小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 腹痛
- 肝肿大
- 呕血和黑便
- 静脉侧支循环
- 脾肿大
- 肝脏肿块
- 黄疸
- 肝掌
- 皮肤毛细血管扩张
- 扑翼样震颤
其他诊断因素
- 腹水
- 体重减轻
- 体重升高
- 营养不良与消瘦
- 厌食
- 疲劳
- 意识模糊
- 瘙痒
- 发热
- 恶心和呕吐
- 杵状指
- 掌腱膜挛缩症
- 腿肿胀
- 腮腺肿大
- 男性乳房发育
- 性腺机能减退症
- 痴呆
- 周围神经病
危险因素
- 长期大量饮酒
- 丙型肝炎
- 女性
- 吸烟
- 肥胖
- 年龄＞ 65 岁
- 西班牙人
- 遗传易感性
诊断性检查
首要检查
- 血清天门冬氨酸氨基转移酶 （AST） 和丙氨酸氨基转移酶（ALT）
- 血清 AST/ALT 比值
- 血清碱性磷酸酶
- 血清胆红素
- 血清白蛋白，蛋白质
- 血清 γ-谷氨酰胺转移酶（γ-GT）
- 全血细胞计数（FBC）
- 血清电解质、镁、磷
- 血清尿素和肌酐
- 血清凝血酶原时间（PT）、国际标准化比值（INR）
- 肝脏超声
需考虑的检查
- 病毒性肝炎血清学分析
- 血清铁、铁蛋白、转铁蛋白
- 尿铜（收集 24 小时）
- 血清铜蓝蛋白
- 血清抗线粒体抗体（AMA）
- 血清抗核抗体 （ANA）和抗平滑肌抗体（ ASMA）
- 血清 α-1 抗胰蛋白酶水平
- 血清氨
- 血清叶酸
- 非侵入性的肝脏弹性检测
- 腹部 CT 和磁共振成像
- 肝脏活检
新兴检查
- 血清缺糖基转铁蛋白检测
- 血清线粒体 AST
- 磷脂酰乙醇（PEth）
治疗流程
所有患者
撰稿人
作者
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
利益声明
CM acts as a consultant for Nestlé, Durect, Allergan, Intercept, and DISCUS. He works for the Veterans Administration on a part time basis, has received grants from the NIH and VAMC, and is working on the update of the AGC nutritional guideline..
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
利益声明
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).
鸣谢
Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.
利益声明
MP declares that he has no competing interests.
同行评议者
Lorenzo Leggio, MD, MSc
Postdoctoral Research Associate
Center for Alcohol and Addiction Studies
Brown University
Providence
RI
利益声明
LL declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
利益声明
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
利益声明
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
利益声明
AM declares that he has no competing interests.
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