Alcoholic liver disease other diagnostic studies: Difference between revisions
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==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: | [[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== | ==Other Diagnostic Studies== | ||
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==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" | ||
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| 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> | ||
|} | |} | ||
Revision as of 23:19, 24 January 2018
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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[1][2][3][4][5][6][7][8]
- Fatty liver
- Macrovesicular fat
- Alcoholic hepatitis
- Polymorphonuclear infiltration
- Hepatic necrosis
- Mallory bodies in hepatocytes
- Perivenular and perisinusoidal fibrosis
- Ballooning hepatocytes
- Steatosis
- Alcoholic cirrhosis
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 13.0 13.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.