Doença hepática esteatótica
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- ausência de consumo significativo de bebidas alcoólicas
- anormalidade leve nos testes da função hepática
- obesidade troncular
Other diagnostic factors
- fadiga e mal-estar
- desconforto abdominal no quadrante superior direito
- hepatoesplenomegalia
- sinais de doença hepática crônica
Risk factors
- obesidade
- resistência insulínica ou diabetes
- dislipidemia
- hipertensão
- síndrome metabólica
- perda de peso rápida
- uso de determinados medicamentos
- nutrição parenteral total (NPT)
- doenças associadas à DHG
Diagnostic tests
1st tests to order
- 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
Tests to consider
- 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
Emerging tests
- fragmentos de citoqueratina-18
Treatment algorithm
sem doença hepática em estágio terminal
doença hepática em estágio terminal
Contributors
Authors
Shahid M. Malik, MD
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
Disclosures
SMM declares that he has no competing interests.
Kapil B. Chopra, MD, FACP, FAASLD, AGAF
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
Disclosures
KBC declares that he has no competing interests.
Acknowledgements
Dr Shahid M. Malik and Dr Kapil B. Chopra would like to gratefully acknowledge Dr Rachel Zhuang, a previous contribution to this topic.
Disclosures
RZ declares no competing interests.
Peer reviewers
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
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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Escore MELDNa (para fins de listagem de transplantes de fígado, não é adequado para pacientes com menos de 12 anos de idade ) (unidades SI)
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