Hepatopatía alcohólica

Última revisión: 9 Nov 2022
Última actualización: 10 Mayo 2022

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • presencia de factores de riesgo
  • dolor abdominal
  • hepatomegalia
  • hematemesis y melena
  • colaterales venosas
  • esplenomegalia
  • masa hepática
  • ictericia
  • eritema palmar
  • telangiectasia cutánea
  • asterixis
Más principales factores de diagnóstico

Otros factores de diagnóstico

  • ascitis
  • pérdida de peso
  • aumento de peso
  • desnutrición y consunción
  • anorexia
  • fatiga
  • confusión
  • prurito
  • fiebre
  • náuseas y vómitos
  • acropaquia
  • contractura de Dupuytren
  • inflamación de las piernas
  • agrandamiento de la glándula parótida
  • ginecomastia
  • hipogonadismo
  • demencia
  • neuropatía periférica
Otros factores de diagnóstico

Factores de riesgo

  • consumo prolongado y excesivo de alcohol
  • hepatitis C
  • sexo femenino
  • tabaquismo
  • obesidad
  • edad >65 años
  • etnia hispana
  • predisposición genética
Más factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • aspartato aminotransferasa (AST) sérica, alanina aminotransferasa (ALT)
  • relación aspartato transaminasa (AST)/alanina aminotransferasa (ALT) en suero
  • fosfatasa alcalina en suero
  • bilirrubina sérica
  • albúmina sérica, proteína
  • gamma glutamil transferasa sérica (gamma-GT)
  • hemograma completo (HC)
  • electrolitos, magnesio y fósforo séricos
  • urea y creatinina séricas
  • tiempo de protrombina en suero (TP), INR
  • ecografía hepática
Más primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

  • serología de hepatitis viral
  • hierro, ferritina y transferrina séricos
  • cobre en orina (24 horas)
  • ceruloplasmina sérica
  • anticuerpos antimitocondriales (AAM) séricos
  • anticuerpos antinucleares (ANA) y anticuerpos antimúsculo liso (AML) en suero
  • nivel sérico de alfa-1-antitripsina
  • amoniaco sérico
  • folato sérico
  • pruebas no invasivas de la elasticidad del hígado
  • tomografía computarizada (TC) o resonancia magnética (IRM) de abdomen
  • biopsia hepática
Más pruebas diagnósticas que deben considerarse

Pruebas emergentes

  • prueba sérica de transferrina deficiente en carbohidratos
  • aspartato transaminasa (AST) mitocondrial en suero

Algoritmo de tratamiento

En curso

todos los pacientes

Colaboradores

Autores

Craig McClain, MD
Craig McClain

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

Divulgaciones

CM acts as a consultant for Nestlé, Durect, Allergan, Intercept and DISCUS. He works for the Veterans Administration on a part time basis, has received grants from the NIH and VAMC, and is working on the update of the AGC nutritional guideline..

Luis Marsano, MD
Luis Marsano

Professor and Director of Hepatology

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

University of Louisville School of Medicine

Louisville

KY

Divulgaciones

LM is on the speaker bureau for Salix (maker of Rifaximin - Xifaxan); Rifaximin is part of the therapy (supported by practice guidelines) of hepatic encephalopathy. He is also on the speaker bureau of Grifols (one of the makers of albumin for intravenous infusion); albumin is used as part of the treatment of spontaneous bacterial peritonitis (supported by practice guidelines).

Agradecimientos

Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.

Divulgaciones

MP declares that he has no competing interests.

Revisores por pares

Lorenzo Leggio, MD, MSc

Postdoctoral Research Associate

Center for Alcohol and Addiction Studies

Brown University

Providence

RI

Divulgaciones

LL declares that he has no competing interests.

Nancy Reau, MD

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Divulgaciones

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

Divulgaciones

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 travelling 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 travelling 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

Divulgaciones

AM declares that he has no competing interests.

  • Hepatopatía alcohólica images
  • Diferenciales

    • Infección por virus de la hepatitis B (VHB)
    • Infección por virus de la hepatitis C (VHC)
    • Infección por virus de la hepatitis A
    Más Diferenciales
  • Guías de práctica clínica

    • Guideline on informed consent for GI endoscopic procedures
    • Testing, evaluation, and monitoring of hepatitis C
    Más Guías de práctica clínica
  • Folletos para el paciente

    Hepatopatía alcohólica

    Hepatitis B: ¿debo vacunarme?

    Más Folletos para el paciente
  • Calculadoras

    Cuestionario AUDIT de Cribado de Consumo de Alcohol

    Función discriminante de Maddrey modificada

    Más Calculadoras
  • Videos

    Demostración animada del drenaje de la ascitis

    Más videos
  • padlock-lockedInicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad