Alcoholic liver disease other diagnostic studies: Difference between revisions

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__NOTOC__
__NOTOC__
{{Alcoholic liver disease}}
{{Alcoholic liver disease}}
{{CMG}}
{{CMG}}; {{AE}} {{MKA}}
 
==Overview==
==Overview==
[[Liver biopsy]] is used to confirm the diagnosis when alcoholic hepatitis is suspected, and to help in guiding medical treatment. Microscopic findings on biopsy that indicate alcoholic hepatitis are: polymorphonuclear infiltration of cells, hepatic necrosis, ballooning hepatocytes, [[Mallory bodies]] within cells, and perivenular and perisinusoidal fibrosis.
[[Liver biopsy]] is used to confirm the diagnosis when [[alcoholic hepatitis]] is suspected, and to help in guiding medical treatment. [[Microscopic]] findings on [[biopsy]] that indicate [[alcoholic hepatitis]] are: [[Polymorphonuclear cells|Polymorphonuclear]] infiltration of [[cells]], hepatic [[necrosis]], ballooning [[hepatocytes]], [[Mallory bodies]] within [[cells]], and perivenular and perisinusoidal [[fibrosis]].


==Other Diagnostic Studies==
==Other Diagnostic Studies==
===Liver Biopsy===
===Liver Biopsy===
Findings on [[liver biopsy]] in cases of alcoholic liver disease include:<ref name="pmid15763228">{{cite journal |vauthors=Lefkowitch JH |title=Morphology of alcoholic liver disease |journal=Clin Liver Dis |volume=9 |issue=1 |pages=37–53 |year=2005 |pmid=15763228 |doi=10.1016/j.cld.2004.11.001 |url=}}</ref><ref name="pmid5641156">{{cite journal |vauthors=Rubin E, Lieber CS |title=Alcohol-induced hepatic injury in nonalcoholic volunteers |journal=N. Engl. J. Med. |volume=278 |issue=16 |pages=869–76 |year=1968 |pmid=5641156 |doi=10.1056/NEJM196804182781602 |url=}}</ref><ref name="pmid7806041">{{cite journal |vauthors=Fromenty B, Grimbert S, Mansouri A, Beaugrand M, Erlinger S, Rötig A, Pessayre D |title=Hepatic mitochondrial DNA deletion in alcoholics: association with microvesicular steatosis |journal=Gastroenterology |volume=108 |issue=1 |pages=193–200 |year=1995 |pmid=7806041 |doi= |url=}}</ref><ref name="pmid3699404">{{cite journal |vauthors=Chedid A, Mendenhall CL, Tosch T, Chen T, Rabin L, Garcia-Pont P, Goldberg SJ, Kiernan T, Seeff LB, Sorrell M |title=Significance of megamitochondria in alcoholic liver disease |journal=Gastroenterology |volume=90 |issue=6 |pages=1858–64 |year=1986 |pmid=3699404 |doi= |url=}}</ref><ref name="pmid6700382">{{cite journal |vauthors=Uchida T, Kronborg I, Peters RL |title=Giant mitochondria in the alcoholic liver diseases--their identification, frequency and pathologic significance |journal=Liver |volume=4 |issue=1 |pages=29–38 |year=1984 |pmid=6700382 |doi= |url=}}</ref><ref name="pmid6629323">{{cite journal |vauthors=Fauerholdt L, Schlichting P, Christensen E, Poulsen H, Tygstrup N, Juhl E |title=Conversion of micronodular cirrhosis into macronodular cirrhosis |journal=Hepatology |volume=3 |issue=6 |pages=928–31 |year=1983 |pmid=6629323 |doi= |url=}}</ref><ref name="pmid649765">{{cite journal |vauthors=Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH |title=The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization |journal=J. Clin. Pathol. |volume=31 |issue=5 |pages=395–414 |year=1978 |pmid=649765 |pmc=1145292 |doi= |url=}}</ref><ref name="pmid2466751">{{cite journal |vauthors=Van Eyken P, Sciot R, Desmet VJ |title=A cytokeratin immunohistochemical study of alcoholic liver disease: evidence that hepatocytes can express 'bile duct-type' cytokeratins |journal=Histopathology |volume=13 |issue=6 |pages=605–17 |year=1988 |pmid=2466751 |doi= |url=}}</ref>
* [[Fatty liver]]
* [[Fatty liver]]
** Macrovesicular fat
** Macrovesicular fat
* Alcoholic hepatitis
* [[Alcoholic hepatitis]]
** Polymorphonuclear infiltration
** [[Polymorphonuclear cell|Polymorphonuclear]] infiltration
** Hepatic necrosis
** Hepatic [[necrosis]]
** [[Mallory bodies]] in [[hepatocytes]]
** [[Mallory bodies]] in [[hepatocytes]]
** Perivenular and perisinusoidal fibrosis
** Perivenular and perisinusoidal [[fibrosis]]
** Ballooning hepatocytes
** Ballooning [[hepatocytes]]
** [[Steatosis]]
** [[Steatosis]]
* [[Alcoholic cirrhosis]]
* [[Alcoholic cirrhosis]]
** [[Micronodular cirrhosis]]
** Micronodular [[cirrhosis]]
 
