Hepatopatía alcohólica
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
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
Factores de riesgo
- consumo prolongado y excesivo de alcohol
- hepatitis C
- sexo femenino
- tabaquismo
- obesidad
- edad >65 años
- etnia hispana
- predisposición genética
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
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
Pruebas emergentes
- prueba sérica de transferrina deficiente en carbohidratos
- aspartato transaminasa (AST) mitocondrial en suero
Algoritmo de tratamiento
todos los pacientes
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
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
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.
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