Cirrhosis and portal hypertension: an overview

Chapter 9 Cirrhosis and portal hypertension


an overview





Cirrhosis




Classification





TABLE 9.1 Etiology and diagnostic workup of the common causes of cirrhosis


































































Etiology Diagnostic evaluation
Infection
Hepatitis B HBsAg, anti-HBs, anti-HBc, HBV DNA
Hepatitis C Anti-HCV, HCV RNA
Hepatitis D Anti-HDV
Toxins
Alcohol History, AST/ALT ratio, liver biopsy
Cholestasis
Primary biliary cirrhosis AMA, IgM, liver biopsy
Secondary biliary cirrhosis MRCP, ERCP, liver biopsy
Primary sclerosing cholangitis MRCP, ERCP, liver biopsy
Autoimmune
Autoimmune hepatitis ANA, IgG level smooth muscle antibodies, liver-kidney microsomal antibodies, liver biopsy
Vascular
Cardiac cirrhosis Echocardiogram, liver biopsy
Budd–Chiari syndrome CT, US, MRI/MRA,
Sinusoidal obstruction syndrome History of offending drug use, liver biopsy
Metabolic
Hemochromatosis Iron studies, HFE gene mutation, liver biopsy
Wilson disease Serum and urinary copper, ceruloplasmin, slit lamp eye examination, liver biopsy
Alpha-1 antitrypsin deficiency Alpha-1 antitrypsin level, protease inhibitor type, liver biopsy
NASH Liver biopsy
Cryptogenic Exclude NASH, drugs

ALT, alanine aminotransferase; AMA, antimitochondrial antibodies; ANA, antinuclear antibodies; anti-HBc, antibody to hepatitis B core antigen; anti-HBs, antibody to hepatitis B surface antigen; anti-HCV, antibody to hepatitis C virus; anti-HDV, antibody to hepatitis D virus; AST, aspartate aminotransferase; CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; HBsAg, hepatitis B surface antigen; IgG, immunoglobulin G; IgM, immunoglobulin M; MRA, magnetic resonance angiography; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; NASH, nonalcoholic steatohepatitis; US, ultrasonography.




Clinical Features


The manifestations of cirrhosis are protean. Patients with cirrhosis may come to clinical attention in numerous ways:








A patient with cirrhosis may present with none, some, or all of the following findings:





Jun 4, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on Cirrhosis and portal hypertension: an overview
Premium Wordpress Themes by UFO Themes