Cirrhosis diagnosis

Ferral, H., Male, R., Cardiel, M., Munoz, L., Quiroz y Ferrari, F. Cirrhosis diagnosis by liver surface analysis with high-frequency ultrasound. Gastrointest. Radiol. 1992 17 74-78... 

Jeffrey, G.R, Prince, R.L., van der Schaaf, A. Fatal intrapulmonary arteriovenous shunting in cirrhosis diagnosis by radionuclide lung perfusion scan. Med. J. Aust. 1990 152 549-553... 

Di Lelio, A., Cestari, C., Lomazzi, A., Beretta, L. Cirrhosis diagnosis with sonographic study of the liver surface. Radiology 1989 172 389-392... 

Primary biliary cirrhosis is characterized by progressive inflammatory destruction of the bile ducts. Immune-mediated inflammation of intrahepatic bile ducts results in remodeling and scarring, causing retention of bile within the liver and subsequent hepatocellular damage and cirrhosis. The number of patients affected with primary biliary cirrhosis is difficult to estimate because many people are asymptomatic and incidental diagnosis during routine health care visits is common. 

Signs and symptoms of SBP in a patient with cirrhosis and ascites should prompt a diagnostic paracentesis (Fig. 19-4). In SBP, there is decreased total serum protein, elevated white blood cell count (with left shift), and the ascitic fluid contains at least 0.250 x 103/mm3 (0.250 x 109/L) neutrophils. Bacterial culture of ascitic fluid may be positive, but lack of growth does not exclude the diagnosis. 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

Which of these values are consistent with the diagnosis of cirrhosis ... 

Jaundice is often a late manifestation of cirrhosis, and its absence does not exclude the diagnosis. The classic signs of cirrhosis, such as palmar... 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

The second case is that of a 34-year-old woman who had been exposed to vapors of 1,4-dichlorobenzene at work and became acutely ill with nausea and vomiting, and was hospitalized with hemorrhage from the gastrointestinal tract (Cotter 1953). The physical and chemical findings led to the diagnosis of subacute yellow atrophy and cirrhosis of the liver from 1,4-dichlorobenzene exposure. No further information was located. 

Diagnosis of alcoholic cirrhosis of the liver was made based on Mrs MW s clinical features, liver function tests, abdominal ultrasound, CT scan and liver biopsy. 

Causes of cirrhosis can usually be identified by the patient s history combined with serological and histological investigation. Alcoholic liver disease and hepatitis C and B are the most common causes of cirrhosis. The association of excessive alcohol consumption with liver disease has been recognised for centuries. After the identification of the hepatitis C vims and of non-alcoholic steatohepatitis in obese patients with diabetes, the diagnosis of cirrhosis without an apparent cause (cryptogenic cirrhosis) is rarely made. Genetic causes of cirrhosis include haemochromatosis and Wilson s disease. 

Primary bihary cirrhosis May be asymptomatic. Prominent rise in alkaline phosphatase, cholesterol and bilirubin. More common in women. Diagnosis through detection of antimitochondrial antibodies, with biopsy. 

Transferrin A high-affinity serum iron transport protein Transferrin is synthesised in the liver and its levels are diminished in cirrhosis Iron overload i.e haemochromatosis/haemosiderosis may lead to cirrhosis. A transferrin saturation >55% in males (and postmenopausal women) or >50% in premenopausal women requires investigation to exclude a diagnosis of hereditary haemochromatosis... 

Autoimmune hepatitis typically occurs in females, at puberty and between the ages of 40 and 70. It can also occur in males at any age. It may present in a number of ways as a mild hepatitis, as a severe acute hepatitis or as established cirrhosis. The functioning capacity of the liver will vary depending on the stage of disease. The diagnosis of AIH is based on serum biochemistry, liver histology, and the presence of certain autoantibodies in the serum. Exclusion of other potential causes of hepatitis, e.g. hepatitis B or C, alcohol consumption, is needed before a definitive diagnosis can be made. There are no featnres that are specifically indicative of AIH, but it usually responds to treatment with corticosteroids. Once remission is indnced azathioprine or... 

Diagnosis (including the presence or absence of fibrosis, cirrhosis and hepatic decompensation). 

A biopsy is often required to make a diagnosis of most types of liver disease. A specimen of liver can be used to identify fibrosis, cirrhosis, cholestasis and hepatitis, both acute and chronic, and tumours. Biochemical measurements can also be taken from a biopsy specimen to determine iron and copper content, virology, microbiology and haematology (e.g. increased numbers of eosinophils in a drug-induced cause). The biopsy can give an indication of the extent of the liver damage. See Chapter 3 for slides of liver biopsies. 

Patient 2 Patient Information Name/DoB/unit number Colin Day, 43 years old Diagnosis (lype/cause) (if known) Cryptogenic cirrhosis Relevant biochemical tests ... 

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