Diagnostic Tests for Primary biliary cirrhosis
Primary biliary cirrhosis: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Primary biliary cirrhosis
includes:
Primary biliary cirrhosis Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Primary biliary cirrhosis:
- Liver Health & Hepatitis: Home Testing
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 of Primary biliary cirrhosis:
Diagnostic Tests for Primary biliary cirrhosis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Primary biliary cirrhosis.
ASCITES:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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).
Testing
A. Diagnostic paracentesis should be performed to determine the nature of the ascitic fluid and to evaluate for the presence of SBP.
B. An ascitic fluid polymorphonuclear leukocyte count of more than 250 cells/mm3 indicates infection (SBP) and the patient should be empirically treated as such.
C. If a culture is obtained, 10 ml of ascitic fluid should be injected into blood culture bottles at the bedside to increase sensitivity (1,4).
D. The serum-ascites albumin gradient (SAAG) is the difference between the serum albumin concentration and the ascitic fluid albumin concentration. This gradient is 97% accurate in determining the underlying mechanism of ascites and replaces the former classification of ascitic fluid as either a transudate or an exudate (1). An SAAG of more than 1.1 g/dl indicates the patient has portal hypertension (seen with diagnoses such as cirrhosis, heart failure, alcoholic hepatitis, massive metastatic liver disease, or Budd-Chiari syndrome) (4). An SAAG of less than 1.1 g/dl indicates the patient does not have portal hypertension and a process such as peritoneal carcinomatosis, tuberculous peritonitis, pancreatic ascites, serositis from connective tissue diseases, nephrotic syndrome, or biliary ascites may be present (1,4).
E. Cytology, smear, and culture for mycobacteria are expensive and have very low yields. They should only be ordered if there is a very high pretest probability.
F. Other tests that can be ordered include amylase (pancreatic ascites), triglycerides (chylous ascites), and lactate dehydrogenase and glucose (secondary peritonitis) (4).
G. Ultrasonography can detect as little as 100 ml of fluid in the abdomen (3). It is useful both for confirming the presence of ascites and in guiding diagnostic paracentesis.
Diagnostic assessment
If ascites is suspected on history and physical examination, a diagnostic paracentesis should be performed. Basic orders include a cell count and differential and albumin concentration (ascitic and serum). The SAAG should be calculated. Culture and other optional tests should be performed, based on clinical suspicion. If the diagnosis is uncertain because of a low volume of ascites, an ultrasound should be performed to guide a diagnostic paracentesis. If the patient is having significant symptoms or tense ascites, a therapeutic large-volume paracentesis should be performed and the fluid analyzed as above. Complications of paracentesis have been reported in approximately 1% of patients (i.e., abdominal wall hematomas), including those with an underlying coagulopathy (1).
A. Indications for hospitalization (5) or referral include:
1. Worsening ascites despite initial management attempts
2. Tense ascites
3. Systemic signs or symptoms (liver failure, renal failure, encephalopathy, pancreatitis, gastrointestinal bleeding)
4. Suspicion of infection (SBP)
5. Patient noncompliant with medical management
References
1. Runyon BA. Management of adult patients with ascites caused by cirrhosis. AASLD practice guidelines. Hepatology 1998;27(1):264–272.
2. Cattau EL, Benjamin SB, Knuff TE, Castell DO. The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA 1982;247:1164.
3. Goldberg BB, Goodman GA, Clearfield HR. Evaluation of ascites by ultrasound. Radiology 1970;96:15–22.
4. Habeeb KS, Herrera JL. Management of ascites. Paracentesis as a guide. Postgrad Med 1997;101(1):191–200.
5. Lipsky MS, Sternbach MR. Evaluation and initial management of patients with ascites. Am Fam Physician 1996;54(4):1327–1333.>>>
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Most people know that alcohol abuse can cause liver damage. But what exactly does alcohol do to your liver? And how much alcohol puts you at risk?...
Hepatitis B is a viral infection of the liver often spread through sexual contact. But people are usually unaware they carry the virus. Find out if...
Hepatitis C is called a silent epidemic because many people are unaware they carry this virus of the liver. But experts say hepatitis C is a public...
Many people with viral hepatitis don't know they are infected. Listen as experts discuss who should be tested and review the causes, prevention...
See full list of 5 related videos
» Next page: Diagnosis of Primary biliary cirrhosis
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
