Liver cirrhosis: difficulties in the diagnosis


DOI: https://dx.doi.org/10.18565/therapy.2021.3.106-114

Luzina E.V., Tomina E.A., Shchadneva S.I., Lareva N.V., Belozertseva L.V.

1) Chita State Medical Academy of the Ministry of Healthcare of Russia; 2) Chita Regional Clinical Hospital
Abstract. All over the world, there is an increase in the liver cirrhosis (LC) incidence, and this problem is becoming more and more actual. The manifestations of LC are due to the peculiarities of hemodynamics, liver dysfunctions, and the development of systemic inflammation, which entails the formation of various complications, from which patients die. Diagnosis of LC presents certain difficulties, especially in the early stages. The article contains the own clinical observation of a patient with an unusual LC from the point of view of different specialists: hematologist, rheumatologist and gastroenterologist.
Keywords: liver cirrhosis, thrombocytopenia, systemic connective tissue diseases, portal vein thrombosis
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Literature


  1. Mendez-Sanchez N., Zamarripa-Dorsey F., Panduro A. et al. Current trends of liver cirrhosis in Mexico: Similitudes and differences with other world regions. World J Clin Cases. 2018; 6(15): 922–30. doi: 10.12998/wjcc.v6.i15.922.

  2. Rezaei N., Asadi-Lari M., Sheidaei A. et al. Liver cirrhosis mortality at national and provincial levels in Iran between 1990 and 2015: A meta regression analysis. PLoS One. 2019; 14(1): e0198449. doi: 10.1371/journal.pone.0198449.

  3. Mokdad A.A., Lopez A.D., Shahraz S. et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014; 12: 145. doi: 10.1186/s12916-014-0145-y.

  4. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Bur-den of Disease Study 2017. GBD 2017 Cirrhosis Collaborators. Lancet Gastroenterol Hepatol. 2020; 5(3): 245–66. doi: 10.1016/S2468-1253(19)30349-8.

  5. KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications. The Korean Association for the Study of the Liver (KASL). Clin Mol Hepatol. 2018; 24(3): 230–77. doi: 10.3350/cmh.2018.1005.

  6. Schoonen W.M., Kucera G., Coalson J. et al. Epidemiology of immune thrombocytopenic purpura in the general practice research database. Br J Haematol. 2009; 145(2): 235–44. doi: 10.1111/j.1365-2141.2009.07615.x.

  7. Gauer R.L., Braun M.M. Thrombocytopenia. Am Fam Physician. 2012; 85(6): 612–22.

  8. Рукавицын О.А. (ред.) Гематология: национальное руководство [Электронный ресурс]. М.: ГЭОТАР-Медиа. 2017; 784 с. Доступ: https://www.rosmedlib.ru/book (дата обращения – 22.10.2020). [Rukavicin О.А. (ed.) Hematology: National clinical guidelines [Electronic resource]. M.: GEOTAR-Media. 2017; 784 pp. Available at: https://www.rosmedlib.ru/book (date of access – 22.10.2020) (In Russ.)].

  9. Arnold D.M., Nazy I., Clare R. et al. Misdiagnosis of primary im-mune thrombocytopenia and frequency of bleeding: Lessons from the McMaster ITP Registry. Blood Adv. 2017; 1(25): 2414–420. doi: 10.1182/bloodadvances.2017010942.

  10. Национальные клинические рекомендации по диагностике и лечению идиопатической тромбоцитопенической пурпуры (первичной иммунной тромбоцитопении) у взрослых (редакция 2018 г.). Доступ: https://www.volgmed.ru/uploads/files/2018-4/83275 (дата обращения – 14.10.2020). [National clinical guidelines for the diagnosis and treatment of idiopathic thrombocytopenic purpura (Primary immune thrombocytopenia) in adults (2018 edition). Available at: https://www.volgmed.ru/uploads/files/2018-4/83275 (date of access – 22.10.2020) (In Russ.)].

  11. Савченко В.Г. (ред.) Алгоритмы диагностики и протоколы лечения заболеваний системы крови. М.: Практика. 2018; 1264 с. [Savchenko V.G. (ed.). Diagnostic algorithms and treatment protocols for diseases of the blood system. M.: Praktika = Practice. 2018; 1264 pp. (In Russ.)].

