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Doença hepática esteatótica

Última revisão: 13 Sep 2025
Última atualização: 27 Jun 2024

Resumen

Definición

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • ausência de consumo significativo de bebidas alcoólicas
  • anormalidade leve nos testes da função hepática
  • obesidade troncular
完整详情

其他诊断因素

  • fadiga e mal-estar
  • desconforto abdominal no quadrante superior direito
  • hepatoesplenomegalia
  • sinais de doença hepática crônica
完整详情

危险因素

  • obesidade
  • resistência insulínica ou diabetes
  • dislipidemia
  • hipertensão
  • síndrome metabólica
  • perda de peso rápida
  • medicações
  • nutrição parenteral total (NPT)
  • doenças associadas à DHG
完整详情

诊断性检查

首要检查

  • aspartato aminotransferase (AST) e alanina aminotransferase (ALT) séricas
  • bilirrubina total
  • fosfatase alcalina
  • gama-glutamiltransferase
  • Hemograma completo
  • perfil metabólico
  • perfil lipídico
  • tempo de protrombina (TP) e razão normalizada internacional (INR)
  • albumina sérica
  • perfil de doença hepática autoimune
  • perfil de ferro
  • antígeno de superfície da hepatite B, anticorpo anti-superfície e anticorpo anti-núcleo
  • anticorpo do vírus da hepatite C
  • nível de alfa 1-antitripsina e fenótipo
  • ultrassonografia do fígado
完整详情

需考虑的检查

  • insulina em jejum
  • cálculo do modelo de avaliação de homeostase (HOMA)
  • ressonância nuclear magnética (RNM) abdominal
  • elastografia
  • biópsia hepática
  • ceruloplasmina
  • Teste de mutação genética no gene HFE
  • anticorpo anti-M2 mitocondrial
完整详情

新兴检查

  • fragmentos de citoqueratina-18

治疗流程

持续性治疗

sem doença hepática em estágio terminal

doença hepática em estágio terminal

撰稿人

作者

Shahid M. Malik, MD
Shahid M. Malik

Clinical Associate Professor of Medicine

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

Program Director, Transplant Hepatology Fellowship Program

Starzl Transplantation Institute

University of Pittsburgh Medical Center

Pittsburgh

PA

利益声明

SMM declares that he has no competing interests.

Kapil B. Chopra, MD, FACP, FAASLD, AGAF
Kapil B. Chopra

Professor of Medicine

Medical Director of Comprehensive Liver Program and Liver Pancreas Institute

University of Pittsburgh School of Medicine

University of Pittsburgh Medical Center

Pittsburgh

PA

利益声明

KBC declares that he has no competing interests.

鸣谢

Dr Shahid M. Malik and Dr Kapil B. Chopra would like to gratefully acknowledge Dr Rachel Zhuang, a previous contribution to this topic.

利益声明

RZ declares no competing interests.

同行评议者

Philip Newsome, PhD, FRCPE

Senior Lecturer in Hepatology & Honorary Consultant Physician

Liver Research Group

Institute of Biomedical Research

The Medical School

University of Birmingham

Birmingham

UK

Disclosures

PN declares that he has no competing interests.

Stephen A. Harrison, MD, LTC, MC

Chief of Hepatology

Department of Medicine

Gastroenterology & Hepatology Service

Brooke Army Medical Center

Fort Sam Houston

Associate Professor of Medicine

University of Texas Health Science Center

Houston

TX

Disclosures

SAH is an author of a reference cited in this topic.

Robert D. Goldin, MBCHB, MD, FRCPath

Reader in Liver and GI Pathology

Imperial College at St. Mary's

London

UK

Disclosures

RDG 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

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023 May 1;77(5):1797-835.Full text  Abstract

Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017 Feb;64(2):319-34.Full text  Abstract

European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-402.Full text  Abstract

Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017 Jan;112(1):18-35.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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