Workup-cirrhosis

(Am J Gastro 2017;112:18; Lancet 2021;398:1359)

• Abd U/S w/ Doppler: liver size & echotexture, r/o HCC, ascites, ✓ patency of vasculature

• Determine etiology: hepatitis serologies (HBsAg, anti-HBs, anti-HCV), autoimmune hepatitis studies (IgG, ANA, ASMA), Fe and Cu studies, α1-AT, AMA

• Assess fibrosis: biomarkers (FibroSURE = panel of 5 markers validated in HCV, ↑ score predictive of fibrosis); elastography (U/S or MR-based; measurement of liver stiffness)

• Liver bx (gold standard): percutaneous or transjugular (consider if ascites or coagulopathy), used to confirm presence of cirrhosis and dx etiology, not always needed