异常健康检查 | gutCARE

异常健康检查

健康检查通常涉及旨在在出现症状之前查找疾病的测试。健康筛查对于早期发现疾病和状况至关重要。通过对这些慢性病或癌症进行早期发现和良好管理,可以避免或延迟并发症的发生,从而改善患者的预后和生存率。

您的医疗保健从业人员可能出于以下四个常见原因之一而决定将您转介给肠胃科医生:

  • 癌症标志物升高
  • 贫血
  • 肝血检查异常
  • 肝结节

1.升高的癌症标记

a.甲胎蛋白(AFP)

传统上,甲胎蛋白(AFP)用于筛查存在肝癌或肝细胞癌风险的患者,例如由于任何原因或乙肝携带者而患有肝硬化的患者。然而,AFP可在其他癌症中升高,例如睾丸癌,胃癌,胆道癌,胰腺癌和肺癌。AFP也可在非恶性疾病(例如肝硬化,病毒性肝炎,共济失调毛细血管扩张症和妊娠)中升高。

b. 癌胚抗原(CEA)

癌胚抗原(CEA)是一种糖蛋白,存在于正常粘膜细胞中。但是,血液测试中发现的升高水平可能与癌症有关,尤其是结直肠癌,而超过10 ug / L的水平很少是由良性疾病引起的。敏感性随着前进的结直肠癌阶段而增加。CEA水平可用于评估大肠癌患者的预后(以及其他因素),检测复发和监测治疗。

可能导致血液CEA水平升高的疾病包括大肠癌,乳腺癌,肺癌,胃癌,食道癌,胰腺癌,间皮瘤,骨骼转移,肝硬化,慢性活动性肝炎,慢性肾功能衰竭,胰腺疾病,炎症性肠病疾病,憩室炎,肠易激综合症,呼吸系统疾病,例如胸膜炎症,肺炎,吸烟和动脉粥样硬化

c. 碳水化合物抗原19-9

CA19-9是细胞内粘附分子。血液中CA 19.9的升高主要发生在胰腺癌和胆道癌患者中,但在大肠癌,胃癌,肝细胞癌,食管癌和卵巢癌患者中也可能升高。

诸如肝硬化,胆汁淤积,胆管炎,胰腺炎和糖尿病的病情也可能导致CA 19.9的血液水平升高。

2. 贫血

贫血也是常见的健康筛查异常。 男性贫血的典型定义是血红蛋白水平低于13.5g / dL,女性贫血的定义是血红蛋白低于12g / dL。 大多数贫血患者最初没有症状,只有在血红蛋白明显降低时才会出现症状。

贫血可分为小细胞性(MCV小于80FL),正常性(MCV 80-100FL)或大细胞性(MCV大于100FL)。 小细胞性贫血的最常见原因是缺铁性贫血,尽管诸如α地中海贫血或β地中海贫血等遗传性疾病需要排除。

缺铁性贫血的最常见原因是素食者和素食者的饮食中缺乏铁,月经过多,怀孕,消化性溃疡,胃肠道癌(结肠直肠,胃和小肠),炎性肠病,结肠息肉和痔疮

维生素B12缺乏症可能引起大细胞性贫血。

由于恶性贫血,慢性酒精中毒或肠道狭窄(克罗恩病),盲环症候群和细菌过度生长(手术后),严格素食者可能会发现维生素B12缺乏症

3. 肝脏血液异常检查

在健康检查期间通常会发现异常的肝血检查结果,患者通常没有症状。 这些肝功能异常检查可分为三大类:

i. 孤立的胆红素水平升高(高胆红素血症)
ii. 血清碱性磷酸酶(ALP)和 伽玛GT(GGT)
iii. 丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)主要升高

i. Causes of isolated hyperbilirubinemia include:

• Hemolysis
• Drugs
• Hereditary Disorders such as Gilbert’s syndrome, Crigler- Najjar syndrome, Dubin-Johnson syndrome
• Chronic liver disease

ii. Causes of raised serum alkaline phosphatase (ALP) and gamma-GT (Cholestasis) include:

• Primary biliary cirrhosis
• Drugs (tricyclic antidepressants, erythromycin, oral contraceptive pill, anabolic steroids)
• Primary sclerosing cholangitis
• Cardiac failure
• Malignancy – Liver, bilary or pancreatic cancers

iii. Predominately raised ALT/AST (‘Hepatitic picture’) include:

• Non-alcoholic steatohepatitis (NASH)
• Alcoholic hepatitis
• Cirrhosis
• Medications
• Chronic hepatitis B, C
• Autoimmune hepatitis
• Acute hepatitis A, B, C, EBV and CMV infection
• Metabolic-Glycogen Storage disorders, Wilson’s disease

Further Evaluation

Patients with elevated cancer markers, anaemia or abnormal liver bloods tests or liver nodules require a detailed history and physical examination and usually will require further evaluation.

Your gastroenterologist at gutCARE will take a detailed history from you for hepatitis B or C, significant alcohol intake and family history of liver cancer in cases of an elevated AFP blood test. They may perform an abdominal examination and inspection of the testes in men to exclude testicular cancer. Further investigations may include a transabdominal ultrasound, CT or MRI scan and fibroscan liver stiffness measurement and further blood tests.

If you have an elevated CEA blood test, your gastroenterologist may ask you about a history of smoking and symptoms suggestive of colorectal (per rectum bleeding, change in bowel habits) or lung (cough, hemoptysis). Gastroscopy, colonoscopy and further non-invasive imaging may be performed where appropriate.

If you have an elevated CA19-9 blood test, your gastroenterologist may require CT or MRI imaging to exclude pancreatic and biliary malignancy and a gastroscopy and colonoscopy where appropriate. Patients may also require further evaluation using state-of-the-art endoscopic ultrasound.

In patients with anaemia, your gastroenterologist at gutCARE may suggest further evaluation including a gastroscopy, colonoscopy or capsule endoscopy as well as referral to a dietician or gynaecologist.

If you have abnormal liver blood test results or liver nodule, your gastroenterologist will take complete history of your lifestyle (including recent travel, transfusions, unprotected sexual intercourse, alcohol intake, diabetes mellitus, obesity, hyperlipidemia, family history) and a thorough clinical examination for signs of chronic liver disease.

Diagnosis of the definitive cause of your abnormal live blood tests or liver nodule may include further investigations for hepatitis B, C, autoimmune hepatitis, Wilson’s disease. Your gastroenterologist may also order an ultrasound, CT, MRI, MRCP scan. Lastly to assess whether you might have liver cirrhosis, your gastroenterologist may order a Fibroscan liver stiffness assessment or liver biopsy.

Treatment

The treatment of these patients is dependent on the final diagnosis following evaluation.

Category
digestive illnesses

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