Author: Li Tongzeng (Beijing You’an Hospital Affiliated to Capital Medical University)
Some people like to use blood liver fibrosis indicators, liver elasticity test values, etc. to determine whether liver cirrhosis has occurred.
Actually, this is not comprehensive enough. For the clinical diagnosis of liver cirrhosis, in addition to the past medical history, symptoms and signs, a series of examinations must be done before it can be used as a diagnosis. It is not comprehensive enough to only look at individual values. Let’s analyze them one by one.
One, medical history
Liver cirrhosis develops on the basis of long-term liver damage. Repeated inflammation and necrosis and liver fibrosis will develop into liver cirrhosis if there is no treatment. The most common cause of liver cirrhosis in my country is Viral hepatitis, mainly chronic hepatitis B and C, other causes of cirrhosis include alcoholic liver disease, autoimmune liver disease, and other less common causes.
Therefore, regular screening should be performed for people with a history of chronic liver disease to determine whether liver cirrhosis has occurred.
Of course, there are also people who have no history of chronic liver disease, or have a history of chronic liver disease but the patient himself has no symptoms and has never checked the health of the liver, which requires clinical symptoms and examinations to diagnose Cirrhosis of the liver.
Image source: Zhanku Hailuo
2. Symptoms and signs
Patients with liver cirrhosis in the early stage may have no obvious symptoms. Patients in the stage of liver decompensation generally have symptoms and signs such as fatigue, loss of appetite, liver palms, spider nevus, and severe gallbladder disease. Jaundice caused by elevated erythrocytes, patients with decompensated cirrhosis can be complicated by ascites, ruptured bleeding caused by esophagus and fundus varices caused by portal hypertension, hepatic encephalopathy, and decreased urine output caused by hepatorenal syndrome.
In the end stage of liver cirrhosis, liver failure can occur. The patient will experience weight loss, massive ascites, hematemesis, oliguria, and lower extremity edema. Due to encephalopathy, there is a decline in computing power and orientation, confusion and ignorance of the people around, irritability, severe coma, and death due to liver failure.
Three, laboratory examination
Liver function, blood routine, coagulation function, blood biochemistry, and blood ammonia level can all reflect the severity of liver cirrhosis. If these indicators are normal or slightly abnormal, it indicates that they are in the compensated stage of liver cirrhosis. If there is an abnormality, it may indicate that it may enter the decompensation period.
If the blood routine shows a decrease in leukocytes and platelets, the liver function shows that the aspartate aminotransferase (AST) exceeds the alanine aminotransferase (ALT), the bilirubin level is increased, and hypoalbuminemia , decreased blood coagulation function, all indicate the performance of decompensated liver cirrhosis, and increased blood ammonia indicates an increased risk of hepatic encephalopathy.
The more abnormal these indicators are, the more severe the liver cirrhosis is.
Image source: Zhanku Hailuo
IV. Imaging examination
B-ultrasound, transient elastography of the liver or CT, MRI to check the shape of the liver. Before the early manifestation of liver cirrhosis, the transient elastography of the liver can diagnose liver fibrosis. After sclerosis, both ultrasound and CT can see that the liver shrinks, or the liver surface is obviously uneven, showing obvious jagged or wavy, the liver edge becomes very blunt, and the liver parenchyma echoes unevenly. Nodular, then it can be judged as cirrhosis.
Generally, such patients with liver cirrhosis will also be accompanied by thinning, twisting, and uneven thickness of the hepatic veins. The spleen is enlarged and the portal vein is widened by imaging, and ascites is often seen in the abdominal cavity. Decompensated liver cirrhosis, etc. Imaging tests can determine the severity of cirrhosis.
Summary:
Clinicians are usually not difficult to diagnose cirrhosis by combining the patient’s medical history, symptoms, laboratory tests, and imaging studies. Severity, early detection and early treatment can prevent patients with cirrhosis from progressing to the stage of liver failure.
Image source: Zhanku Hailuo
References:
[1] Chinese Society of Hepatology, Chinese Society of Infectious Diseases. Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2015 Update) [J]. Chinese Journal of Hepatology, 2015, 23(12):888-905.
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