that can point to the diagnosis without a biopsy. People with cirrhosis, caused by chronic liver disease, usually have evidence of cirrhosis based on their history, physical exam, laboratory tests and radiologic studies.

• The predictable symptoms include extreme tiredness, general pain in the upper-right part of the belly, weakness and a sense of illness (known as malaise).
• Physical examination may include findings, such as characteristic skin changes (spider angiomata and palmar erythema), ascites, swelling (edema), an enlarged liver (hepatomegaly) or a tremor.
• Radiologic tests include ultrasonagraphy or MRI, which can be useful in determining the appearance of structural changes in the liver.

This information, plus the fact that almost one-third of people with chronic hepatitis eventually develop cirrhosis, can provide substantial clinical evidence for diagnosing cirrhosis.

Clinical evidence, however, is not foolproof and lacks the ability to explain why a person has cirrhosis. The only way to be certain of cirrhosis, to know about its severity and to try to identify why there is cirrhosis, is to undergo a liver biopsy. This liver biopsy, though, does have disadvantages. Depending on the biopsy technique, there can be risks of pain, infection, bleeding complications or damage to surrounding organs. Also, there can be problems with accuracy associated with biopsy results.

• More About Cirrhosis
• More About Liver Biopsy
• More About Chronic Hepatitis

_Sources:

Bacon B. Cirrhosis and Its Complications. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Long DL, Jameson JL, Loscalzo J. Harrison's Online. "Acute Viral Hepatitis". Harrison's Online

Berenguer M, Wright TL. Hepatitis C. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1693-1697.

Pratt D, Kaplan M. Evaluation of Liver Function. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Long DL, Jameson JL, Loscalzo J. Harrison's Online. "Acute Viral Hepatitis". Harrison's Online