Diagnosi Differenziale Della Cirrosi Epatica | 99856848.com

Cirrosi epatica, diagnosi differenziale Edema o ascite dovuto altre cause, ad esempio, insufficienza cardiaca congestizia CHF, sindrome nefrosica, mixedema Epatomegalia dovuta ad altre cause, ad esempio, epatite, carcinoma epatocellulare Encefalopatia dovuta ad altre causa, per esempio. La cirrosi epatica può essere secondaria ad alcolismo, pregressa epatite, morbo di Wilson, cirrosi biliare primaria e secondaria ed emocromatosi. Un’anamnesi di TB deve far sospettare una localizzazione secondaria addominale. Guida pratica alla diagnosi differenziale.

Diagnosi differenziale della cirrosi epatica. Da quali malattie è necessario distinguere la cirrosi del fegato? Prima di tutto, è il cancro. Per la diagnosi vengono utilizzati i dati di ultrasuoni, laparoscopia e biopsia. Quest'ultimo metodo consente di distinguere la cirrosi del fegato in modo più accurato. CIRROSI EPATICA 28/06/17 Pagina 2 Cirrosi epatica l Tra le cause di morte principale non solo in Giappone ma anche nei paesi europei l Rappresenta la tappa terminale e comune di un danno epatico cronico di diversa origine. • Fibrosi e sovvertimento strutturale distruzione epatociti e deposizione di collagene • Ipertensione portale con shunts. Lo studio morfologico della biopsia epatica è considerato un "gold standard" per la diagnosi della cirrosi epatica. La piccola tuberosità è caratteristica della cirrosi biliare, i grandi nodi indicano cirrosi post-epatite o altre cause. La diagnosi differenziale è posta con i linfonodi metastatici in HCC ed i tumori delle vie biliari. Altro reperto riscontrabile nelle epatopatie croniche è l’ipertrofia del processo papillare del lobo caudato segnalato che simula una linfoadenopatia periilare ma che rappresenta un ponte parenchimale che si congiunge al lobo caudato. La cirrosi epatica è una patologia cronica che nel corso degli anni porta a una forma più grave: la cirrosi epatica scompensata, caratterizzata da una compromissione morfologica e funzionale del fegato e dal coinvolgimento sistemico dell’organismo. Cirrosi epatica scompensata: cause. Le principali cause della malattia derivano da.

CIRROSI:CIRROSI EPATICA,Terapia cirrosi epatica, sintomi cirrosi epatica, terapia cirrosi epatica, sintomi cirrosi epatiche, complicanze della cirrosi epatica,Colangiopancreatografia retrograda, Diagnosi Cirrosi epatica, Cirrosi biliare primitiva, Encefalopatia epatica, Sindrome epatorenale, Peritonite Batterica Spontanea PBS, Ascite. Ecografia, TAC, risonanza magnetica, scintigrafia epatica suggeriscono la presenza di una cirrosi insieme naturalmente al quadro clinico e laboratoristico, ma la diagnosi precisa é fornita dalla biopsia epatica che può essere eseguita per via percutanea, laparoscopica o transgiugulare. •La cirrosi epatica è caratterizzata dal punto di vista anatomo-patologico dalla presenza contemporanea di: estesa fibrosi noduli di rigenerazione epatocitaria •Rappresenta la tappa terminale e comune di un danno epatico cronico di diversa origine. •Le. CAUSE DI MORTE. Le cisti del fegato sono piccoli sacchi pieni di fluidi che si trovano nel contesto del fegato. Nella maggior parte dei casi si tratta di "cisti semplici" o "non-parassitarie", ossia formazioni non tumorali, non associate al cosiddetto rene policistico e non causate da batteri o parassiti. La parete di queste formazioni è.

