Utilidad de la ecografía abdominal en el diagnóstico y seguimiento de la hepatopatía difusa crónica

espanolIntroduccion y objetivos: la cirrosis hepatica representa el estadio final evolutivo de las hepatopatias cronicas y representa un cambio tanto del manejo como del pronostico de la enfermedad. La ecografia abdominal convencional continua siendo la tecnica de primera linea en la valoracion inicial de los pacientes con sospecha de enfermedad hepatica y en el seguimiento de estos enfermos tras el diagnostico. Por tal motivo, el objetivo del presente estudio consistio en describir la experiencia de nuestro servicio en el diagnostico y seguimiento de pacientes con hepatopatia cronica difusa en la practica clinica habitual. Materiales y metodos: Estudio retrospectivo observacional realizado en un hospital de tercer nivel en la comunidad de Andalucia. Se incluyeron un total de 3111 ecografias realizadas de forma reglada en nuestro centro entre 2009 y 2011. Se recogieron datos como la indicacion para su realizacion, diagnosticos ecograficos a nivel hepatico asi como tambien a nivel biliar, pancreatico y genitourinario. Se valoro la presencia de esteatosis, cirrosis hepatica y de lesiones ocupantes de espacio (LOE). De las LOES observadas, se obtuvo la frecuencia de carcinoma hepatocelular (CHC) y de metastasis hepaticas, ambas confirmadas mediante otros estudios de imagen o mediante estudios histologicos. Finalmente, se obtuvieron las distintas etiologias de hepatopatia cronica de los pacientes con CHC confirmado. Resultados: Se realizaron un total de 3111 ecografias, conformadas por 58% de varones, con una edad promedio de 54.5 anos, indicadas en su mayoria por control evolutivo (52%), seguido de dolor abdominal (21%), despistaje de LOES (20%) e hipertransaminasemia (4.0%). En el 21% de las exploraciones, no se identifico ningun hallazgo anormal. A nivel hepatico, el diagnostico ecografico de esteatosis hepatica se observo en 12% de las exploraciones, siendo el grado II el mas frecuente (61%). En 840/3111 (27%) de las exploraciones se observaron signos de hepatopatia cronica difusa. Un patron ecografico de cirrosis hepatica se observo en 684/3111 (22%) del total de las exploraciones de las cuales 438/684 (64%) presentaban signos ecograficos de hipertension portal. Entre 2009 y 2011, se detectaron 178 LOES, de las cuales 96/178 (54%) correspondian a CHC, 82/96 (85%) sobre higado cirrotico y 14/96 (15%) sobre higado con signos ecograficos de hepatopatia cronica difusa sin cirrosis. El virus de la hepatitis C (VHC) y alcohol, 65% y 13% respectivamente, fueron las etiologias mas frecuentes de hepatopatia cronica en los casos de CHC confirmado. Conclusiones: La ecografia abdominal es una herramienta rentable que nos permite evaluar de forma eficaz y rapida la presencia de lesiones a nivel renal, bilio-pancreatico y concretamente a nivel hepatico. En nuestro estudio, esta tecnica ha mostrado ser de gran utilidad en el seguimiento de pacientes con hepatopatia cronica debido a que nos aporta informacion fundamental para un abordaje diagnostico y terapeutico dirigido. EnglishIntroduction and aims: Liver cirrhosis represents the final stage in the evolution of chronic liver disease and represents a change in both the management and the prognosis of the disease. Conventional abdominal ultrasound remains being the first line technique in the initial assessment of patients with suspected liver disease and in their follow up after diagnosis. Therefore, the aim of this study was to describe the experience of our service in the diagnosis and follow-up of patients with chronic diffuse liver disease in routine clinical practice. Material and methods: Retrospective observational study performed in a tertiary care hospital in Andalusia. The study includes a total of 3111 ultrasound scans performed on a scheduled basis at our hospital between 2009 and 2011. Collected data included the indication for patients to have a scan done as well as the results of diagnostic ultrasounds of liver, bladder, pancreas, and genitourinary tracts. The study also assessed the presence of fatty liver, liver cirrhosis and space-occupying lesions (SOL). The frequency of hepatocellular carcinoma (HCC) and liver metastases was obtained from the SOLs observed, both confirmed by other imaging or histological studies. Finally, the different etiologies of chronic liver disease in patients with HCC were confirmed. Results: A total of 3111 scans were performed; 58% of the scanned patients were men, with an average age of 54,5; scans were mainly indicated for development control (52% of cases), followed by abdominal pain (21% of cases), screening of SOLs (20% of cases) and hypertransaminasemia (4% of cases). 21% of the examinations showed no evidence of abnormal findings. Ultrasound diagnosis of fatty liver was observed in 12% of examinations, grade II being the most frequent type (61% of cases). Signs of chronic diffuse liver disease could be observed in 840/3111 (27% of cases) of the examinations. An ultrasound pattern of liver cirrhosis was observed in 684/3111 (22% of cases) of total examinations, of which 438/684 (64% of cases) had ultrasound signs of portal hypertension. Between 2009 and 2011, 178 cases of SOLs were found, of which 96/178 (54% of cases) were HCC, 82/96 (85% of cases) in cirrhotic livers and 14/96 (15% of cases) in livers with ultrasound signs of chronic diffuse liver disease without cirrhosis. Hepatitis C virus (HCV ) and alcohol, 65 % and 13 % respectively, were the most frequent etiologies of chronic liver disease in confirmed cases of HCC. Conclusions: An abdominal ultrasound is a cost-effective tool that allows us an effective and quick evaluation of the presence of lesions in the kidney, bladder and specifically in the liver. Our study has demonstrated the usefulness of this technique to follow-up patients with chronic liver disease as it gives us essential information for a targeted diagnostic and therapeutic approach.