Diagnosis of Primary biliary cirrhosis
Diagnostic Test list for Primary biliary cirrhosis:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Primary biliary cirrhosis
includes:
Primary biliary cirrhosis Diagnosis: Book Excerpts
Tests and diagnosis discussion for Primary biliary cirrhosis:
Primary biliary cirrhosis is diagnosed through laboratory tests,
x-rays, and in some cases, a liver biopsy (a simple operation to remove a
small piece of liver tissue).
(Source: excerpt from Primary Biliary Cirrhosis: NIDDK)
Diagnosis of Primary biliary cirrhosis: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Primary biliary cirrhosis:
Diagnostic Tests for Primary biliary cirrhosis: Online Medical Books
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for more information about diagnostis of Primary biliary cirrhosis.
ASCITES:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there associated dyspnea? If there is associated dyspnea, one should look for congestive heart failure, pulmonary emphysema, and other cardiopulmonary conditions.
- Is there hepatomegaly? If there is associated hepatomegaly, certainly cirrhosis of the liver has to top the list of possibilities, but additional causes of ascites with hepatomegaly are constrictive pericarditis, the cardiomyopathies, Budd-Chiari syndrome, metastatic carcinoma, and hydatid cyst.
- Is there edema of the lower extremities or significant proteinuria? Edema in the lower extremities along with significant proteinuria certainly suggests a nephrotic syndrome, whether it is due to glomerulonephritis, diabetes, or a collagen disease. It also suggests end-stage nephritis. If there is no significant proteinuria, then a primary peritoneal condition such as tuberculous peritonitis or peritoneal carcinomatosis must be considered. Remember, a large ovarian cyst can simulate ascites.
- Is there a history of a primary tumor elsewhere? GI tumors may spread to the peritoneal surface and cause ascites, but a malignant melanoma may do the same thing.
DIAGNOSTIC WORKUP
Ultrasonography may help confirm the presence of ascites and differentiate it from other conditions such as pregnancy or ovarian cysts. A peritoneal tap with analysis of the fluid to determine whether it is a transudate or exudate and cell block studies as well as amylase, culture and sensitivity should be done; an elevated amylase indicates pancreatic disease. A CBC, chemistry panel, urinalysis, and sedimentation rate need to be done in all cases, and the urinary sediment should be examined under the microscope.
To rule out congestive heart failure, venous pressure and circulation time, EKG, pulmonary function studies, echocardiography, and chest x-ray should be done. To rule out pulmonary emphysema, pulmonary function studies and chest x-rays should be done. To rule out liver disease, a liver profile may be done along with a serum protein electrophoresis and a CT scan of the liver. A tuberculin test can be done to rule out tuberculous peritonitis, but the ascitic fluids should be studied with an
AFB
smear and culture. Guinea pig inoculation is sometimes necessary for a positive diagnosis. Laparoscopy is useful in differentiating peritoneal carcinomatosis from tuberculous peritonitis. A CT scan of the abdomen should be done to determine if there is peritoneal carcinomatosis or a primary malignancy of the GI tract and other structures in the abdomen. An upper GI series and barium enema may need to be done. Also, colonoscopy and gastroscopy may need to be done.
As the diagnostic tests become more expensive, the clinician should consider a referral to a gastroenterologist, nephrologist, or hepatologist before proceeding.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Ascites:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Hepatic, resulting in portal hypertension
–Hepatic cirrhosis: Extrahepatic biliary atresia, α-1-antitrypsin deficiency,
galactosemia, tyrosinemia
–Portal vein thrombosis
–Cavernous transformation: Catheterization,
dehydration, clotting disorder, omphalitis
–Budd-Chiari syndrome, due to neoplasm,
collagen disease, hypercoagulopathy, OCP
–Arteriovenous fistula
–Fulminant hepatic failure (drugs, virus)
–Congenital hepatic fibrosis
–Lysosomal storage diseases (e.g., Gaucher)
-
Bile ascites (bile peritonitis): Spontaneous rupture of the common bile duct
-
Renal
–Nephrotic syndrome
–Urinary ascites (due to bladder rupture)
–Obstructive uropathy: Congenital ascites may
be seen with bilateral hydronephrosis
-
Peritoneal dialysis
-
Cardiac
–Congestive heart failure
–Chronic constrictive pericarditis
–Inferior vena cava web
–Erythroblastosis fetalis
-
Peritonitis
–Tuberculous peritonitis
–Schistosomiasis (Mansoni)
–Tularemia
–Abscess
-
Gastrointestinal disorders
–Infarcted bowel
–Bowel perforation
–Pancreatitis, ruptured pancreatic duct
–Protein-losing gastroenteropathy
-
Chylous ascites
–Collection of lymph within the abdominal cavity; secondary to lymphatic obstruction from trauma, surgery, tumor, tuberculosis, or filariasis
-
Gynecologic
–Ovarian tumors, cyst torsion or rupture
-
Malignancy
–Leukemia, lymphoma, neuroblastoma
-
Systemic lupus erythromatosus
-
Ventriculoperitoneal shunt
-
Hypothyroidism
Workup and Diagnosis
- History and physical exam
–Clinical hallmark of ascites is abdominal distension
–Five classic signs of ascites: Flank bulging, flank dullness, shifting dullness, fluid wave, puddle sign
–Only appreciated when there is considerable fluid
–Respiratory distress may develop with tense ascites
–Umbilical herniation can be seen with large ascites
–Peripheral edema or anasarca may accompany severe
hypoalbuminemia
-
Urinalysis and urine electrolytes (for proteinuria)
-
CBC with diff (lymphopenia in lymphatic obstruction)
-
-
-
Serum electrolytes (for sodium management)
-
True liver function tests
–Examines the synthetic function of the liver
–Serum albumin, vitamin K, and coagulation factors
-
Abdominal ultrasound detects small volume of ascites
-
-
-
KUB may show centrally floating intestines
- Paracentesis: Milky fluid indicates chylous ascites, fluid analysis will reveal elevated protein and triglycerides and lymphocytosis (fluid serous in a fasting patient)
–Bile may indicate perforation of common bile duct
–High creatinine: Seen with bladder rupture
–Ascitic fluid analysis for cell count, cytology, protein,
LDH, amylase, lipase, creatinine, pH, culture, Gram stain, bile, lipids, and sudan red staining for fat
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Cirrhosis and fibrosis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS Liver biopsy, the definitive test for cirrhosis, detects destruction and fibrosis of hepatic tissue.
