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Xem bài sửa và giảng

I. Ôn cửu dương và cửu âm:

A. Cirrhosis is most commonly caused by alcohol, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease.

B. Diagnosis is based on blood testing, medical imaging, and liver biopsy.

The following findings are typical in cirrhosis:

  • Thrombocytopenia - typically multifactorial. Due to alcoholic marrow suppression, sepsis, lack of folate, platelet sequestering in the spleen as well as decreased thrombopoietin.[9] However, this rarely results in a platelet count < 50 000/mL.[31]
  • Aminotransferases – AST and ALT are moderately elevated, with AST > ALT. However, normal aminotransferase levels do not preclude cirrhosis.[9]
  • Alkaline phosphatase – slightly elevated but less than 2–3 times the upper limit of normal.
  • Gamma-glutamyl transferase – correlates with AP levels. Typically much higher in chronic liver disease from alcohol.[31]
  • Bilirubin – Levels normal when compensated but may elevate as cirrhosis progresses.
  • Albumin – levels fall as the synthetic function of the liver declines with worsening cirrhosis, since albumin is exclusively synthesized in the liver
  • Prothrombin time – increases, since the liver synthesizes clotting factors.
  • Globulins – increased due to shunting of bacterial antigens away from the liver to lymphoid tissue.
  • Serum sodiumhyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.
  • Leukopenia and neutropenia – due to splenomegaly with splenic margination.
  • Coagulation defects – the liver produces most of the coagulation factors and thus coagulopathy correlates with worsening liver disease.

FibroTest is a biomarker for fibrosis that can be done instead of a biopsy.

Other laboratory studies performed in newly diagnosed cirrhosis may include:

II. Giải thích SLB:

  • Spider angiomata or spider nevi are vascular lesions consisting of a central arteriole surrounded by many smaller vessels (hence the name "spider") and occur due to an increase in estradiol. One study found that spider angiomata occur in about 1/3 of cases.
  • Palmar erythema is a reddening of palms at the thenar and hypothenar eminences also as a result of increased estrogen.
  • Gynecomastia, or increase in breast gland size in men that is not cancerous, is caused by increased estradiol and can occur in up to 2/3 of patients.[12] This is different from increase in breast fat in overweight people.[13]
  • Hypogonadism, a decrease in male sex hormones may manifest as impotence, infertility, loss of sexual drive, and testicular atrophy, and can result from primary gonadal injury or suppression of hypothalamic/pituitary function. Hypogonadism is associated with cirrhosis due to alcoholism or hemochromatosis.
  • Liver size can be enlarged, normal, or shrunken in people with cirrhosis.
  • Ascites, accumulation of fluid in the peritoneal cavity (space in the abdomen), gives rise to "flank dullness". This may be visible as an increase in abdominal girth.
  • Fetor hepaticus is a musty breath odor resulting from increased dimethyl sulfide.
  • Jaundice, or icterus is yellow discoloration of the skin and mucous membranes, (with the white of the eye being especially noticeable) due to increased bilirubin (at least 2–3 mg/dL or 30 µmol/L). The urine may also appear dark.

C. Child-Pugh score. This scoring system uses bilirubin, albumin, INR, the presence and severity of ascites, and encephalopathy to classify patients into class A, B, or C.

Đăng bởi: ycantho - Ngày đăng: 04/09/2017
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