Gastrointestinal varices laboratory findings: Difference between revisions

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==Laboratory Findings==
==Laboratory Findings==
=== Markers of chronic liver disease/cirrhosis ===
* Laboratory abnormalities may be the first indication of [[cirrhosis]].
* Laboratory abnormalities may be the first indication of [[cirrhosis]].


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** Rarely results in a [[Platelet|platelet count]] < 50,000/mL   
** Rarely results in a [[Platelet|platelet count]] < 50,000/mL   
** Mechanism of [[thrombocytopenia]]:  
** Mechanism of [[thrombocytopenia]]:  
*** caused by [[portal hypertension]] with congestive [[splenomegaly]]: sequesters circulating [[Platelet|platelets]]   
*** Caused by [[portal hypertension]] with congestive [[splenomegaly]]: sequesters circulating [[Platelet|platelets]]   
*** decreased [[thrombopoietin]] levels  
*** Decreased [[thrombopoietin]] levels  


* [[Anemia]]
* [[Anemia]]
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*** [[Transudate]] - [[Serum-ascites albumin gradient|SAAG]] > 1.1 g/dL (indicates the [[ascites]] is due to [[portal hypertension]])
*** [[Transudate]] - [[Serum-ascites albumin gradient|SAAG]] > 1.1 g/dL (indicates the [[ascites]] is due to [[portal hypertension]])
*** [[Exudate]] - [[Serum-ascites albumin gradient|SAAG]] < 1.1 g/dL (indicates the [[ascites]] is due to non-portal hypertension etiology)
*** [[Exudate]] - [[Serum-ascites albumin gradient|SAAG]] < 1.1 g/dL (indicates the [[ascites]] is due to non-portal hypertension etiology)
'''AST to platelet ratio index''' '''(APRI)'''
* APRI value of less than equal to 0.5 rules out significant [[fibrosis]] and [[cirrhosis]], and a value of greater than equal to 1.5 rules in significant [[fibrosis]]<ref name="pmid16773685">{{cite journal |vauthors=Sebastiani G, Alberti A |title=Non invasive fibrosis biomarkers reduce but not substitute the need for liver biopsy |journal=World J. Gastroenterol. |volume=12 |issue=23 |pages=3682–94 |year=2006 |pmid=16773685 |pmc=4087461 |doi= |url=}}</ref><ref name="pmid24764667">{{cite journal |vauthors=Kim MY, Jeong WK, Baik SK |title=Invasive and non-invasive diagnosis of cirrhosis and portal hypertension |journal=World J. Gastroenterol. |volume=20 |issue=15 |pages=4300–15 |year=2014 |pmid=24764667 |pmc=3989965 |doi=10.3748/wjg.v20.i15.4300 |url=}}</ref>


==== FibroTest ====
==== FibroTest ====
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* '''[[Alpha 1-antitrypsin]]''' - reduced in [[Alpha 1-antitrypsin deficiency|alpha-1 antitrypsin deficiency]].
* '''[[Alpha 1-antitrypsin]]''' - reduced in [[Alpha 1-antitrypsin deficiency|alpha-1 antitrypsin deficiency]].


===Combinations of tests===
===Combination of tests===
* [[Clinical prediction rule]]s exist to help diagnosis cirrhosis according to a [[systematic review]] by the [[Rational Clinical Examination]] project.<ref name="pmid22357834">{{cite journal| author=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL et al.| title=Does this patient with liver disease have cirrhosis? | journal=JAMA | year= 2012 | volume= 307 | issue= 8 | pages= 832-42 | pmid=22357834 | doi=10.1001/jama.2012.186 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357834  }} </ref>  
* [[Clinical prediction rule]]s exist to help diagnosis cirrhosis according to a [[systematic review]] by the [[Rational Clinical Examination]] project.<ref name="pmid22357834">{{cite journal| author=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL et al.| title=Does this patient with liver disease have cirrhosis? | journal=JAMA | year= 2012 | volume= 307 | issue= 8 | pages= 832-42 | pmid=22357834 | doi=10.1001/jama.2012.186 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357834  }} </ref>  
* Pohl's Index:
* Pohl's Index:

Latest revision as of 21:28, 24 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Cirrhosis of the liver is the most common cause of portal hypertension worldwide. A range of laboratory values may be obtained in the evaluation of cirrhosis, in order to determine disease severity and causation. Liver function tests, complete blood count, basic metabolic panel and coagulation factors are standard in the evaluation of cirrhosis. More specific testing for markers and serum enzymes may be performed when certain etiologies are suspected.

Laboratory Findings

Markers of chronic liver disease/cirrhosis

  • Laboratory abnormalities may be the first indication of cirrhosis.

Liver function tests:

Hematologic abnormalities:  [29]

AST to platelet ratio index (APRI)

FibroTest

Other laboratory studies performed in newly diagnosed cirrhosis may include:

Combination of tests

  • Another method is the Lok index[41]
  • A more recent meta-analysis has focused on the diagnosis of cirrhosis among patients with hepatitis C[43] using the Lok index:
    • < 0.2 has negative likelihood ratio of 0.21
    • > 0.6 has positive likelihood ratio of 4.4

References

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  2. 2.0 2.1 Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.
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