Hepatische Granulome – eine diagnostische Herausforderung
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Hepatische Granulome – eine diagnostische Herausforderung. / Horst, Ludwig J; Weidemann, Sören; Lohse, Ansgar W; Sebode, Marcial.
in: Z RHEUMATOL, Jahrgang 81, Nr. 7, 09.2022, S. 567-576.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Hepatische Granulome – eine diagnostische Herausforderung
AU - Horst, Ludwig J
AU - Weidemann, Sören
AU - Lohse, Ansgar W
AU - Sebode, Marcial
N1 - © 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
PY - 2022/9
Y1 - 2022/9
N2 - Hepatic granulomas can have various causes and their detection requires a systematic diagnostic evaluation. First, identification of risk factors for granulomatous diseases and the exclusion of extrahepatic organ manifestation are necessary. Laboratory investigations and serological screening for the most common underlying diseases of liver granulomas in Germany, such as primary biliary cholangitis (PBC), sarcoidosis and infectious causes (primarily tuberculosis and hepatitis C infections), are recommended. A liver biopsy is essential for confirming the diagnosis, whereby a minilaparoscopically guided tissue sampling offers many advantages, such as the macroscopic detection of granulomas on the liver surface, on the peritoneum or on the spleen. Whether the detection of hepatic granulomas results in a therapeutic consequence, depends decisively on the underlying primary disease. If hepatic granulomas are present without concomitant liver parenchymal damage or other manifestations that would make treatment necessary, a watch and wait approach under close clinical and laboratory monitoring is sufficient. If liver values increase or in cases of hepatic parenchymal damage, urgent treatment of the underlying disease is indicated.
AB - Hepatic granulomas can have various causes and their detection requires a systematic diagnostic evaluation. First, identification of risk factors for granulomatous diseases and the exclusion of extrahepatic organ manifestation are necessary. Laboratory investigations and serological screening for the most common underlying diseases of liver granulomas in Germany, such as primary biliary cholangitis (PBC), sarcoidosis and infectious causes (primarily tuberculosis and hepatitis C infections), are recommended. A liver biopsy is essential for confirming the diagnosis, whereby a minilaparoscopically guided tissue sampling offers many advantages, such as the macroscopic detection of granulomas on the liver surface, on the peritoneum or on the spleen. Whether the detection of hepatic granulomas results in a therapeutic consequence, depends decisively on the underlying primary disease. If hepatic granulomas are present without concomitant liver parenchymal damage or other manifestations that would make treatment necessary, a watch and wait approach under close clinical and laboratory monitoring is sufficient. If liver values increase or in cases of hepatic parenchymal damage, urgent treatment of the underlying disease is indicated.
KW - Biopsy/adverse effects
KW - Granuloma/diagnosis
KW - Humans
KW - Liver Diseases/diagnosis
KW - Retrospective Studies
KW - Sarcoidosis/diagnosis
U2 - 10.1007/s00393-022-01235-z
DO - 10.1007/s00393-022-01235-z
M3 - SCORING: Review
C2 - 35763059
VL - 81
SP - 567
EP - 576
JO - Z RHEUMATOL
JF - Z RHEUMATOL
SN - 0340-1855
IS - 7
ER -
