小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 腹胀
- 黄疸和瘙痒
- 呕血和黑便
- 手和指甲特征(如白甲、肝掌、蜘蛛痣)
- 面部特征(如毛细血管扩张症、蜘蛛痣、巩膜黄染)
- 腹部特征(如侧支循环、肝脾功能亢进、腹胀)
- 意识状态改变
其他诊断因素
- 全身性症状
- 下肢水肿
- 肝臭味
- 肌肉萎缩
- 外周水肿
- 复发性感染
- 性欲减退
- 胸壁特征(如男子女性型乳房)
- 呼吸困难
- 胸痛
- 晕厥
危险因素
- 酒精滥用
- 静脉毒品使用
- 不使用工具避孕的性交
- 肥胖
- 出生国家
- 输血
- 纹身
诊断性检查
首要检查
- 肝功能检查
- γ-谷氨酰转肽酶(GGT)
- 血清白蛋白
- 血清钠
- 凝血酶原时间
- 血小板计数
- 丙型肝炎病毒抗体
- 乙型肝炎表面抗原
需考虑的检查
- 总铁、总铁结合力(TIBC)、转铁蛋白饱和度和铁蛋白
- 抗核抗体
- 抗平滑肌抗体(ASMA)
- 抗线粒体抗体(AMA)
- 血清铜蓝蛋白水平
- 血浆α-1抗胰蛋白酶
- 血清蛋白电泳
- 腹部超声
- 腹部 CT 检查
- 腹部 MRI
- 上消化道内镜检查
- 肝脏活检
- 非侵入性的肝脏弹性检测
治疗流程
所有患者
撰稿人
作者
Grace E. Dolman, PhD MA (Cantab) MRCP
Clinical Research Fellow
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
利益声明
GED declares that she has no competing interests.
Patrick T. F. Kennedy, MB BCh BAO BMedSci FRCP MD
Reader and Honorary Consultant in Hepatology
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
利益声明
PTFK acts as an advisor for Gilead Sciences, Janssen, and Immunocore. PTFK has received grant funding from Gilead Sciences. These roles are unrelated to the current article.
鸣谢
Dr Grace E. Dolman and Dr Patrick T. F. Kennedy would like to gratefully acknowledge Dr Keith D. Lindor and Dr Flavia Mendes, previous contributors to this topic.
利益声明
KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals. FM declares that she has no competing interests.
同行评议者
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.
Cynthia Levy, MD
Clinical Assistant Professor
Division of Gastroenterology Hepatology and Nutrition
University of Florida
Gainesville
FL
利益声明
CL declares that she has no competing interests.
James Neuberger, DM, FRCP, Hon
Consultant Physician
Hon Professor in Medicine
Associate Medical Director NHSBT
Queen Elizabeth Hospital
Birmingham
UK
利益声明
JN declares that he has no competing interests.
鉴别诊断
- 布加综合征
- 门静脉血栓形成
- 脾静脉血栓形成
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- 消化道内镜操作的知情同意
- 慢加急性肝衰竭临床指南
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