  12. Кулагин А.Д., Лисуков И.А., Птушкин В.В. с соавт. Национальные клинические рекомендации по диагностике и лечению пароксизмальной ночной гемоглобинурии. Онкогематология. 2014; 2: 20–28. [Kulagin A.D., Lisukov I.A., Ptushkin V.V. et al. National clinical guidelines for the diagnosis and treatment of paroxysmal nocturnal hemoglobinuria. Onkogematologiya = Oncohematology. 2014; 2: 20–28 (In Russ.)].

  13. Kurokawa T., Zheng Y.-W., Ohkohchi N. Novel functions of platelets in the liver. J Gastroenterol Hepatol. 2016; 31(4): 745–51. doi: 10.1111/jgh.13244.

  14. Максимова А.Ю., Гаренских Н.В., Бессонова Е.Н., Базарный В.В. Оценка тромбоцитарных показателей в автоматизированном анализе крови у пациентов с циррозом печени. Вестник уральской академической науки. 2019; 3: 351–356. [Maximova A.Y., Garenskich N.V., Bessonova E.N., Basarniy V.V. Estimation of platelet parameters with an automated hematology analyzer in patients with liver cirrhosis. Vestnik ural’skoy akademicheskoy nauki = Bulletin of the Ural academic science. 2019; 3: 351–356 (In Russ.)]. doi: https://dx.doi.org/10.22138/2500-0918-2019-16-3-351-356.

  15. Grozovsky R., Begonja A.J., Liu K. et al. The Ashwell–Morell receptor regulates hepatic thrombopoietin production via JAK2-STAT3 signaling. Nat Med. 2015; 21(1): 47–54. doi: 10.1038/nm.3770.

  16. Qi Х., De Stefano V., Wang J. et al Prevalence of inherited an-tithrombin, protein C, and protein S deficiencies in portal vein system thrombosis and Budd–Chiari syndrome: a systematic review and meta-analysis of observational studies J Gastroenterol Hepatol. 2013; 28(3): 432–42. doi: 10.1111/jgh.12085.

  17. Бокерия Л.А., Затевахин И.И., Кириенко А.И. с соавт. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО). Флебология. 2015; 4-2: 1–52. [Bockeria L.A., Zatevakhin I.I., Kirienko A.I. et al. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications. Flebologiya = Phlebology. 2015; 4-2: 1–52 (In Russ.)].

  18. Насонова Е.Л. (ред.), Насонова В.А. (ред.). Ревматология: национальное руководство. М.: ГЭОТАР-Медиа. 2010; 720 с. [Nasonova E.L. (ed.), Nasonova V.A. (ed.). Rheumatology: National clinical guidelines. M.: GEOTAR-Media. 2010; 720 рp. (In Russ.)].

  19. Клюквина Н.Г., Насонов Е.Л. Особенности клинических и лабораторных проявлений системной красной волчанки. Современная ревматология. 2012; 4: 40–48. [Klyukvina N.G., Nasonov E.L. Features of clinical and laboratory manifestations of sys-temic lupus erythematosus. Sovremennaya revmatologiya = Modern rheumatology. 2012; 4: 40–48 (In Russ.)].

  20. Zhang W., Wang F., Wang H. et al. Severe thrombocytopenia in connective tissue diseases: a single-center review of 131 cases. Clin Rheumatol. 2018; 37(12): 3337–44. doi: 10.1007/s10067-018-4312-y.

  21. Гавва Т.Н., Кузьменкова Л.В., Земсков Е.В., Клюквина Н.Г. Тяжелое поражение легких у больной с недиагностированной системной красной волчанкой. Современная ревматология. 2018; 4: 118–122. [Gavva T.N., Kuzmenkova L.V., Zemskov E.V., Klyukvina N.G. Severe lung involvement in a female patient with undiagnosed systemic lupus erythematosus. Sovremennaya revmatologiya = Modern rheumatology. 2018; 4: 118–122 (In Russ.)]. doi: https://dx.doi.org/10/14412/1996-7012-2018-4-118-122.

  22. Шаяхметова Р.У., Ананьева Л.П. Смешанное заболевание соединительной ткани. Современная ревматология. 2019; 1: 11–18. [Shayakhmetova R.U., Ananyeva L.P. Mixed connective tissue disease. Sovremennaya revmatologiya = Modern rheumatology. 2019; 1: 11–18 (In Russ.)]. doi: https://dx.doi.org/10.14412/1996-7012-2019-1-11-18.

