Decreased serum albumin and a prolonged prothrombin time directly reflect impaired hepatic function. Serum globulin increases in many forms of chronic liver disease. Transaminase is often modestly elevated, while alkaline phosphatase may be normal or increased, particularly with biliary obstruction. Bilirubin is usually normal. Alcohol directly suppresses the bone marrow.
Hypersplenism also can lead to leukopenia and thrombocytopenia.
Isotopic scintiscans with technetium-99m sulfur colloid show irregular liver uptake and increased uptake in the spleen and bone marrow. Doppler ultrasound can demonstrate portal blood flow. CT better evaluates liver size and texture and, for hemochromatosis, density. Endoscopy is best for diagnosing esophageal varices. The prognosis for patients with cirrhosis is difficult to estimate because the condition has many causes.