==Other diagnostic tests==
 
Biomarkers for assessing [[fibrosis]] in patients with alcoholic liver disease:<ref name="pmid25356026">{{cite journal |vauthors=Mueller S, Seitz HK, Rausch V |title=Non-invasive diagnosis of alcoholic liver disease |journal=World J. Gastroenterol. |volume=20 |issue=40 |pages=14626–41 |year=2014 |pmid=25356026 |pmc=4209529 |doi=10.3748/wjg.v20.i40.14626 |url=}}</ref>
*[[FibroTest]]<ref name="pmid19053048">{{cite journal |vauthors=Naveau S, Gaudé G, Asnacios A, Agostini H, Abella A, Barri-Ova N, Dauvois B, Prévot S, Ngo Y, Munteanu M, Balian A, Njiké-Nakseu M, Perlemuter G, Poynard T |title=Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease |journal=Hepatology |volume=49 |issue=1 |pages=97–105 |year=2009 |pmid=19053048 |doi=10.1002/hep.22576 |url=}}</ref>
**Based on α2-macroglobulin, haptoglobin, GGT, ApoA1 and bilirubin
*FibrometerA<ref name="pmid15704051">{{cite journal |vauthors=Naveau S, Raynard B, Ratziu V, Abella A, Imbert-Bismut F, Messous D, Beuzen F, Capron F, Thabut D, Munteanu M, Chaput JC, Poynard T |title=Biomarkers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=2 |pages=167–74 |year=2005 |pmid=15704051 |doi= |url=}}</ref>
**Based on prothrombin time, α2-macroglobulin, hyaluronic acid and age
*Hepascore<ref name="pmid16317693">{{cite journal |vauthors=Calès P, Oberti F, Michalak S, Hubert-Fouchard I, Rousselet MC, Konaté A, Gallois Y, Ternisien C, Chevailler A, Lunel F |title=A novel panel of blood markers to assess the degree of liver fibrosis |journal=Hepatology |volume=42 |issue=6 |pages=1373–81 |year=2005 |pmid=16317693 |doi=10.1002/hep.20935 |url=}}</ref>
**Based on bilirubin, GGT, α2-macroglobulin, hyaluronic acid , age and gender


==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>==
==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>==
===Biopsy : Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>===
===Biopsy : Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>===
{|class="wikitable"
{| class="wikitable"
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[AASLD guidelines classification scheme#Class of recommendation|Class I]]
| colspan="1" style="text-align:center; background:LightGreen" |[[AASLD guidelines classification scheme#Class of recommendation|Class I]]
|-
|-
| bgcolor="LightGreen"| '''1.''' <nowiki>"</nowiki> For patients with a clinical diagnosis of severe alcoholic hepatitis (AH) for whom medical treatment is contemplated, or for those in whom reasonable uncertainty exists regarding the underlying diagnosis, a liver biopsy should be considered. This decision will depend on local expertise and ability in performing a liver biopsy in patients with coagulopathy, the patient’s severity of illness, and the type of therapy under consideration ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C]]) <nowiki>"</nowiki>
| bgcolor="LightGreen" | '''1.''' <nowiki>"</nowiki> For patients with a clinical diagnosis of severe alcoholic hepatitis (AH) for whom medical treatment is contemplated, or for those in whom reasonable uncertainty exists regarding the underlying diagnosis, a liver biopsy should be considered. This decision will depend on local expertise and ability in performing a liver biopsy in patients with coagulopathy, the patient’s severity of illness, and the type of therapy under consideration ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C]]) <nowiki>"</nowiki>


|}
|}
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WS}}
{{WH}}


{{WH}}
[[Category:Surgery]]
{{WS}}
[[Category:Pathology]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Alcohol abuse]]
[[Category:Up-To-Date]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Medicine]]

Latest revision as of 20:20, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

Overview

Liver biopsy is used to confirm the diagnosis when alcoholic hepatitis is suspected, and to help in guiding medical treatment. Microscopic findings on biopsy that indicate alcoholic hepatitis are: Polymorphonuclear infiltration of cells, hepatic necrosis, ballooning hepatocytes, Mallory bodies within cells, and perivenular and perisinusoidal fibrosis.