Liver scan shows abnormal thickening and a liver mass. Cholecystography and cholangiography visualize the gallbladder and the biliary duct system, respectively; splenoportal venography visualizes the portal venous system. Percutaneous trans-hepatic cholangiography differentiates extrahepatic from intrahepatic obstructive jaundice and discloses hepatic pathology and the presence of gallstones.
Laboratory findings that are characteristic of cirrhosis include:
❑ decreased white blood cell count, hemoglobin level and hematocrit, albumin, serum electrolyte levels (sodium, potassium, chloride, and magnesium), and cholinesterase
❑ elevated levels of globulin, serum ammonia, total bilirubin, alkaline phosphatase, serum aspartate aminotransferase, serum alanine aminotransferase, and lactate dehydrogenase and increased thymol turbidity
❑ anemia, neutropenia, and thrombocytopenia, characterized by prolonged prothrombin and partial thromboplastin times
❑ deficiencies of folic acid, iron, and vitamins A, B12, C, and K.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Ascites:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Does the patient use alcohol or drugs? Alcoholic hepatitis is the most common cause of cirrhosis and ascites. Intravenous drug use places the patient at risk for ascites from either acute or chronic viral hepatitis (hepatitis B and C).
B. Is the patient at risk for sexually transmitted diseases? Hepatitis B is commonly acquired sexually, therefore a complete sexual history is mandatory.
C. Is the patient otherwise at risk for acquiring hepatitis? Other individuals at risk include hemodialysis patients, recipients of organ transplantations, close contacts of persons with hepatitis, members of high-risk populations (Asia, the South Pacific, sub-Saharan Africa), recipients of blood or blood products, individuals with tattoos, prior acupuncture or ear piercing, and needlestick victims.
D. Does the patient have signs of fluid retention? Ask about increased abdominal girth, weight gain, leg edema, penile or scrotal edema, and umbilical herniation (Chapter 2.3).
E. Are there any secondary symptoms to suggest fluid retention? Increased abdominal fluid leads to vague complaints of nausea, anorexia, early satiety, heartburn, abdominal pain, shortness of breath, or orthopnea.
F. Is there a suspicion of infection? Of patients admitted with ascites, 10% to 27% have spontaneous bacterial peritonitis (SBP); 48% to 57% of these patients will die (4). Ask about fever, abdominal pain, or mental status changes (encephalopathy) (Chapters 2.6, 3.2, and 9.1).
G. Is there a past history of heart failure, cancer, or tuberculosis? These are included in the 20% of nonhepatic causes of ascites.
Physical examination
Obtain vital signs (temperature, respiratory rate, blood pressure, and weight). Ascites is rarely the sole physical finding. Examine for evidence of liver disease (jaundice, spider angiomata, Dupuytren’s contracture, caput medusae); hepatomegaly may be absent if chronic cirrhosis exists. Examine the skin for evidence of intravenous (IV) drug use, tattoos, and pigment changes (hemochromatosis). Jugular venous distention, a third heart sound, pulmonary crackles, and peripheral edema suggest heart failure. Abdominal tenderness can reflect pancreatitis or infection. Tests for ascites include shifting dullness, bulging flanks, flank dullness, fluid wave, and the “puddle” sign (i.e., percussing the abdomen with the patient on hands and knees). The reliability of these tests are unpredictable (2). These techniques are not helpful when a small volume ( <1,000 ml) of ascites exists; 1,500 ml of fluid must be present before shifting dullness is detected. The “puddle” sign is no longer considered valuable because of its low sensitivity and patient discomfort (2,5).
>
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Cirrhosis:
Diagnosis
(Handbook of Diseases)
A liver biopsy, the definitive test for cirrhosis, detects destruction and fibrosis of hepatic tissue. A liver scan shows abnormal thickening and, possibly, a liver mass.
Plain films of the abdomen may reveal hepatic or splenic enlargement. Ultrasonography can aid in the assessment of liver size and the detection of ascites or hepatic enlargement. Doppler ultrasonography is used to evaluate patency of the splenic, portal, and hepatic veins. Computed tomography with I.V. contrast or magnetic resonance imaging with serum alpha-fetoprotein levels can help with further assessment of liver nodules. A biopsy of suspicious liver nodules or masses can be performed to check for cancer. Esophagogastroscopy can be used to detect causes of bleeding in the esophagus, stomach, and proximal duodenum and confirm the presence of varices.
The following laboratory findings are characteristic of cirrhosis:
❑ decreased platelet count, decreased hematocrit, and decreased levels of hemoglobin, albumin, electrolytes (sodium, potassium, chloride, and magnesium), and folate
❑ elevated levels of globulin, serum ammonia, total bilirubin, alkaline phosphatase, serum aspartate aminotransferase, serum alanine aminotransferase, and lactate dehydrogenase
❑ increased thymol turbidity
❑ coagulation abnormalities characterized by prolonged prothrombin and partial thromboplastin times.
Clinical tip The best indications of hepatic function are prothrombin time and cholesterol and albumin levels.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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