Page 4 - 06- Cirrhosis of the Liver

hyperkalemia, and hyponatremia
Hepatorenal syndrome characterized by creatinine clearance < 40 mL/min (or serum Cr > 1.5)
with urine volume < 500 mL/day and urine sodium < 10 mEq/L.
Abdominal ultrasound q6–12mo to screen for hepatocellular carcinoma (HCC)
Doppler ultrasound or elastography to assess liver parenchyma and Doppler for hepatic/portal
vein

Follow-Up Tests & Special Considerations
Consider:
Hepatitis serologies
Serum ethanol and GGT if alcohol abuse suspected
Antimitochondrial antibody to screen for primary biliary cirrhosis
Antismooth muscle and antinuclear antibodies to screen for chronic active (autoimmune)
hepatitis
Transferrin saturation (>50%) and ferritin (markedly increased) to screen for
hemochromatosis; if abnormal, check hemochromatosis (HFE) genetics/mutation analysis.
α -Antitrypsin phenotype screen
1
Ceruloplasmin to screen for Wilson disease; if low, check copper excretion (serum copper plus
24-hour urine copper).
α-Fetoprotein level to screen for HCC
Diagnostic Procedures/Other
Liver biopsy: required for definitive diagnosis, percutaneous if INR <1.5 and no ascites;
otherwise, transjugular; serologic testing gaining use as a surrogate for biopsy
Ultrasound-based elastography: noninvasive alternative to liver biopsy, increasing availability;
evaluates fibrosis
Endoscopy if esophageal varices/portal hypertensive gastropathy are a concern
Magnetic resonance elastography: most accurate noninvasive method in obese and/or
nonalcoholic fatty liver disease (NAFLD) (1)[A]

Test Interpretation
Fibrous bands and regenerative nodules are classic biopsy features of cirrhosis. Other histologic
patterns:
Alcoholic liver disease: steatosis, polymorphonuclear (PMN) leukocyte infiltrate, ballooning
degeneration of hepatocytes, Mallory bodies, giant mitochondria
HBV/HCV: periportal lymphocytic inflammation
NASH: same as alcoholic liver disease; steatosis may “burn-out” in advanced disease.
Biliary cirrhosis: PMN infiltrate in wall of bile ducts, inflammation increased in portal spaces,
progressive loss of bile ducts in portal spaces
Hemochromatosis: intrahepatic iron stores increased via iron stain or weighted biopsy tissue
α -Antitrypsin deficiency: positive periodic acid–Schiff bodies in hepatocytes
1

TREATMENT

Outpatient care except for major gastrointestinal (GI) bleeding, altered mental status,
sepsis/infection, rapid hepatic decompensation, or renal failure