Resumo
Definição
Cirrhosis is a diffuse pathologic process, characterized by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.[1]
It can arise from a variety of causes and is the final stage of any chronic liver disease. It can lead to portal hypertension, liver failure, and hepatocellular carcinoma. In general, it is considered to be irreversible in its advanced stages, although there can be significant recovery if the underlying cause is treated.[Figure caption and citation for the preceding image starts]: Laparoscopic view of a cirrhotic liverCourtesy of Dr Eugene Schiff and Dr Lennox Jeffers; used with permission [Citation ends].
História e exame físico
Principais fatores diagnósticos
- abdominal distension
- jaundice and pruritus
- blood in vomit (hematemesis) and black stool (melena)
- hand and nail features (e.g., leukonychia, palmar erythema, spider nevi)
- facial features, e.g., telangiectasia, spider nevi, jaundiced sclera
- abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension)
- altered mental status
Outros fatores diagnósticos
- constitutional symptoms
- lower extremity swelling
- hepatic fetor
- muscle wasting
- peripheral edema
- recurrent infections
- decreased libido
- chest wall features (e.g., gynecomastia)
- dyspnea
- chest pain
- syncope
Fatores de risco
- alcohol misuse
- intravenous drug use
- unprotected intercourse
- obesity
- country of birth
- blood transfusion
- tattooing
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- liver function tests
- gamma-glutamyl transferase (GGT)
- serum albumin
- serum sodium
- serum potassium
- prothrombin time
- platelet count
- antibodies to hepatitis C virus ± hepatitis C virus RNA
- hepatitis B surface antigen ± hepatitis B DNA assay
Investigações a serem consideradas
- total iron, total iron binding capacity (TIBC), transferrin saturation, and serum ferritin
- antinuclear antibody
- antismooth muscle antibody
- liver kidney microsomal antibody
- antimitochondrial antibody
- serum immunoglobulins
- serum ceruloplasmin
- plasma alpha-1 antitrypsin
- alpha-fetoprotein
- abdominal ultrasound
- abdominal CT
- abdominal MRI
- upper gastrointestinal endoscopy
- liver biopsy
- imaging-based noninvasive tests
- blood-based noninvasive tests
- portal pressure assessment
Algoritmo de tratamento
all patients
Colaboradores
Autores
Apostolos Koffas, MD (AUTH), MRCP (UK), FESBGH
Consultant Hepatologist (Locum)
Barts Health NHS Trust
London
UK
Declarações
AK declares that he has no competing interests.
Patrick T. F. Kennedy, MB, BCh, BAO, BMedSci, FRCP, MD
Professor and Consultant Hepatologist
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
Declarações
PTFK acts as an advisor for Gilead Sciences, Janssen, and Immunocore. PTFK has received grant funding from Gilead Sciences.
Agradecimentos
Dr Apostolos Koffas and Professor Patrick T. F. Kennedy would like to gratefully acknowledge Dr Grace E. Dolman, Dr Keith D. Lindor, and Dr Flavia Mendes, previous contributors to this topic.
Declarações
GED declares that she has no competing interests. KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals. FM declares that she has no competing interests.
Revisores
Phillipp Hartmann, MD, MAS, DABOM
Assistant Professor - Pediatric Gastroenterology
Hepatology & Nutrition - University of California San Diego
Rady Children’s Hospital San Diego
San Diego
CA
Declarações
PH declares that he has no competing interests.
James Neuberger, DM, FRCP, Hon
Consultant Physician
Hon Professor in Medicine
Associate Medical Director NHSBT
Queen Elizabeth Hospital
Birmingham
UK
Declarações
JN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Kaplan DE, Ripoll C, Thiele M, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024 May 1;79(5):1180-211.Texto completo Resumo
de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII: renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis: 2021 update. J Hepatol. 2021 Sep;75(3):659-89.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Texto completo Resumo
Rogal SS, Hansen L, Patel A, et al. AASLD practice guidance: palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022 Sep;76(3):819-53.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatic encephalopathy. J Hepatol. 2022 Sep;77(3):807-24.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.
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