Cirrhosis differential diagnosis: Difference between revisions

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==Overview==
==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]].
Cirrhosis may present in a similar way to some other diseases. History, [[physical examination]], and [[diagnostic]] testing may help in differentiating cirrhosis from other diseases such as [[malignancy]], [[constrictive pericarditis]], [[Budd-Chiari syndrome]], [[portal vein thrombosis]] and [[splenic vein thrombosis]].


==Differentiating Cirrhosis From Other Diseases==
==Differentiating Cirrhosis From Other Diseases==
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| style="background:#DCDCDC; + " |'''Cirrhosis'''
| style="background:#DCDCDC; + " |'''Cirrhosis'''
|
|
* [[Abdominal pain]] and bloating
* [[Abdominal pain]] and [[bloating]]
* [[Menstrual disorder|Menstrual irregularities]]
* [[Menstrual disorder|Menstrual irregularities]]
* Symptoms of [[hypogonadism]]:
* [[Symptoms]] of [[hypogonadism]]:
** [[Erectile dysfunction|Impotence]]
** [[Erectile dysfunction|Impotence]]
** [[Infertility]]
** [[Infertility]]
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** [[Altered mental status]]
** [[Altered mental status]]
** [[Confusion]]
** [[Confusion]]
** Sleep disturbances
** [[Sleep]] disturbances
|
|
[[Ultrasound]] findings in cirrhosis are as follows:<ref name="pmid22357834">{{cite journal |vauthors=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM |title=Does this patient with liver disease have cirrhosis? |journal=JAMA |volume=307 |issue=8 |pages=832–42 |year=2012 |pmid=22357834 |doi=10.1001/jama.2012.186 |url=}}</ref><ref name="pmid3533689">{{cite journal |vauthors=Becker CD, Scheidegger J, Marincek B |title=Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography |journal=Gastrointest Radiol |volume=11 |issue=4 |pages=305–11 |year=1986 |pmid=3533689 |doi= |url=}}</ref><ref name="pmid2526349">{{cite journal |vauthors=Di Lelio A, Cestari C, Lomazzi A, Beretta L |title=Cirrhosis: diagnosis with sonographic study of the liver surface |journal=Radiology |volume=172 |issue=2 |pages=389–92 |year=1989 |pmid=2526349 |doi=10.1148/radiology.172.2.2526349 |url=}}</ref><ref name="pmid3891495">{{cite journal |vauthors=Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW |title=Is ultrasonography useful in the assessment of diffuse parenchymal liver disease? |journal=Gastroenterology |volume=89 |issue=1 |pages=186–91 |year=1985 |pmid=3891495 |doi= |url=}}</ref><ref name="pmid3532188">{{cite journal |vauthors=Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G |title=Cirrhosis: value of caudate to right lobe ratio in diagnosis with US |journal=Radiology |volume=161 |issue=2 |pages=443–5 |year=1986 |pmid=3532188 |doi=10.1148/radiology.161.2.3532188 |url=}}</ref><ref name="pmid10341686">{{cite journal |vauthors=Simonovský V |title=The diagnosis of cirrhosis by high resolution ultrasound of the liver surface |journal=Br J Radiol |volume=72 |issue=853 |pages=29–34 |year=1999 |pmid=10341686 |doi=10.1259/bjr.72.853.10341686 |url=}}</ref><ref name="pmid22144108">{{cite journal |vauthors=Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S |title=Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities |journal=Hepatology |volume=54 |issue=6 |pages=1987–97 |year=2011 |pmid=22144108 |doi=10.1002/hep.24545 |url=}}</ref><ref name="pmid22424438">{{cite journal |vauthors= |title=EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma |journal=J. Hepatol. |volume=56 |issue=4 |pages=908–43 |year=2012 |pmid=22424438 |doi=10.1016/j.jhep.2011.12.001 |url=}}</ref>
[[Ultrasound]] findings in cirrhosis are as follows:<ref name="pmid22357834">{{cite journal |vauthors=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM |title=Does this patient with liver disease have cirrhosis? |journal=JAMA |volume=307 |issue=8 |pages=832–42 |year=2012 |pmid=22357834 |doi=10.1001/jama.2012.186 |url=}}</ref><ref name="pmid3533689">{{cite journal |vauthors=Becker CD, Scheidegger J, Marincek B |title=Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography |journal=Gastrointest Radiol |volume=11 |issue=4 |pages=305–11 |year=1986 |pmid=3533689 |doi= |url=}}</ref><ref name="pmid2526349">{{cite journal |vauthors=Di Lelio A, Cestari C, Lomazzi A, Beretta L |title=Cirrhosis: diagnosis with sonographic study of the liver surface |journal=Radiology |volume=172 |issue=2 |pages=389–92 |year=1989 |pmid=2526349 |doi=10.1148/radiology.172.2.2526349 |url=}}</ref><ref name="pmid3891495">{{cite journal |vauthors=Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW |title=Is ultrasonography useful in the assessment of diffuse parenchymal liver disease? |journal=Gastroenterology |volume=89 |issue=1 |pages=186–91 |year=1985 |pmid=3891495 |doi= |url=}}</ref><ref name="pmid3532188">{{cite journal |vauthors=Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G |title=Cirrhosis: value of caudate to right lobe ratio in diagnosis with US |journal=Radiology |volume=161 |issue=2 |pages=443–5 |year=1986 |pmid=3532188 |doi=10.1148/radiology.161.2.3532188 |url=}}</ref><ref name="pmid10341686">{{cite journal |vauthors=Simonovský V |title=The diagnosis of cirrhosis by high resolution ultrasound of the liver surface |journal=Br J Radiol |volume=72 |issue=853 |pages=29–34 |year=1999 |pmid=10341686 |doi=10.1259/bjr.72.853.10341686 |url=}}</ref><ref name="pmid22144108">{{cite journal |vauthors=Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S |title=Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities |journal=Hepatology |volume=54 |issue=6 |pages=1987–97 |year=2011 |pmid=22144108 |doi=10.1002/hep.24545 |url=}}</ref><ref name="pmid22424438">{{cite journal |vauthors= |title=EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma |journal=J. Hepatol. |volume=56 |issue=4 |pages=908–43 |year=2012 |pmid=22424438 |doi=10.1016/j.jhep.2011.12.001 |url=}}</ref>
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Transient [[elastography]] and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of [[fibrosis]] in various [[liver]] diseases: <ref name="pmid20581229">{{cite journal |vauthors=Castera L, Pinzani M |title=Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? |journal=Gut |volume=59 |issue=7 |pages=861–6 |year=2010 |pmid=20581229 |doi=10.1136/gut.2010.214650 |url=}}</ref><ref name="pmid22239521">{{cite journal |vauthors=Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E |title=Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis |journal=J. Viral Hepat. |volume=19 |issue=2 |pages=e212–9 |year=2012 |pmid=22239521 |doi=10.1111/j.1365-2893.2011.01537.x |url=}}</ref><ref name="pmid18395077">{{cite journal |vauthors=Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E |title=Performance of transient elastography for the staging of liver fibrosis: a meta-analysis |journal=Gastroenterology |volume=134 |issue=4 |pages=960–74 |year=2008 |pmid=18395077 |doi=10.1053/j.gastro.2008.01.034 |url=}}</ref><ref name="pmid15690481">{{cite journal |vauthors=Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M |title=Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C |journal=Hepatology |volume=41 |issue=1 |pages=48–54 |year=2005 |pmid=15690481 |doi=10.1002/hep.20506 |url=}}</ref><ref name="pmid14698338">{{cite journal |vauthors=Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R |title=Transient elastography: a new noninvasive method for assessment of hepatic fibrosis |journal=Ultrasound Med Biol |volume=29 |issue=12 |pages=1705–13 |year=2003 |pmid=14698338 |doi= |url=}}</ref><ref name="pmid23558397">{{cite journal |vauthors=Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F |title=EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology |journal=Ultraschall Med |volume=34 |issue=2 |pages=169–84 |year=2013 |pmid=23558397 |doi=10.1055/s-0033-1335205 |url=}}</ref><ref name="pmid25911335">{{cite journal |vauthors= |title=EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis |journal=J. Hepatol. |volume=63 |issue=1 |pages=237–64 |year=2015 |pmid=25911335 |doi=10.1016/j.jhep.2015.04.006 |url=}}</ref><ref name="pmid21205132">{{cite journal |vauthors=Castera L, Bedossa P |title=How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy? |journal=Liver Int. |volume=31 Suppl 1 |issue= |pages=13–7 |year=2011 |pmid=21205132 |doi=10.1111/j.1478-3231.2010.02380.x |url=}}</ref><ref name="pmid23732714">{{cite journal |vauthors=Chou R, Wasson N |title=Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review |journal=Ann. Intern. Med. |volume=158 |issue=11 |pages=807–20 |year=2013 |pmid=23732714 |doi=10.7326/0003-4819-158-11-201306040-00005 |url=}}</ref><ref name="pmid26779260">{{cite journal |vauthors=Khallafi H, Qureshi K |title=Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach |journal=Interdiscip Perspect Infect Dis |volume=2015 |issue= |pages=809289 |year=2015 |pmid=26779260 |pmc=4686715 |doi=10.1155/2015/809289 |url=}}</ref><ref name="pmid23954643">{{cite journal |vauthors=Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA |title=Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=12 |pages=1573–84.e1–2; quiz e88–9 |year=2013 |pmid=23954643 |pmc=3900882 |doi=10.1016/j.cgh.2013.07.034 |url=}}</ref> 
Transient [[elastography]] and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of [[fibrosis]] in various [[liver]] diseases: <ref name="pmid20581229">{{cite journal |vauthors=Castera L, Pinzani M |title=Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? |journal=Gut |volume=59 |issue=7 |pages=861–6 |year=2010 |pmid=20581229 |doi=10.1136/gut.2010.214650 |url=}}</ref><ref name="pmid22239521">{{cite journal |vauthors=Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E |title=Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis |journal=J. Viral Hepat. |volume=19 |issue=2 |pages=e212–9 |year=2012 |pmid=22239521 |doi=10.1111/j.1365-2893.2011.01537.x |url=}}</ref><ref name="pmid18395077">{{cite journal |vauthors=Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E |title=Performance of transient elastography for the staging of liver fibrosis: a meta-analysis |journal=Gastroenterology |volume=134 |issue=4 |pages=960–74 |year=2008 |pmid=18395077 |doi=10.1053/j.gastro.2008.01.034 |url=}}</ref><ref name="pmid15690481">{{cite journal |vauthors=Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M |title=Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C |journal=Hepatology |volume=41 |issue=1 |pages=48–54 |year=2005 |pmid=15690481 |doi=10.1002/hep.20506 |url=}}</ref><ref name="pmid14698338">{{cite journal |vauthors=Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R |title=Transient elastography: a new noninvasive method for assessment of hepatic fibrosis |journal=Ultrasound Med Biol |volume=29 |issue=12 |pages=1705–13 |year=2003 |pmid=14698338 |doi= |url=}}</ref><ref name="pmid23558397">{{cite journal |vauthors=Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F |title=EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology |journal=Ultraschall Med |volume=34 |issue=2 |pages=169–84 |year=2013 |pmid=23558397 |doi=10.1055/s-0033-1335205 |url=}}</ref><ref name="pmid25911335">{{cite journal |vauthors= |title=EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis |journal=J. Hepatol. |volume=63 |issue=1 |pages=237–64 |year=2015 |pmid=25911335 |doi=10.1016/j.jhep.2015.04.006 |url=}}</ref><ref name="pmid21205132">{{cite journal |vauthors=Castera L, Bedossa P |title=How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy? |journal=Liver Int. |volume=31 Suppl 1 |issue= |pages=13–7 |year=2011 |pmid=21205132 |doi=10.1111/j.1478-3231.2010.02380.x |url=}}</ref><ref name="pmid23732714">{{cite journal |vauthors=Chou R, Wasson N |title=Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review |journal=Ann. Intern. Med. |volume=158 |issue=11 |pages=807–20 |year=2013 |pmid=23732714 |doi=10.7326/0003-4819-158-11-201306040-00005 |url=}}</ref><ref name="pmid26779260">{{cite journal |vauthors=Khallafi H, Qureshi K |title=Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach |journal=Interdiscip Perspect Infect Dis |volume=2015 |issue= |pages=809289 |year=2015 |pmid=26779260 |pmc=4686715 |doi=10.1155/2015/809289 |url=}}</ref><ref name="pmid23954643">{{cite journal |vauthors=Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA |title=Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=12 |pages=1573–84.e1–2; quiz e88–9 |year=2013 |pmid=23954643 |pmc=3900882 |doi=10.1016/j.cgh.2013.07.034 |url=}}</ref> 
*The FibroScan (transient elastography) uses elastic waves to determine [[liver]] stiffness which theoretically may be converted into a liver score.
*The FibroScan (transient elastography) uses elastic waves to determine [[liver]] stiffness which theoretically may be converted into a liver score.
*The FibroScan produces an ultrasound image of the [[liver]] (from 20-80mm) along with a pressure reading (in kPa).
*The FibroScan produces an [[ultrasound]] image of the [[liver]] (from 20-80mm) along with a pressure reading (in kPa).
*Transient [[elastography]] is much faster than a [[biopsy]] (usually lasts 2.5-5 minutes) and is completely painless.
*Transient [[elastography]] is much faster than a [[biopsy]] (usually lasts 2.5-5 minutes) and is completely painless.
*Findings on transient [[elastography]] may show reasonable correlation with the severity of cirrhosis:<ref>{{cite journal |author=Foucher J, Chanteloup E, Vergniol J, ''et al'' |title=Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study |journal=Gut |volume=55|issue=3 |pages=403-8 |year=2006 |pmid=16020491 |doi=10.1136/gut.2005.069153}}</ref><ref name="pmid22733854">{{cite journal |author=Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X |title=Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B |journal=[[Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine]] |volume=31 |issue=7 |pages=1053–60 |year=2012|pmid=22733854 |doi= |url=}}</ref>
*Findings on transient [[elastography]] may show reasonable correlation with the severity of cirrhosis:<ref>{{cite journal |author=Foucher J, Chanteloup E, Vergniol J, ''et al'' |title=Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study |journal=Gut |volume=55|issue=3 |pages=403-8 |year=2006 |pmid=16020491 |doi=10.1136/gut.2005.069153}}</ref><ref name="pmid22733854">{{cite journal |author=Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X |title=Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B |journal=[[Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine]] |volume=31 |issue=7 |pages=1053–60 |year=2012|pmid=22733854 |doi= |url=}}</ref>
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| style="background:#DCDCDC; + " | '''Portal vein thrombosis'''
| style="background:#DCDCDC; + " | '''Portal vein thrombosis'''
|
|
* Symptoms depend on the underlying cause:
* [[Symptoms]] depend on the underlying cause:
* If pancreatitis is present, the patient may develop:
* If [[pancreatitis]] is present, the patient may develop:
** Upper [[abdominal pain]] radiating to the back
** Upper [[abdominal pain]] radiating to the back
** Vomiting
** Vomiting
Line 109: Line 109:
