Diagnosis of liver cirrhosis

        Diagnosis

        It is not difficult to diagnose cirrhosis of the liver, and the early diagnosis of cirrhosis is more difficult.

        1, decompensated: history and symptoms of chronic hepatitis can be used for reference, such as a typical spider, liver palms should be highly suspected, liver hard or smooth and (or) >2cm hard, splenomegaly, and no other reasons, is early diagnosis of cirrhosis of liver function, can be normal, or protein electrophoresis abnormal, monoamine oxidase, serum P- III -P diagnosis when necessary, liver pathological examination or laparoscopy to diagnose.

        2, decompensation: symptoms, signs, laboratory tests have significant performance, such as ascites, esophageal varices, splenomegaly and hypersplenism obviously have the abnormal liver function tests, not difficult to diagnose, but sometimes need to differentiate from other diseases.

differential diagnosis

        1, the clinical manifestations of liver cirrhosis is more complex, need to be identified with a similar performance of the disease, ascites and the following identification of the disease:

        (1) tuberculous peritonitis: liver cirrhosis at the beginning, and rapid progress, may have abdominal pain, palpation tenderness, and differential tuberculous peritonitis, the symptoms of tuberculosis, abdomen flexible, tenderness and rebound tenderness, symptoms and signs of persistent abdominal exudate, properties of water very few, for bloody ascites.

        (2) cancerous peritonitis: abdominal cancer can be transferred to the peritoneum and ascites, over 40 years of age, the rapid development of rapid onset, ascites was bloody ascites cancer cell can be found.

        (3) ovarian cancer: especially false mucinous cystic carcinoma, often with chronic ascites as the clinical manifestations, progress is slow, ascites was transudate, sometimes resulting in difficult diagnosis, and gynecological laparoscopy is helpful to the diagnosis of.

        (4) constrictive pericarditis: with massive ascites, easily misdiagnosed as cirrhosis, but elevated venous pressure, jugular venous distention, liver, heart, odd pulse, pulse pressure small performance can be distinguished.

        (5) giant hydronephrosis and ovarian cyst: a rare, no shifting dullness, no liver disease, the former pyelography, which can help the diagnosis of gynecological examination.

        2, the upper gastrointestinal bleeding and peptic ulcer, bleeding gastritis, gastric mucosal prolapse, bile duct bleeding and other phase identification:

        (1) peptic ulcer bleeding: often has a history of ulcer, spleen is no hypersplenism, but with the existence of cirrhosis, it is difficult to distinguish, emergency endoscopy is helpful in the diagnosis of cirrhosis, patients with esophageal variceal bleeding accounted for 53%, the rest is ulcer or gastric mucous membrane lesions.

        (2) hemorrhagic gastritis: can have incentives such as alcohol, drugs and other causes, can have stomach pain, and liver cirrhosis combined with gastric mucosal lesions, identify difficulties, reliable diagnostic method is emergency endoscopic examination.

        (3) hemobilia: a rare, often have abdominal pain, fever, jaundice, swollen gallbladder tenderness, hematemesis often, in abdominal pain after gastroscopy, or bleeding after endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography, biliary diseases can be found.

Above all kinds of bleeding can be necessary to choose the celiac artery angiography method for differential diagnosis, the contrast agent in the bleeding part of the development and development, according to the anatomical site can infer the source of bleeding.

        (4): the need to identify disease caused by splenomegaly, and other causes such as malaria, leukemia, Hodgkin's disease, schistosomiasis and leishmaniasis, malaria has a history of recurrent episodes, blood found in Plasmodium, peripheral blood leukocytes of chronic myelogenous leukemia up to more than 10 * 109/L, with immature granulocyte classification, bone marrow examination Hodgkin's disease can be diagnosed, often accompanied by lymphadenopathy, rely on lymph node biopsy can be diagnosed, Kala Azar has been rare in our country, the occasional individual cases, irregular fever, epistaxis, gingival bleeding, anemia and peripheral white blood cells was significantly reduced (3 * 109/L), bone marrow examination or splenic puncture can be found Li Du in body, repeated history of water contact, the eggs of Schistosoma japonicum ring, complement fixation test and skin tests positive for rectal mucosal biopsy can find the schistosome eggs, do stool Incubation test.