  23. Алекперов Р.Т. Смешанное заболевание соединительной ткани, недифференцированное заболевание соединительной ткани и перекрестные синдромы. Альманах клинической медицины. 2019; 5: 435–444. [Alekperov R.T. Mixed connective tissue disease, undifferentiated connective tissue disease and overlap syndromes. Al’manakh klinicheskoy meditsiny = Almanac of clinical medicine. 2019; 5: 435–444 (In Russ.)]. doi: https://doi.org/10.18786/2072-0505-2019-47-022.

  24. Райхельсон К.Л., Мительглик У.А., Зубарева А.С. с соавт. Встречаемость аутоантител у больных с аутоиммунными заболеваниями печени и хроническим гепатитом С. Медицинская иммунология. 2013; 4: 351–360. [Raikhelson K.L., Mitelglik U.A., Zubareva A.S. et al. Incidence of autoantibodies in patients with autoimmune liver diseases and chronic hepatitis C. Meditsinskaya immunologiya = Medical Immunology. 2013; 4: 351–360 (In Russ.)].

  25. Lian M., Hua J., Sheng L., Qiu D.K. Prevalence and significance of autoantibodies in patients with alcoholic liver disease. J Dig Dis. 2013; 14(7): 396–401. doi: 10.1111/1751-2980.12057.

  26. Wu Q., Shen L., Chu J. et al. Characterization of uncommon porto-systemic collateral circulations in patients with hepatic cirrhosis. Oncol Lett. 2015; 9(1): 347–50. doi: 10.3892/ol.2014.2626.

  27. Bashour F.N., Teran J.C., Mullen K.D. Prevalence of peripheral blood cytopenias (hypersplenism) in patients with nonalcoholic chronic liver disease. Am J Gastroenterol. 2000; 95(10): 2936–39. doi: 10.1111/j.1572-0241.2000.02325.x.

  28. Li L., Duan M., Chen W. et al. The spleen in liver cirrhosis: revisiting an old enemy with novel targets. J Transl Med. 2017; 15(1): 111. doi: 10.1186/s12967-017-1214-8.

  29. Воробьев А.И. (ред.) Руководство по гематологии: в 3 т. Т. 3. 3-е изд., перераб. и доп. М.: Ньюдиамед. 2005: 416 с. [Vorobyov A.I. (ed.) Guide to hematology: in 3 vol. V. 3. 3rd ed., rev. and add. Moscow: Newdiamed. 2005: 416 рp. (In Russ.)].

  30. Nomura Y., Kage M., Ogata T. et al. Influence of splenectomy in patients with liver cirrhosis and hypersplenism. Hepatol Res. 2014; 44(10): E100–E109. doi: 10.1111/hepr.12234.

  31. Ren S., Zhang S., Li M. et al. NF-κB p65 and c-Rel subunits promote phagocytosis and cytokine secretion by splenic macrophages in cirrhotic patients with hypersplenism. Int J Biochem Cell Biol. 2013; 45(2): 335–43. doi: 10.1016/j.biocel.2012.11.012.

  32. Шерлок Ш., Дули Д. Заболевания печени и желчных путей: Практич. рук.: Пер. с англ. Под ред. З.Г. Апросиной, Н.А. Мухина. М.: ГЭОТАР-Медицина. 1999; 864 с. [Sherlock Sh., Dooley J. Diseases of the liver and biliary tract: A practical guide. Transl. from English. Ed. by Aprosina Z.G., Mukhina N.A. Moscow: GEOTAR-Meditsina.1999; 864 рp. (In Russ.)].

  33. Irvine K.M., Ratnasekera I., Powell E.E., Hume D.A. Causes and consequences of innate immune dysfunction in cirrhosis. Front Immunol. 2019; 10: 293. doi: 10.3389/fimmu.2019.00293.

  34. Яковенко А.В., Яковенко Э.П., Карпова Р.В. Цирроз печени, клинико-патогенетические аспекты. Фарматека. 2012; 13: 32–36. [Yakovenko A.V., Yakovenko E.P., Karpova R.V. Liver cirrhosis, clinical and pathogenetic aspects. Farmateka. 2012; 13: 32–36 (In Russ.)].

  35. Soulaidopoulos S., Cholongitas E., Giannakoulas G. et al. Review article: Update on current and emergent data on hepatopulmonary syndrome. World J Gastroenterol. 2018; 24(12): 1285–98. doi: 10.3748/wjg.v24.i12.1285.