Other Diagnostic Studies

Liver Biopsy

Findings on liver biopsy in cases of alcoholic liver disease include:[1][2][3][4][5][6][7][8]

Other diagnostic tests

Biomarkers for assessing fibrosis in patients with alcoholic liver disease:[9]

  • FibroTest[10]
    • Based on α2-macroglobulin, haptoglobin, GGT, ApoA1 and bilirubin
  • FibrometerA[11]
    • Based on prothrombin time, α2-macroglobulin, hyaluronic acid and age
  • Hepascore[12]
    • Based on bilirubin, GGT, α2-macroglobulin, hyaluronic acid , age and gender

2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[13]

Biopsy : Guidelines (DO NOT EDIT)[13]

Class I
1. " For patients with a clinical diagnosis of severe alcoholic hepatitis (AH) for whom medical treatment is contemplated, or for those in whom reasonable uncertainty exists regarding the underlying diagnosis, a liver biopsy should be considered. This decision will depend on local expertise and ability in performing a liver biopsy in patients with coagulopathy, the patient’s severity of illness, and the type of therapy under consideration (Level of evidence: C) "

References

  1. ↑ Lefkowitch JH (2005). "Morphology of alcoholic liver disease". Clin Liver Dis. 9 (1): 37–53. doi:10.1016/j.cld.2004.11.001. PMID 15763228.
  2. ↑ Rubin E, Lieber CS (1968). "Alcohol-induced hepatic injury in nonalcoholic volunteers". N. Engl. J. Med. 278 (16): 869–76. doi:10.1056/NEJM196804182781602. PMID 5641156.
  3. ↑ Fromenty B, Grimbert S, Mansouri A, Beaugrand M, Erlinger S, Rötig A, Pessayre D (1995). "Hepatic mitochondrial DNA deletion in alcoholics: association with microvesicular steatosis". Gastroenterology. 108 (1): 193–200. PMID 7806041.
  4. ↑ Chedid A, Mendenhall CL, Tosch T, Chen T, Rabin L, Garcia-Pont P, Goldberg SJ, Kiernan T, Seeff LB, Sorrell M (1986). "Significance of megamitochondria in alcoholic liver disease". Gastroenterology. 90 (6): 1858–64. PMID 3699404.
  5. ↑ Uchida T, Kronborg I, Peters RL (1984). "Giant mitochondria in the alcoholic liver diseases--their identification, frequency and pathologic significance". Liver. 4 (1): 29–38. PMID 6700382.
  6. ↑ Fauerholdt L, Schlichting P, Christensen E, Poulsen H, Tygstrup N, Juhl E (1983). "Conversion of micronodular cirrhosis into macronodular cirrhosis". Hepatology. 3 (6): 928–31. PMID 6629323.
  7. ↑ Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH (1978). "The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization". J. Clin. Pathol. 31 (5): 395–414. PMC 1145292. PMID 649765.
  8. ↑ Van Eyken P, Sciot R, Desmet VJ (1988). "A cytokeratin immunohistochemical study of alcoholic liver disease: evidence that hepatocytes can express 'bile duct-type' cytokeratins". Histopathology. 13 (6): 605–17. PMID 2466751.
  9. ↑ Mueller S, Seitz HK, Rausch V (2014). "Non-invasive diagnosis of alcoholic liver disease". World J. Gastroenterol. 20 (40): 14626–41. doi:10.3748/wjg.v20.i40.14626. PMC 4209529. PMID 25356026.
  10. ↑ Naveau S, Gaudé G, Asnacios A, Agostini H, Abella A, Barri-Ova N, Dauvois B, Prévot S, Ngo Y, Munteanu M, Balian A, Njiké-Nakseu M, Perlemuter G, Poynard T (2009). "Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease". Hepatology. 49 (1): 97–105. doi:10.1002/hep.22576. PMID 19053048.
  11. ↑ Naveau S, Raynard B, Ratziu V, Abella A, Imbert-Bismut F, Messous D, Beuzen F, Capron F, Thabut D, Munteanu M, Chaput JC, Poynard T (2005). "Biomarkers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease". Clin. Gastroenterol. Hepatol. 3 (2): 167–74. PMID 15704051.
  12. ↑ Calès P, Oberti F, Michalak S, Hubert-Fouchard I, Rousselet MC, Konaté A, Gallois Y, Ternisien C, Chevailler A, Lunel F (2005). "A novel panel of blood markers to assess the degree of liver fibrosis". Hepatology. 42 (6): 1373–81. doi:10.1002/hep.20935. PMID 16317693.
  13. ↑ 13.0 13.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.

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