Evidences suggest that concept of ‘cirrhosis’ is evolving and compensated and decompensated cirrhosis vary from each other in terms of prognosis. The term ‘advanced chronic liver disease (ACLD)’ is a representative of the continuum of histological changes occurring in the liver, which progresses even after cirrhosis has developed, and might resolve after eliminating the etiological factor causing the liver disease. In compensated ACLD, portal hypertension is the result of the progression to a stage with higher risk of clinical complication, which need an appropriate evaluation and treatment. 

The most important diagnostic tools for cirrhosis include invasive tests to diagnose such as liver biopsy. While, hepatic venous pressure gradient measurement and endoscopy are chiefly used for the diagnosis of portal hypertension in several difficult clinical scenarios, however, their requirement can be diminished by using different non-invasive tests in standard cases. 

The most widely used is a combination of markers of liver synthetic function such as albumin, bilirubin and prothrombin time along with two clinical variables presence and severity of ascites and encephalopathy, constitute the Child-Pugh score. Several serum tests including direct markers of extracellular matrix remodelling and indirect markers like liver function tests, transaminases, platelet count and combined panels/scores can provide information on fibrosis staging, diagnosis of cirrhosis, presence of portal hypertension and prognosis of patients with cACLD. 

Among ultrasound-elastography methods, transient elastography has been the first developed to evaluate liver stiffness. It has proven its efficacy in identifying and identifying cirrhosis in patients with chronic liver disease of many different aetiologies, especially in patients with chronic viral hepatitis. Other newer ultrasound-elastography methods that are used in standard ultrasound equipments include point shear-wave elastography that takes advantage of acoustic radiation force impulse imaging and two-dimensional shear-wave elastography.

Source: Procopet B, Berzigotti A. Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterol Rep (Oxf). 2017;5(2):79-89.