Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- 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 diagnósticos
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- 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
Investigações a serem consideradas
- 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
- exames não invasivos de elasticidade hepática
- tomografia computadorizada (TC) abdominal, ressonância nuclear magnética (RNM) do abdome
- biópsia hepática
Novos exames
- teste de transferrina deficiente em carboidrato (TDC) sérica
- AST mitocondrial sérica
- Fosfatidiletanol (PEth)
Algoritmo de tratamento
todos os 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
Declarações
CM receives contract research support from the National Institutes of Health, the Veterans Administration, and Target Pharma Solutions.
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
Disclosures
LM declares that he has no competing interests.
Acknowledgements
Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.
Disclosures
MP declares that he has no competing interests.
Peer reviewers
Lorenzo Leggio, MD, MSc
Postdoctoral Research Associate
Center for Alcohol and Addiction Studies
Brown University
Providence
RI
Disclosures
LL declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Disclosures
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
Disclosures
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
Disclosures
AM declares that he has no competing interests.
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