** [[Cullen's sign]]  
** [[Cullen's sign]]  
** [[Grey-Turner's sign]]
** [[Grey-Turner's sign]]
* If the cause is [[ascending cholangitis]], symptoms include:
* If the cause is [[ascending cholangitis]], [[symptoms]] include:
** Fever  
** [[Fever]]
** [[rigors]]
** [[Rigors]]
** Right upper quadrant pain
** [[Right upper quadrant (abdomen)|Right upper quadrant]] [[pain]]
** Dark urine  
** Dark [[urine]]
** Pale stools  
** Pale [[stools]]
* If abdominal sepsis is the cause, symptoms include:
* If [[abdominal]] [[sepsis]] is the cause, [[symptoms]] include:
* [[fever]]
* [[Fever]]
* [[abdominal pain]]  
* [[Abdominal pain]]  
* Signs of [[peritonitis]]
* [[Medical sign|Signs]] of [[peritonitis]]
|
|
* [[Doppler ultrasound]] and abdominal CT show a [[portal vein]] filling defect and absence of flow in the [[portal vein]].  
* [[Doppler ultrasound]] and [[abdominal]] [[Computed tomography|CT scan]] show a [[portal vein]] filling defect and absence of flow in the [[portal vein]].  
* MR or direct [[Angiogram|angiography]] show a normal [[Hepatic vein|hepatic venous]] pressure gradient.
* MR or direct [[Angiogram|angiography]] show a normal [[Hepatic vein|hepatic venous]] pressure gradient.
|-
|-
| style="background:#DCDCDC; + " | '''Schistosomiasis'''
| style="background:#DCDCDC; + " | '''Schistosomiasis'''
|
|
* Patients may have a history of travel to endemic areas
* Patients may have a history of travel to [[endemic]] areas
* Constitutional symptoms such as
* Constitutional [[symptoms]] such as
** Malaise
** [[Malaise]]
** [[rigors]]
** [[Rigors]]
** [[anorexia]]
** [[Anorexia]]
** [[weight loss]]
** [[Weight loss]]
** [[vomiting]]
** [[Vomiting]]
** D[[diarrhea|iarrhea]]
** [[diarrhea|Diarrhea]]
** [[headache]]
** [[Headache]]
** Muscular aches  
** [[Muscular aches]]
** [[weakness]]
** [[Weakness]]
** [[abdominal pain]]
** [[Abdominal pain]]
** [[urticaria]]
** [[Urticaria]]
** [[fever]]
** [[Fever]]
** [[lymphadenopathy]]  
** [[Lymphadenopathy]]  
|
|
* MR or direct [[Angiogram|angiography]] shows a normal [[Hepatic vein|hepatic venous]] pressure gradient
* MR or direct [[Angiogram|angiography]] shows a normal [[Hepatic vein|hepatic venous]] pressure gradient
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| style="background:#DCDCDC; + " | '''Sarcoidosis'''
| style="background:#DCDCDC; + " | '''Sarcoidosis'''
|
|
* Dry cough with [[dyspnea]]
* [[Dry cough]] with [[dyspnea]]
* Anterior or posterior [[uveitis]]
* Anterior or posterior [[uveitis]]
* [[dry eyes]]  
* [[Dry eyes]]  
* [[glaucoma]]
* [[glaucoma]]
* Skin findings may include:
* [[Skin]] findings may include:
** Maculopapular lesions on the face, back, arms and legs  
** [[Maculopapular]] lesions on the [[face]], [[back]], arms and [[legs]]
** [[erythema nodosum]] on the legs
** [[Erythema nodosum]] on the legs
|
|
* Chest x ray may show:
* Chest x ray may show:
** [[hilar lymphadenopathy]]
** [[Hilar lymphadenopathy]]
** Upper lobe [[fibrosis]]
** Upper lobe [[fibrosis]]
** Diffuse reticulonodular shadowing  
** Diffuse reticulonodular shadowing  
** [[Liver biopsy]] shows non-necrotizing, non-caseating [[Granuloma|granulomas]]
** [[Liver biopsy]] shows non-[[necrotizing]], non-caseating [[Granuloma|granulomas]]
|-
|-
| style="background:#DCDCDC; + " | '''Inferior vena cava obstruction'''
| style="background:#DCDCDC; + " | '''Inferior vena cava obstruction'''
|
|
* Signs and symptoms of [[renal cell carcinoma]]:  
* Signs and symptoms of [[renal cell carcinoma]]:  
* Hematuria
* [[Hematuria]]
* [[flank pain]]
* [[Flank pain]]
* Flank or abdominal mass  
* [[Flank]] or [[abdominal]] mass  
* Weight loss
* [[Weight loss]]
* [[hypertension]]
* [[Hypertension]]
|
|
* [[Ultrasound]] of the abdomen shows evidence of [[inferior vena cava]] obstruction
* [[Ultrasound]] of the abdomen shows evidence of [[inferior vena cava]] obstruction
Line 202: Line 202:
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Family history
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Family history
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Right upper quadrant (RUQ) Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |AST
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Aspartate aminotransferase (AST)
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Alanine aminotransferase (ALT)
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Bilirubin (Indirect)
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Bilirubin (Direct)
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology
|-
|-
! rowspan="34" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! rowspan="34" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! colspan="1" rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatocellular Jaundice
! colspan="1" rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatocellular Jaundice
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Liver infiltration: Hemochromatosis, amyloidosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Liver infiltration: [[Hemochromatosis]], [[amyloidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 224: Line 224:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ferritin ↑ in hemochromatosis  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ferritin]] ↑ in [[hemochromatosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Wilson's disease
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Wilson's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 238: Line 238:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Serum cerulloplasmin ↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Serum]] [[ceruloplasmin]] ↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Viral hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Viral hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 252: Line 252:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Specific viral antibody for each type
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Specific [[viral]] [[antibody]] for each type
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Alcoholic hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Alcoholic hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 269: Line 269:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Drug induced hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Drug induced [[hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 283: Line 283:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Autoimmune hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Autoimmune hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 294: Line 294:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-LKM antibody
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-LKM antibody]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cirrhosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cirrhosis
Line 308: Line 308:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low platate
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low [[platelet]] count
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small liver on ultrasond
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small [[liver]] on [[ultrasound]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Nonalcoholic steatohepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Nonalcoholic steatohepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 322: Line 322:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |High lipids
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |High [[lipids]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic hepatopathy
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic]] [[hepatopathy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 336: Line 336:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Cardiovascular risk factors
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cardiovascular]] [[risk factors]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical setting  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical setting  
|-
|-
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cholestatic Jaundice
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cholestatic Jaundice
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Common bile duct]] stone
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 351: Line 351:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on sono
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on [[sonography]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Computed tomography|CT scan]]/[[Endoscopic retrograde cholangiopancreatography|ERCP]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis A]] (cholestatic type)
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 365: Line 365:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-[[Hepatitis A|HAV]] [[antibody]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Abdominal]] [[ultrasound]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Epstein Barr virus|EBV]] / [[CMV]] [[hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 379: Line 379:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive [[serology]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary biliary cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 393: Line 393:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-mitochondrial antibody|Antimitochondrial antibody]] ([[Anti-mitochondrial antibody|AMA]]) positive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary sclerosing cholangitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 407: Line 407:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pos. autoantibodies  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive [[autoantibodies]] ([[p-ANCA]])
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP,
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on [[Magnetic resonance cholangiopancreatography|MRCP]],
Liver biopsy
[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Sickle cell disease
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sickle cell disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 422: Line 422:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreatic carcinoma