“CIRROSI EPATICA e sue COMPLICANZE. nella diagnosi differenziale tra F0nella diagnosi differenziale tra F0--F1 e F3 F1 e F3--F4.F4. Cirrosi epatica HCV relata. Fegato con margini nodulari Gastroenterologia Perugia. 1% circa 600.000 è affetto da cirrosi. In Umbria circa 8.000 persone. Lo studio radiologico in queste condizioni cliniche è di importanza fondamentale, in quanto la diagnosi differenziale fra benignità e malignità nello studio delle lesioni epatiche è talmente accurata che spesso non è nemmeno necessario ricorrere a un prelievo bioptico. Di solito si origina nel contesto di una cirrosi epatica.

Nell’altra metà dei pazienti, i sintomi iniziali sono rappresentati da prurito e/o da astenia, che possono precedere gli altri sintomi di mesi o di anni. In una fase successiva, si possono sviluppare tutte le caratteristiche cliniche e le complicanze della cirrosi epatica. Le cause di cirrosi epatica, e quindi di encefalopatia cronica, sono svariate, ma tra queste le più frequenti sono: infezione cronica da virus dell’epatite B e C, epatite alcolica, emocromatosi e morbo di Wilson, cirrosi criptogenetiche la causa della cirrosi è sconosciuta. Fattori di rischio. La comparsa dell’encefalopatia, sulla base. La diagnosi differenziale della cirrosi epatica praticamente non incontra difficoltà. Nel processo di esame, è differenziato da echinococcosi, cancro e sifilide, durante i quali si verificano cambiamenti simili ai cambiamenti cirrotici nella ghiandola digestiva.

Una volta che le altre cause di stato confusionale e coma sono state escluse, la diagnosi di encefalopatia epatica è prettamente clinica: nessun test, infatti, è in grado di confermare o escludere completamente una diagnosi.</plaintext> Diagnosi di cirrosi epatica Femorale Come con altre malattie, la diagnosi di cirrosi inizia con un'indagine primaria di una persona malata, la chiarificazione delle.</p> <p>L'ascite con cirrosi epatica si verifica nel 50% dei pazienti entro 10 anni, e tra le cause di questa malattia è ¾ di tutti i casi di idropisia. Poiché la maggior parte dei casi di cirrosi epatica sono associati all'alcolismo e colpiscono gli uomini 75-80%, l'ascite è anche più spesso osservata nel sesso più forte. Caratteristica del liquido ascitico ai fini della diagnosi differenziale è il rapporto tra la concentrazione dell'albumina del siero/albumina ascite che consente secondo lo studio di Runyon del 1995 di porre diagnosi differenziale tra le varie forme: Rapporto > o =a 1,1 ad indicare la caratteristica trasudatizia nelle seguenti condizioni. L'encefalopatia epatica cronica è di solito connessa a cirrosi epatica. La cirrosi epatica è una grave malattia degenerativa del fegato, che insorge quando quest'ultimo, in risposta a lesioni e insulti, sostituisce le normali cellule costituenti con cellule cicatriziali per nulla funzionali. Complicanze dovute alla cirrosi epatica, epatocarcinoma primitivo 30% delle cause di morte insufficienza cardiaca. Diagnosi differenziale I. definizione delle forme secondarie. 2. aumento della ferritina sierica da altre cause: affezioni epatiche, infiammazioni, neoplasie. Diagnosi. La diagnosi di cirrosi epatica con l’esame del microbioma intestinale La presenza della cirrosi nella steatosi epatica non alcolica NAFLD è il predittore più importante della mortalità. Tuttavia, l’individuazione della cirrosi, prima che la malattia sia in uno stadio avanzato, è difficile e richiede un approccio invasivo.</p> <p>Esami del sangue: Molti dei pazienti arrivano alla diagnosi di malattia cronica epatica e di cirrosi perché vengono rilevati nel sangue livelli elevati di transaminasi GOT e GPT, anche denominate AST e ALT in alcuni laboratori, due enzimi prodotti dal fegato quando le sue cellule si rompono a causa dell'infiammazione.</p><img 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" 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