Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- abdominal pain
- hepatomegaly
- hematemesis and melena
- venous collaterals
- splenomegaly
- hepatic mass
- jaundice
- palmar erythema
- cutaneous telangiectasia
- asterixis
Otros factores de diagnóstico
- ascites
- weight loss
- weight gain
- malnutrition and wasting
- anorexia
- fatigue
- confusion
- pruritus
- fever
- nausea and vomiting
- finger clubbing
- Dupuytren contracture
- leg swelling
- parotid gland enlargement
- gynecomastia
- hypogonadism
- dementia
- peripheral neuropathy
Factores de riesgo
- prolonged and heavy alcohol consumption
- hepatitis C
- female sex
- cigarette smoking
- obesity
- age >65 years
- Hispanic ethnicity
- genetic predisposition
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- serum aspartate aminotransferase (AST), alanine aminotransferase (ALT)
- serum AST/ALT ratio
- serum alkaline phosphatase
- serum bilirubin
- serum albumin, protein
- serum gamma glutamyl transferase (gamma-GT)
- CBC
- serum electrolytes, magnesium, phosphorus
- serum BUN and creatinine
- serum prothrombin time (PT), INR
- hepatic ultrasound
Pruebas diagnósticas que deben considerarse
- viral hepatitis serology
- serum iron, ferritin, transferrin
- urine copper (24-hour collection)
- serum ceruloplasmin
- serum antimitochondrial antibody (AMA)
- serum antinuclear antibody (ANA) and antismooth muscle antibody (ASMA)
- serum alpha-1 antitrypsin level
- serum ammonia
- serum folate
- noninvasive tests of liver elasticity
- CT abdomen, MRI abdomen
- liver biopsy
Pruebas emergentes
- serum carbohydrate-deficient transferrin test
- serum mitochondrial AST
- Phosphatidylethanol (PEth)
Algoritmo de tratamiento
all patients
Colaboradores
Autores
Craig McClain, MD
Professor
Chief of Research Affairs
Associate Vice President for Health Affairs/Research
Division of Gastroenterology, Hepatology and Nutrition
Department of Medicine
University of Louisville School of Medicine
Louisville
KY
Disclosures
CM receives contract research support from the National Institutes of Health, the Veterans Administration, and Target Pharma Solutions.
Luis Marsano, MD
Professor and Director of Hepatology
Division of Gastroenterology, Hepatology and Nutrition
Department of Medicine
University of Louisville School of Medicine
Louisville
KY
Declarações
LM declares that he has no competing interests.
Agradecimentos
Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.
Declarações
MP declares that he has no competing interests.
Revisores
Lorenzo Leggio, MD, MSc
Postdoctoral Research Associate
Center for Alcohol and Addiction Studies
Brown University
Providence
RI
Declarações
LL declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Declarações
NR declares that she has no competing interests.
Nick Sheron, MD, FRCP
Head of Clinical Hepatology and Senior Lecturer
Division of Infection, Inflammation and Immunity
University of Southampton Medical School
Southampton General Hospital NHS Trust
Southampton
UK
Declarações
NS has received research grants from the Medical Research Council (MRC), Wellcome Trust, British Liver Trust, Alcohol Education Research Council, and various other funding bodies. He has undertaken paid consultancy work and received traveling expenses from pharmaceutical companies developing drugs for the treatment of inflammatory bowel disease and liver disease. He has been paid for medico-legal work in the areas of hepatitis C and alcohol-related liver disease. The following memberships and advisory work are unpaid apart from traveling expenses: EU Alcohol Forum, EU Alcohol Marketing Taskforce, Royal College of Physicians Alcohol Committee, Alcohol Health Alliance UK. NS has undertaken advisory and media work for the UK Department of Health, Home Office, Department of Transport, Cross Cabinet Strategy Committee, National Institute for Health and Care Excellence, Southampton City Council, UK Police, and British Liver Trust, and various other NGOs, local government, and other bodies. NS is an unpaid trustee of the Drinkaware Trust, an independent body set up by the UK Government to use industry resources to reduce alcohol-related harm. The Trust is funded entirely by the alcohol industry, with a board of trustees comprising 5 industry members, 5 members with alcohol-related health expertise, and 3 lay members.
Alastair MacGilchrist, MD, FRCP
Consultant Hepatologist
Royal Infirmary of Edinburgh
Edinburgh
UK
Declarações
AM declares that he has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Jophlin LL, Singal AK, Bataller R, et al. ACG clinical guideline: alcohol-associated liver disease. Am J Gastroenterol. 2024 Jan 1;119(1):30-54.Texto completo Resumo
Crabb DW, Im GY, Szabo G, et al. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020 Jan;71(1):306-33.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Hepatitis B virus (HBV) infection
- Hepatitis C virus (HCV) infection
- Hepatitis A virus infection
Mais Diagnósticos diferenciaisDiretrizes
- AASLD Practice Guideline on non-invasive liver disease assessments of portal hypertension
- ACG clinical guideline: alcohol-associated liver disease
Mais DiretrizesFolhetos informativos para os pacientes
Alcoholic liver disease
Hepatitis B: should I have the vaccine?
Mais Folhetos informativos para os pacientesCalculadoras
Alcohol Consumption Screening AUDIT Questionnaire
Modified Maddrey's Discriminant Function
Mais CalculadorasVideos
Abdominal paracentesis animated demonstration
Mais vídeos
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal