Última revisão: 23 Out 2020
Última atualização: 15 Out 2019

Resumo

Definição

História e exame físico

Principais fatores de diagnóstico

  • presença de fatores de risco
  • dor abdominal
  • hepatomegalia
  • hematêmese e melena
  • veias acessórias
  • esplenomegalia
  • massa hepática
  • icterícia
  • eritema palmar
  • telangiectasia cutânea
  • asterixis (flapping)

Outros fatores de diagnóstico

  • ascite
  • perda de peso
  • ganho de peso
  • desnutrição e atrofia
  • anorexia
  • fadiga
  • confusão
  • prurido
  • febre
  • náuseas e vômitos
  • baqueteamento digital
  • Contratura de Dupuytren
  • edema dos membros inferiores
  • aumento da glândula parótida
  • ginecomastia
  • hipogonadismo
  • demência
  • neuropatia periférica

Fatores de risco

  • consumo de álcool prolongado e em grandes quantidades
  • hepatite C
  • sexo feminino
  • tabagismo
  • obesidade
  • idade >65 anos
  • etnia hispânica
  • predisposição genética

Exames diagnósticos

1° exames a serem solicitados

  • aspartato aminotransferase (AST), alanina aminotransferase (ALT) séricas
  • proporção AST/ALT séricas
  • fosfatase alcalina sérica
  • bilirrubina sérica
  • proteína, albumina sérica
  • gama-glutamiltransferase (gama-GT) sérica
  • Hemograma completo
  • eletrólitos, magnésio e fósforo séricos
  • ureia e creatinina séricas
  • tempo de protrombina sérica (PT), INR
  • ultrassonografia hepática
Mais 1° exames a serem solicitados

Exames a serem considerados

  • sorologia para hepatites virais
  • ferro, ferritina e transferrina séricos
  • cobre na urina (coleta de 24 horas)
  • ceruloplasmina sérica
  • anticorpo antimitocondrial (AAM) sérico
  • anticorpo anti-nuclear (AAN) e anticorpo antimúsculo liso (AAML) séricos
  • nível sérico de alfa 1-antitripsina
  • amônia sérica
  • folato sérico
  • tomografia computadorizada (TC) abdominal, ressonância nuclear magnética (RNM) do abdome
  • biópsia hepática
Mais exames a serem considerados

Novos exames

  • teste de transferrina deficiente em carboidrato (TDC) sérica
  • AST mitocondrial sérica
  • painel de biomarcadores não invasivos
Mais novos exames

Algoritmo de tratamento

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

Divulgações

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

Divulgações

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.

Divulgações

MP declares that he has no competing interests.

Colegas revisoresMOSTRAR TODOS

Postdoctoral Research Associate

Center for Alcohol and Addiction Studies

Brown University

Providence

RI

Divulgações

LL declares that he has no competing interests.

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Divulgações

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

Divulgações

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

Divulgações

AM declares that he has no competing interests.

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