Liver Cirrhosis Pdf 2013
Appropriate treatment can stabilize cirrhosis or even reverse it. Cirrhosis can be prevented with individualized, risk-adapted treatment based on the early detection of chronic liver disease. Esophagogastroduodenoscopy can be performed early on to assess the risk of variceal bleeding.
The etiology of cirrhosis
Complications of liver cirrhosis. Noninvasive diagnosis of cirrhosis in chronic hepatitis C based on standard laboratory tests.
In chronic hepatitis B, the risk of cirrhosis depends to a large extent on the burden of viral infection i. Liver biopsy is unnecessary, or even contraindicated, if the diagnosis of cirrhosis has been clearly established from the clinical findings and imaging studies e.
Current issue Upcoming issue All issues. The indications for liver biopsy.
The cost-effectiveness of screening for chronic hepatitis B infection in the United States. Wittekind, Institute of Pathology, University of Leipzig. Noninvasive testing is being increasingly used to detect hepatic fibrosis and to stage liver disease. Timely intervention can prevent progression to the next disease stage.
Increased caffeine consumption is associated with reduced hepatic fibrosis. There are, however, ways to prevent cirrhosis, because the diseases that most commonly lead to it progress slowly, and measures are available to prevent and treat them. Prophylaxis, diagnosis and therapy of hepatitis B virus infection - the German guideline. In most patients, the progression of fibrosis can be averted by early detection and appropriate treatment. Abstract Background Cirrhosis of the liver is the end stage of chronic liver disease.
Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels. Cirrhosis is more common in overweight persons and smokers. It should be borne in mind that, once hepatic disease has reached the stage of cirrhosis, histological determination of the original underlying etiology may be difficult or impossible.
Key Messages The most common and most important causes of liver cirrhosis in Germany are fatty liver diseases that arise from two widespread conditions, pdf version of unbearable lightness of being the metabolic syndrome and alcoholism. Cirrhosis is the final stage attained by various chronic liver diseases after years or decades of slow progression. Cirrhosis of the liver is the end stage of chronic liver disease. To prevent cirrhosis is to prevent hepatocellular carcinoma as well.
Table Diagnostic algorithm for chronic liver disease. Preventing cirrhosis by early diagnosis of chronic liver disease Cirrhosis is the end stage of chronic liver diseases that progress over years or decades. Chronic liver diseases do not usually cause any symptoms.
Ancillary studies include upper abdominal ultrasonography and gastroscopy. Appropriate treatment can bring about the regression of disease from a worse stage to a better one. Management of chronic hepatitis B virus infection.
Patients who engage in behavior that puts them at risk for chronic liver disease are often not aware of the fact, and subtle clinical manifestations are easily overlooked by physicians as well. Noninvasive diagnostic evaluation of cirrhosis A number of laboratory and ultrasound-based methods have been developed recently for the noninvasive diagnostic evaluation of cirrhosis. Cirrhosis is the end stage of chronic liver diseases that progress over years or decades. Wiegand has served as a paid consultant for Gilead.
Current standards in the treatment of chronic hepatitis C. Screening for chronic liver disease should include history and physical examination, serum transaminase measurement, upper abdominal ultrasonography, and, in some cases, transient elastography. Conflict of interest statement. Bioptic diagnosis of chronic hepatitis.
Complete blood count, platelet count, routine coagulation studies. Footnotes Conflict of interest statement Prof. The commonest causes of cirrhosis in Germany are alcoholic and non-alcoholic fatty liver disease and viral hepatitis B or C. There are no laboratory cutoff values for the diagnosis of cirrhosis. Ceruloplasmin, copper in hour urine sample, genetic testing for Wilson disease.
The Etiology Diagnosis and Prevention of Liver Cirrhosis
Smoking and severity of hepatic fibrosis in nonalcoholic fatty liver disease. Whenever possible, patients should not only have their transaminases measured, but should also undergo upper abdominal ultrasonography. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Support Center Support Center. The condition is diagnosed by its characteristic findings on clinical examination, laboratory tests, and ancillary studies.
In non-alcoholic fatty liver disease, the risk of progression of fibrosis can be estimated from the findings of an initial biopsy. Treatment of the underlying disease can often halt or even reverse the progression of early-stage cirrhosis.
Knowledge of these factors enables individual risk stratification, which, in turn, serves as the basis for personalized treatment. The underlying causes of cirrhosis determine its rate of progression and are the focus of preventive efforts and treatment. In advanced liver disease approaching the stage of cirrhosis, thrombocytopenia is seen, along with impaired hepatic biosynthesis as shown by, e.
There is no well-defined threshold value of any laboratory test that can be used to determine when screening for cirrhosis should be performed. Wherever special ultrasonographic techniques such as transient elastography are available, they can be used as additional tests to screen for liver disease and monitor its course. Genetic risk factors play an important part in determining the risk that an individual will develop cirrhosis. Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis.
If the patient also drinks alcohol to excess, the risk of progression is multiplied by a further factor. Open in a separate window. Diagnosis and management of autoimmune hepatitis. The diagnostic evaluation of cirrhosis with ultrasonography is based on the direct relation between the extent of fibrosis and the ultrasonographically determined degree of liver stiffness.
Corresponding address Prof. If the screening tests point to liver disease, a further diagnostic algorithm may be applied to determine the specific type of disease that is present Table. Journal List Dtsch Arztebl Int v. The most common and most important causes of liver cirrhosis in Germany are fatty liver diseases that arise from two widespread conditions, the metabolic syndrome and alcoholism. In most patients, the dynamic process of progressive fibrosis, which could ultimately lead to cirrhosis, can be interrupted by the timely recognition of the risk, followed by appropriate treatment.
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