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 436: Line 436:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT scan for diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Computed tomography|CT scan]] for diagnosis
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |AIDS cholangiopathy
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[AIDS]] cholangiopathy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 449: Line 449:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pos. HIV
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive [[HIV]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Sono or ERCP for diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Sonography]] or ERCP for diagnosis
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Parasites induces cholestasis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Parasites|Parasite]] induces [[cholestasis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 463: Line 463:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ab or parasite serology
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antibodies]] or [[Parasites|parasite]] serology
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Sono or ERCP for diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Sonography]] or [[ERCP]] for diagnosis
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intrahepatic cholestasis of pregnancy
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intrahepatic [[cholestasis]] of [[pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 477: Line 477:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low PLT, Neg viral serology
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low [[platelets]], Negative [[viral]] [[serology]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diagnosed clinically
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diagnosed clinically
|-
|-
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Isolated Jaundice
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Isolated Jaundice
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Crigler-Najjar type 2
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Crigler-Najjar syndrome|Crigler-Najjar type 2]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 492: Line 492:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gilbert
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gilbert's syndrome|Gilbert syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 505: Line 505:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Rotor syndrome
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rotor syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 518: Line 518:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Dubin-Johnson syndrome
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Dubin-Johnson syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 532: Line 532:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hereditory spherocytosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hereditary spherocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 546: Line 546:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Osmotic fragility
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Osmotic fragility
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |G6PD deficiency
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Glucose-6-phosphate dehydrogenase deficiency|Glucose 6 phosphate dehydrogenase (G6PD) deficiency]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 560: Line 560:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Thalassemia
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Thalassemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 573: Line 573:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Genetic testing]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Paroxismal nocturnal hemoglobinoria
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Paroxysmal nocturnal hemoglobinuria]] ([[Paroxysmal nocturnal hemoglobinuria|PNH]])
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 586: Line 586:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Flocytometery
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Flow cytometery
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Immune hemolysis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Immune]] [[hemolysis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 599: Line 599:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Autoantibodies
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Autoantibodies]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hematoma
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hematoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 612: Line 612:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anemia
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Truma or surgery in history
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Trauma]] or [[surgery]] in history
|-
|-
|}
|}

