Just liver disease or cirrhosis?

File:Liver superior.jpg

If there’s one thing consultants always reminisce about, it’s the death of clinical medicine. Nowadays, it’s all about the bloods, the scans, and the invasive tests, when it actuality a learned hand can reveal a great deal. When you see your patient with liver disease however, we often think about the FibroScan, ultrasound or liver biopsy – but what can the examination reveal about cirrhosis?

This article from JAMA involved an extensive literature review, in the end including 86 studies. They found that the following findings were most predictive of cirrhosis:

  • ascites
  • thrombocytopaenia
  • spider naevi
  • and a few simple lab tests

Then they looked at what makes cirrhosis less likely:

  • Lok index < 0.2 (combination of platelets, ALT, AST, and INR)
  • platelet > 160
  • absence of hepatomegaly (interesting…)

Great study as a proponent for basic clinical medicine, to be able to alter your management before you get scans done. Clinical medicine is dying as we get easy access to more scans – but being able to diagnose conditions earlier, or in environments where access isn’t as easy, means that the educated hand is necessary.

Read more, here.

 

source | JAMA

image | Gray’s Anatomy

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