Cirrhosis may be diagnosed by a physician during a physical examination that includes a medical history and list of medications. A physician can sometimes identify early stages of cirrhosis by gently pressing the abdomen to determine whether the liver is enlarged and firm. During later stages of the disease the liver shrinks, causing an enlarged spleen which a physician may also identify by gently touching the abdomen.

If a patient is suspected to have cirrhosis, blood tests may be performed. These can detect changes in the body that occur as a result of cirrhosis. Tests include:

• Hematology tests. Patients with cirrhosis are often anemic and also tend to have larger-than-normal spleens, which leads to abnormally low platelet counts. The loss of functioning liver leads to less clotting protein production and abnormal coagulation labs.
  
  
• Liver function test. When a liver is damaged, it releases enzymes, which may be detected with a blood test.
  
  
• Liver function test. When a liver is damaged, it releases enzymes, which may be detected with a blood test.
  
  
• Bilirubin test. Bilirubin (substance formed from the breakdown of red blood cells that gives bile its color) is processed in the liver and excreted in urine. When the liver is damaged, it cannot process bilirubin, leading to high levels of bilirubin in the blood.

Imaging tests that detect liver damage may also be performed. They include:

• Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs of the body.
  
  
• CAT scan (computed axial tomography). A test that allows for multiple x-rays to be taken from different angles around the patient. It creates images of organs and bones within the body.

• MRI (magnetic resonance imaging). Safe and noninvasive or minimally invasive imaging test that can help physicians diagnose diseases of numerous organs and vessels. It uses powerful magnets to produce images on a computer screen and film.
  
  
• Liver scan. A radioactive substance (radioisotope) that highlights the liver is injected into a vein. After the liver absorbs the substance, the liver is scanned and images are displayed on a computer screen.
  
  
• Laparoscopy. A laparoscope (thin, lighted tube with a tiny video camera) is inserted into the abdomen through a small incision. Images are displayed on a computer screen.

A liver biopsy is often performed to confirm a diagnosis of cirrhosis. During this procedure, a needle is inserted into the abdomen and a tiny sample of liver tissue is removed. The tissue is examined under a microscope for the presence of scarring or other signs of disease.

Tests may also be performed to screen for complications of cirrhosis, such as a CAT scan, upper endoscopy or capsule endoscopy for esophageal varices.