Revision as of 16:19, 27 December 2017

Cirrhosis Microchapters

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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 in differentiating cirrhosis from other diseases such as malignancy, constrictive pericarditis, Budd-Chiari syndrome, portal vein thrombosis and splenic vein thrombosis.

Differentiating Cirrhosis From Other Diseases

Cirrhosis must be differentiated from other causes of abnormal liver function tests, altered liver architecture and size:

Condition Differentiating signs and symptoms Differentiating Tests
Cirrhosis

Ultrasound findings in cirrhosis are as follows:[1][2][3][4][5][6][7][8]

Abdominal MRI may also be helpful in the diagnosis of portal hypertension. Findings on MRI suggestive of cirrhosis with portal hypertension include:[9][10][11][12]

Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in various liver diseases: [13][14][15][16][17][18][19][20][21][22][23] 

  • The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score.
  • The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa).
  • Transient elastography is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless.
  • Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:[24][25]
Constrictive pericarditis
Budd-Chiari Syndrome
Splenic vein thrombosis Signs and symptoms of:
Portal vein thrombosis
Schistosomiasis
Sarcoidosis
Inferior vena cava obstruction
Nodular regenerative hyperplasia None
Idiopathic portal hypertension (hepatoportal sclerosis) None
Vitamin A intoxication, arsenic, and vinyl chloride toxicity None
  • History generally reveals exposure

Differential diagnosis of jaundice are: [26][27][28][29][30]

Classification of jaundice based on etiology Disease History and clinical manifestations Diagnosis
Lab Findings Other blood tests Other diagnostic
Family history Fever Right upper quadrant (RUQ) Pain Pruritis Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) ALK Bilirubin (Indirect) Bilirubin (Direct) Viral serology
Jaundice Hepatocellular Jaundice Liver infiltration: Hemochromatosis, amyloidosis + - -/+ - ↑ ↑ ↑/N ↑/N N - Ferritin ↑ in hemochromatosis Liver biopsy
Wilson's disease + - -/+ - ↑ ↑ N ↑/N N - Serum ceruloplasmin ↑ 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 platelet count Small liver on ultrasound
Nonalcoholic steatohepatitis -/+ - - - ↑ ↑ N ↑/N N - High lipids Liver biopsy
Ischemic hepatopathy -/+ - -/+ - ↑ ↑ N ↑/N N - Cardiovascular risk factors Clinical setting
Cholestatic Jaundice Common bile duct stone -/+ - + + N N ↑ N ↑ - Dilated ducts on sonography CT scan/ERCP
Hepatitis A (cholestatic type) - -/+ + + N N ↑ N ↑ + Anti-HAV antibody Abdominal ultrasound
EBV / CMV hepatitis - -/+ + + N N ↑ N ↑ + Positive serology -
Primary biliary cirrhosis -/+ - -/+ + N/↑ N/↑ ↑ N ↑ - Antimitochondrial antibody (AMA) positive Liver biopsy
Primary sclerosing cholangitis -/+ - -/+ + N/↑ N/↑ ↑ N ↑ - Positive autoantibodies (p-ANCA) Beading on MRCP,

Liver biopsy

Sickle cell disease + - - +/- N/↑ N/↑ ↑ N ↑ - Genetic testing
Pancreatic carcinoma + - -/+ -/+ N/↑ N/↑ ↑ N ↑ - - CT scan for diagnosis
AIDS cholangiopathy - - -/+ -/+ N/↑ N/↑ ↑ N ↑ - Positive HIV Sonography or ERCP for diagnosis
Parasite induces cholestasis - - -/+ -/+ N/↑ N/↑ ↑ N ↑ - Antibodies or parasite serology Sonography or ERCP for diagnosis
Intrahepatic cholestasis of pregnancy -/+ - -/+ + ↑ ↑ ↑ N ↑ - Low platelets, Negative viral serology Diagnosed clinically
Isolated Jaundice Crigler-Najjar type 2 + - - - N N N ↑ ↑ - Genetic testing
Gilbert syndrome + - - - 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
Hereditary spherocytosis + - -/+ - N N N ↑ N - Genetic testing Osmotic fragility
Glucose 6 phosphate dehydrogenase (G6PD) deficiency + - - - N N N ↑ N - Genetic testing
Thalassemia + - - - N N N ↑ N - Genetic testing
Paroxysmal nocturnal hemoglobinuria (PNH) - - - - N N N ↑ N - Flow cytometery
Immune hemolysis - -/+ - - N N N ↑ N - Autoantibodies
Hematoma - -/+ - - N N N ↑ N - Anemia Trauma or surgery in history

