임상적으로 간경변을 진단내릴때 근거

The diagnosis of cirrhosis can be made definitively histologically. However, a firm presumptive diagnosis is reasonable based on physical findings of portal hypertension and/or evidence of liver synthetic dysfunction.

Biopsy may not be necessary when physical exam and diagnostic studies are consistent with decompensated chronic liver disease.

Suspect cirrhosis in patients with chronic liver disease and chronically abnormal markers of liver function portal hypertension.


Chronically elevated AST, ALT or alkaline phosphatase

AST/ALT ratio > 1

Low albumin < 3.8 g/dL

Prolonged prothrombin time or INR > 1.3

High bilirubin > 1.5 mg/dL

Low platelet count < 175,000

Suspect cirrhosis when physical exam shows:

Stigmata of chronic liver disease: muscle wasting, vascular spiders, palmar erythema

Palpable left lobe of the liver

Small liver span

Splenomegaly

Signs of decompensation: jaundice, ascites, asterixis

Suspect cirrhosis with abnormal imaging studies:

Liver-spleen scan - small liver, irregular uptake, splenomegaly, colloid shift to bone marrow

Ultrasound / CT scan - nodular liver, splenomegaly, venous collaterals