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| __NOTOC__ | | __NOTOC__ |
| {{Cirrhosis}} | | {{Cirrhosis}} |
| {{CMG}} {{AE}} {{CP}}}{{Cherry}} | | {{CMG}} {{AE}}{{Cherry}} |
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| ==Overview== | | ==Overview== |
Revision as of 15:36, 19 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
Cirrhosis may present in a similar way to some other diseases. History, physical examination, and diagnostic testing may help to differentiate cirrhosis from other diseases such as malignancy, constrictive pericarditis, Budd-Chiari syndrome, portal vein thrombosis and splenic vein thrombosis.
Differentiating Cirrhosis from other Diseases
Differential diagnosis of cirrhosis on the basis of jaundice is as follows: [1]
| Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
| Lab Findings
|
Other blood tests
|
Other diagnostic
|
| Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
| Jaundice
|
Hepatocellular Jaundice
|
Hemochromatosis
|
+
|
-
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
N
|
-
|
Ferritin ↑
|
Liver biopsy
|
| Wilson's disease
|
+
|
-
|
-/+
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
Serum cerulloplasmin ↑
|
Liver biopsy
|
| Viral hepatitis
|
-
|
-/+
|
-
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
+
|
Specific viral antibody for each type
|
-
|
| Alcoholic hepatitis
|
-
|
-/+
|
-/+
|
-
|
↑↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
| Drug induced hepatitis
|
-
|
-/+
|
-
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
| Autoimmune hepatitis
|
-/+
|
-
|
-
|
-/+
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
Anti-LKM antibody
|
Liver biopsy
|
| Cirrhosis
|
-/+
|
-/+
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
↑/N
|
-/+
|
Low platate
|
Small liver on ultrasond
|
| Cholestatic Jaundice
|
Common bile duct stone
|
-/+
|
-
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
-
|
Dilated ducts on sono
|
CT/ERCP
|
| Hepatitis A cholestatic type
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
| EBV / CMV hepatitis
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
|
| Primary biliary cirrhosis
|
-/+
|
-
|
-/+
|
+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
| Primary sclerosing cholangitis
|
-/+
|
-
|
-/+
|
+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
| Pancreatic carcinoma
|
+
|
-
|
-/+
|
-
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Mass on ultrasond
|
CT scan for diagnosis
|
| Isolated Jaundice
|
Crigler-Najjar type 2
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
↑
|
-
|
Genetic testing
|
| Gilbert
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
↑
|
-
|
Genetic testing
|
| Rotor syndrome
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
N
|
↑
|
-
|
Genetic testing
|
Liver biopsy
|
| Dubin-Johnson syndrome
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
N
|
↑
|
-
|
Genetic testing
|
Liver biopsy
|
| Hereditory spherocytosis
|
+
|
-
|
-/+
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
Osmotic fragility
|
| G6PD deficiency
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
| Thalassemia
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
| Sickle cell disease
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
| Paroxismal nocturnal hemoglobinoria
|
-
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Flocytometery
|
| Immune hemolysis
|
-
|
-/+
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Autoantibodies
|
| Hematoma
|
-
|
-/+
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Anemia
|
Truma or surgery in history
|
|
Differential diagnosis of cirrhosis based on altered hepatic function:
| Condition
|
Differentiating signs and symptoms
|
Differentiating Tests
|
| Constrictive pericarditis
|
|
|
| Budd-Chiari Syndrome
|
- Abdominal pain
- Diarrhea
- Ascites
|
- Doppler ultrasound and CT of the abdomen shows absence of the hepatic vein filling
- Abdominal CT will show a rapid clearing of the caudate lobe of the liver
|
| Splenic vein thrombosis
|
Signs and symptoms of:
|
- Ultrasound of the abdomen and CT will show evidence of a splenic vein thrombosis
- Normal hepatic venous pressure gradient is present
|
| Portal vein thrombosis
|
- Symptoms depend on the underlying cause:
- If pancreatitis is present, the patient may develop:
- If the cause is ascending cholangitis, symptoms include:
- Fever
- rigors
- Right upper quadrant pain
- Dark urine
- Pale stools
- If abdominal sepsis is the cause, symptoms include:
- fever
- abdominal pain
- Signs of peritonitis
|
- Doppler ultrasound and abdominal CT show a portal vein filling defect, and absence of flow in the portal vein.
- MR or direct angiography show a normal hepatic venous pressure gradient.
|
| Schistosomiasis
|
- Patients may have a history of travel to endemic areas
- Constitutional symptoms such as
|
- MR or direct angiography shows a normal hepatic venous pressure gradient
|
| Sarcoidosis
|
|
|
| Inferior vena cava obstruction
|
|
- Ultrasound of the abdomen shows evidence of inferior vena cava obstruction
|
| Nodular regenerative hyperplasia
|
None
|
- Liver biopsy shows small regenerative nodules with little or no fibrosis on reticulin staining
|
| Idiopathic portal hypertension (hepatoportal sclerosis)
|
None
|
|
| Vitamin A intoxication, arsenic, and vinyl chloride toxicity
|
None
|
- History generally reveals exposure
|
Differentiating Cirrhosis from other Diseases Based on Ascitic Fluid
Ascites may be caused by portal hypertension due to cirrhosis of liver or due to other causes such as malignancy. Ascitic fluid analysis should be done to broadly categorize the cause of ascites.
Ascites is broadly classified as two types based on the serum-ascites albumin gradient (SAAG):
References
- ↑ Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.
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