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
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
Pruebas emergentes
- prueba sérica de transferrina deficiente en carbohidratos
- aspartato transaminasa (AST) mitocondrial en suero
- panel de biomarcadores no invasivos
Algoritmo de tratamiento
Colaboradores
Autores
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.
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 pares
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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