最近审阅: 30 十月 2020
最近更新: 24 十月 2019

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
更多 首要检查

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
更多 需考虑的检查

治疗流程

进行中

撰稿人

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.

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.

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.

同行评议者展开全部内容

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.

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.

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.

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