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Cirrose

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Last reviewed: 14 Sep 2025
Last updated: 05 Mar 2025

Summary

Definition

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • distensão abdominal
  • icterícia e prurido
  • sangue no vômito (hematêmese) e fezes negras (melena)
  • alterações das mãos e unhas (por exemplo, leuconíquia, eritema palmar, nevos arâneos)
  • características faciais (por exemplo, telangiectasia, nevos arâneos, esclera ictérica)
  • características abdominais (por exemplo, circulação colateral, hepatoesplenomegalia, distensão)
  • estado mental alterado
Detalhes completos

Outros fatores diagnósticos

  • sintomas constitucionais
  • edema dos membros inferiores
  • odor hepático
  • perda de massa muscular
  • edema periférico
  • infecções recorrentes
  • diminuição da libido
  • características da parede torácica (por exemplo, ginecomastia)
  • dispneia
  • dor torácica
  • síncope
Detalhes completos

Fatores de risco

  • abuso de álcool
  • uso de substâncias por via intravenosa
  • relação sexual sem proteção
  • obesidade
  • país de nascimento
  • transfusão sanguínea
  • tatuagem
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • testes da função hepática
  • GGT
  • albumina sérica
  • sódio sérico
  • potássio sérico
  • tempo de protrombina
  • contagem plaquetária
  • anticorpos contra o vírus da hepatite C
  • antígeno de superfície da hepatite B ± ensaio de ácido desoxirribonucleico (DNA) do vírus da hepatite B
Detalhes completos

Investigações a serem consideradas

  • ferro total, capacidade total de ligação do ferro (TIBC), saturação de transferrina e ferritina sérica
  • fator antinuclear (FAN)
  • anticorpo antimúsculo liso
  • anticorpo microssomal anti-fígado e anti-rim
  • anticorpo antimitocondrial
  • imunoglobulinas séricas
  • ceruloplasmina sérica
  • alfa 1-antitripsina plasmática
  • alfafetoproteína
  • ultrassonografia abdominal
  • tomografia computadorizada (TC) abdominal
  • ressonância nuclear magnética (RNM) abdominal
  • endoscopia digestiva alta
  • biópsia hepática
  • exames de imagem não invasivos
  • exames não invasivos baseados no sangue
  • avaliação da pressão portal
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

todos os pacientes

Colaboradores

Autores

Apostolos Koffas, MD (AUTH), MRCP (UK), FESBGH

Consultant Hepatologist (Locum)

Barts Health NHS Trust

London

UK

Declarações

AK declares that he has no competing interests.

Patrick T. F. Kennedy, MB, BCh, BAO, BMedSci, FRCP, MD

Professor and Consultant Hepatologist

Barts Liver Centre

Barts and the London School of Medicine and Dentistry

London

UK

Declarações

PTFK acts as an advisor for Gilead Sciences, Janssen, and Immunocore. PTFK has received grant funding from Gilead Sciences.

Agradecimentos

Dr Apostolos Koffas and Professor Patrick T. F. Kennedy would like to gratefully acknowledge Dr Grace E. Dolman, Dr Keith D. Lindor, and Dr Flavia Mendes, previous contributors to this topic.

Declarações

GED declares that she has no competing interests. KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals. FM declares that she has no competing interests.

Peer reviewers

Phillipp Hartmann, MD, MAS, DABOM

Assistant Professor - Pediatric Gastroenterology

Hepatology & Nutrition - University of California San Diego

Rady Children’s Hospital San Diego

San Diego

CA

Disclosures

PH declares that he has no competing interests.

James Neuberger, DM, FRCP, Hon

Consultant Physician

Hon Professor in Medicine

Associate Medical Director NHSBT

Queen Elizabeth Hospital

Birmingham

UK

Disclosures

JN declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kaplan DE, Ripoll C, Thiele M, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024 May 1;79(5):1180-211.Full text  Abstract

de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII: renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.Full text  Abstract

National Institute for Health and Care Excellence. Cirrhosis in over 16s: assessment and management. Sep 2023 [internet publication].Full text

European Association for the Study of the Liver. EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis: 2021 update. J Hepatol. 2021 Sep;75(3):659-89.Full text  Abstract

European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Full text  Abstract

Rogal SS, Hansen L, Patel A, et al. AASLD practice guidance: palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022 Sep;76(3):819-53.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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