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

  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.
  2. ↑ Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.
  3. ↑ Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989). "Cirrhosis: diagnosis with sonographic study of the liver surface". Radiology. 172 (2): 389–92. doi:10.1148/radiology.172.2.2526349. PMID 2526349.
  4. ↑ Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW (1985). "Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?". Gastroenterology. 89 (1): 186–91. PMID 3891495.
  5. ↑ Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G (1986). "Cirrhosis: value of caudate to right lobe ratio in diagnosis with US". Radiology. 161 (2): 443–5. doi:10.1148/radiology.161.2.3532188. PMID 3532188.
  6. ↑ Simonovský V (1999). "The diagnosis of cirrhosis by high resolution ultrasound of the liver surface". Br J Radiol. 72 (853): 29–34. doi:10.1259/bjr.72.853.10341686. PMID 10341686.
  7. ↑ Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S (2011). "Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities". Hepatology. 54 (6): 1987–97. doi:10.1002/hep.24545. PMID 22144108.
  8. ↑ "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma". J. Hepatol. 56 (4): 908–43. 2012. doi:10.1016/j.jhep.2011.12.001. PMID 22424438.
  9. ↑ Procopet, Bogdan; Berzigotti, Annalisa (2017). "Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy". Gastroenterology Report. 5 (2): 79–89. doi:10.1093/gastro/gox012. ISSN 2052-0034.
  10. ↑ Aagaard, J; Jensen, LI; Sorensen, TI; Christensen, U; Burcharth, F (1982). "Recanalized umbilical vein in portal hypertension". American Journal of Roentgenology. 139 (6): 1107–1110. doi:10.2214/ajr.139.6.1107. ISSN 0361-803X.
  11. ↑ Cho, K C; Patel, Y D; Wachsberg, R H; Seeff, J (1995). "Varices in portal hypertension: evaluation with CT". RadioGraphics. 15 (3): 609–622. doi:10.1148/radiographics.15.3.7624566. ISSN 0271-5333.
  12. ↑ Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam (2017). "Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy". World Journal of Gastroenterology. 23 (10): 1735. doi:10.3748/wjg.v23.i10.1735. ISSN 1007-9327.
  13. ↑ Castera L, Pinzani M (2010). "Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?". Gut. 59 (7): 861–6. doi:10.1136/gut.2010.214650. PMID 20581229.
  14. ↑ Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E (2012). "Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis". J. Viral Hepat. 19 (2): e212–9. doi:10.1111/j.1365-2893.2011.01537.x. PMID 22239521.
  15. ↑ Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E (2008). "Performance of transient elastography for the staging of liver fibrosis: a meta-analysis". Gastroenterology. 134 (4): 960–74. doi:10.1053/j.gastro.2008.01.034. PMID 18395077.
  16. ↑ Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M (2005). "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C". Hepatology. 41 (1): 48–54. doi:10.1002/hep.20506. PMID 15690481.
  17. ↑ Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R (2003). "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis". Ultrasound Med Biol. 29 (12): 1705–13. PMID 14698338.
  18. ↑ Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F (2013). "EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology". Ultraschall Med. 34 (2): 169–84. doi:10.1055/s-0033-1335205. PMID 23558397.
  19. ↑ "EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis". J. Hepatol. 63 (1): 237–64. 2015. doi:10.1016/j.jhep.2015.04.006. PMID 25911335.
  20. ↑ Castera L, Bedossa P (2011). "How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy?". Liver Int. 31 Suppl 1: 13–7. doi:10.1111/j.1478-3231.2010.02380.x. PMID 21205132.
  21. ↑ Chou R, Wasson N (2013). "Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review". Ann. Intern. Med. 158 (11): 807–20. doi:10.7326/0003-4819-158-11-201306040-00005. PMID 23732714.
  22. ↑ Khallafi H, Qureshi K (2015). "Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach". Interdiscip Perspect Infect Dis. 2015: 809289. doi:10.1155/2015/809289. PMC 4686715. PMID 26779260.
  23. ↑ Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA (2013). "Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 11 (12): 1573–84.e1–2, quiz e88–9. doi:10.1016/j.cgh.2013.07.034. PMC 3900882. PMID 23954643.
  24. ↑ Foucher J, Chanteloup E, Vergniol J; et al. (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut. 55 (3): 403–8. doi:10.1136/gut.2005.069153. PMID 16020491.
  25. ↑ Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X (2012). "Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B". Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 31 (7): 1053–60. PMID 22733854.
  26. ↑ 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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  28. ↑ Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.
  29. ↑ Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.
  30. ↑ Malakouti M, Kataria A, Ali SK, Schenker S (2017). "Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?". J Clin Transl Hepatol. 5 (4): 394–403. doi:10.14218/JCTH.2017.00027. PMC 5719197. PMID 29226106.

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