  36. Mohammad Alizadeh A.H., Fatemi S.R. et al. Clinical features of hepatopulmonary syndrome in cirrhotic patients. World J Gastroenterol. 2006; 12(12): 1954–56. doi: 10.3748/wjg.v12.i12.1954.

  37. Шифф Ю.Р. Цирроз печени и его осложнения. Трансплантация печени. Шифф Ю.Р., Соррел М.Ф., Мэддрей У.С. Пер. с англ. под ред. В.Т. Ивашкина, С.В. Готье, Я.Г. Мойсюка, М.В.Маевской. М.: ГЭОТАР-Медиа. 2012; 592 с. [Schiff E.R. Liver cirrhosis and its complications. Liver Transplantation. Schiff E.R., Sorrell M.F., Maddray W.S. Transl. from English. Ed. by Ivashkin V.T., Gautier S.V., Moisyuk Ya.G., Maevskaya M.V. Moscow: GEOTAR-Media. 2012; 592 рp. (In Russ.)].

  38. Fallon M.B., Krowka M.J., Brown R.S. et al. Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates. Gastroenterology. 2008; 135(4): 1168–75. doi: 10.1053/j.gastro.2008.06.038.

  39. Sharma A.M., Zhu D., Henry Z. Portal veinthrombosis: When to treat and how? Vasc Med. 2016; 21(1): 61–69. doi: 10.1177/1358863X15611224.

  40. Клинические рекомендации EASL: заболевания сосудов печени. Journal of Hepatology. Русское издание. 2016; 2(1): 87–114. [Clinical guidelines for EASL: vascular disease of the liver. Journal of Hepatology. Russian edition. 2016; 2(1): 87–114 (In Russ.)].

  41. Faccia M., Ainora M.A., Ponziani F.R. et al. Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of de-bate. World J Gastroenterol. 2019; 25(31): 4437–51. doi: 10.3748/wjg.v25.i31.4437.

  42. Loffredo L., Pastori D., Farcomeni A., Violi F. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: A systematic review and meta-analysis. Gastroenterology. 2017; 153(2): 480–87e1. doi: 10.1053/j.gastro.2017.04.042.

  43. Подлесских М.Н., Цодиков Г.В., Волчкова Е.В. с соавт. Тромбоз воротной вены в практике гастроэнтеролога. Фарматека. 2010; 2: 54–60. [Podlesskikh M., Tsodikov G., Volchkova E. et al. Portal vein thrombosis in the practice of gastroenterologist. Farmateka. 2010; 2: 54–60 (In Russ.)].


About the Autors

Elena V. Luzina. PhD, associate professor of the Department of therapy of the Faculty of advanced training and professional retraining of specialists, Chita State Medical Academy of the Ministry of Healthcare of Russia, Chairman of the TRANS-Baikal Scientific Society of Gastroenterologists. Address: 672090, Chita, 39а Gorky Str. Tel.: +7 (914) 468-36-91. E-mail: el.luz@list.ru ORCID: 0000-0002-8282-3056. eLibrary SPIN: 6748-9361
Elena A. Tomina, PhD, assistant of the Department of therapy of the Faculty of advanced training and professional retraining of specialists, Chita State Medical Academy of the Ministry of Healthcare of Russia. Address: 672090, Chita, 39а Gorky Str. ORCID: 0000-0003-2423-666X
Snezhana I. Shchadneva, PhD, associate professor of Department of hospital therapy and endocrinology, Chita State Medical Academy of the Ministry of Healthcare of Russia. Address: 672090, Chita, 39а Gorky Str. ORCID: 0000-0003-1593-5565
Natalia V. Lareva, MD, professor, vice-rector for research, head of the Department of therapy of the Faculty of advanced training and professional retraining of specialists, Chita State Medical Academy of the Ministry of Healthcare of Russia. Address: 672090, Chita, 39а Gorky Str. ORCID: 0000-0001-9498-9216. eLibrary SPIN: 1228-6205
Lyudmila V. Belozertseva, Chief freelance rheumatologist of the Ministry of Healthcare of the TRANS-Baikal region, head of the Department of rheumatology of the Chita Regional Clinical Hospital. Address: 672038, Chita, 7 Kokhansky Str. ORCID: 0000-0002-0932-0284

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