小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 无明显饮酒史
- 乏力和不适感
- 肝脾肿大
- 躯干性肥胖
其他诊断因素
- 右上腹不适
- 瘙痒
- 黄疸
- 蜘蛛状血管瘤
- 肝掌
- 指甲改变
- 掌腱膜挛缩症
- 青肿
- 瘀斑
- 抓痕
- 男性乳房发育
- 腮腺肿大
- 睾丸萎缩
- 脱发
- 水母头征
- Cruveilhier-Baumgarten 杂音
- 外周水肿
- 腹水
- 低血压
- 肝性脑病
- 扑翼样震颤
- 肝臭
- 呕血
- 黑粪
危险因素
- 肥胖
- 胰岛素抵抗或糖尿病
- 血脂异常
- 高血压
- 代谢综合征
- 体重迅速下降
- 肝毒性药物
- 全胃肠外营养 (TPN)
- 与肝脏脂肪沉积相关的疾病
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)
- 总胆红素
- 碱性磷酸酶
- γ-谷氨酰转移酶
- 全血细胞计数 (FBC)
- 生化检查
- 血脂
- 凝血酶原时间和 INR
- 血清白蛋白
- 抗核抗体 (antinuclear antibody, ANA) 和抗平滑肌抗体
- 铁检测
需考虑的检查
- 空腹胰岛素
- 稳态模型评估 (homeostatic model assessment, HOMA) 计算
- 甲胎蛋白
- 血清氨
- 终末期肝脏疾病模型评分计算
- 血清腹水白蛋白梯度
- 肝脏超声
- 腹部 CT 扫描
- 腹部 MRI
- 上消化道内镜
- 脑电图 (EEG)
- 门静脉压力测定
- 肝脏活检
新兴检查
- 弹性成像
- 细胞角蛋白-18片段
治疗流程
无终末期肝病
终末期肝病
撰稿人
作者
Shahid M. Malik, MD

Clinical Assistant 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

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.
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
利益声明
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
利益声明
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
利益声明
RDG declares that he has no competing interests.
鉴别诊断
- 酒精性肝病
- 隐源性肝硬化
- 自身免疫性肝炎
更多 鉴别诊断指南
- 非酒精性脂肪性肝病的诊断和管理
- 肝脏生化异常评估
更多 指南医学计算器
MELDNa 评分(用于肝移植等待名单,不适用于 12 岁以下的患者)(SI 单位制)
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