Management of liver cirrhosis between primary care and specialists

Table 1 Diagnostic tests, suggested etiology, and current treatment for the most frequent forms of liver cirrhosis in adult patients

Abnormal test(s)	Etiology	Treatment
γGT (high), MCV (high)	Alcohol	Abstinence
HBsAg, HBV-DNA, HBc-IgM, HDV-RNA (positivity)	HBV + Delta virus infection	Interferon α-2b, nucleoside (Lamivudine, Telbivudine, Entecavir) and nucleotide (Adefovir, Tenofovir) analogues
HCV-RNA (positivity)	HCV infection	Interferon plus ribavirin
γGT (high), alkaline phosphatase (high), AMA (positivity)	Primary biliary cirrhosis	Ursodeoxycholate
ANA, ASMA, LKM (positivity)	Autoimmune hepatitis	Prednisone, azathioprine
Ferritin (high), transferring saturation index (> 45%), liver iron content (high), HFE gene mutation for hereditary hemochromatosis (C282Y, H63D)	Hemochromatosis	Phlebotomy, deferoxamine
Ceruloplasmin (low), serum (low) and 24 h urine copper excretion (high)	Wilson’s disease	D-penicillamine, zinc
HDL-cholesterol (low), glucose (high), triglycerides (high)	NAFLD/NASH	Low caloric diet, exercise, drugs lowering insulin-resistance

AMA: Anti-mitochondrial antibody; ANA: Antinuclear antibody; ASMA: Anti-smooth-muscle antibody; γGT: γ- glutamyltransferase; HBV-DNA: Hepatitis B virus DNA; HCV-RNA: Hepatitis C virus RNA; HBsAg: Hepatitis B surface antigen; HDL: High density lipoprotein; HDV-RNA: Hepatitis delta virus RNA; LKM: Liver kidney microsomes; MCV: Mean corpuscular volume; NASH: Nonalcoholic steatohepatitis; NAFLD: Nonalcoholic fatty liver disease.