Última revisión: 5 Nov 2020
Última actualización: 15 Oct 2019

Resumen

Definición

Anamnesis y exploración física

Factores clave 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 para el 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 que 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 que solicitar

Pruebas que considerar

  • 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
  • tomografía computarizada (TC) o resonancia magnética (IRM) de abdomen
  • biopsia hepática
Más pruebas que considerar

Pruebas emergentes

  • prueba sérica de transferrina deficiente en carbohidratos
  • aspartato transaminasa (AST) mitocondrial en suero
  • panel de biomarcadores no invasivos
Más pruebas emergentes

Algoritmo de tratamiento

Colaboradores

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

Conflicto de intereses

CM declares that he has no competing interests.

Luis Marsano

Professor and Director of Hepatology

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

University of Louisville School of Medicine

Louisville

KY

Conflicto de intereses

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).

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

Conflicto de intereses

MP declares that he has no competing interests.

Revisores paresVER TODO

Postdoctoral Research Associate

Center for Alcohol and Addiction Studies

Brown University

Providence

RI

Conflicto de intereses

LL declares that he has no competing interests.

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Conflicto de intereses

NR declares that she has no competing interests.

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

Conflicto de intereses

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.

Consultant Hepatologist

Royal Infirmary of Edinburgh

Edinburgh

UK

Conflicto de intereses

AM declares that he has no competing interests.

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