Bouma M, van Geldrop W J, Numans M E, Wiersma Tj, Goudswaard A N
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Postbus 3231, 3502 GE Utrecht.
Ned Tijdschr Geneeskd. 2008 Dec 6;152(49):2662-6.
The revised Dutch College of General Practitioners' practice guideline 'Viral hepatitis and other liver diseases' offers advice in the diagnosis and management of viral hepatitis A, B and C and other liver diseases. The guideline is important for general practitioners as well as specialists in internal medicine and gastroenterology. The emphasis is on the management of chronic hepatitis B en C, because the prevalence of these diseases has increased in the Netherlands and, in addition, the treatment options for chronic hepatitis have improved. Consequently, timely recognition and adequate referral of patients with chronic hepatitis B or hepatitis C have become more important. However, many patients with a chronic liver disease have no symptoms. Therefore, the general practitioner should be aware that a patient visiting the practice with fatigue and malaise could have a liver disease if he or she belongs to a high-risk group or has had high-risk contacts. If the general practitioner repeatedly finds increased liver transaminase values during routine examination of asymptomatic patients, additional diagnostic tests should be performed. Further tests should focus on viral hepatitis as well as on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis or, depending on the history-taking, liver damage due to excessive alcohol, medication or drug use.
荷兰全科医生学院修订后的实践指南《病毒性肝炎和其他肝脏疾病》为甲型、乙型和丙型病毒性肝炎以及其他肝脏疾病的诊断和管理提供了建议。该指南对全科医生以及内科和胃肠病学专家都很重要。重点在于慢性乙型和丙型肝炎的管理，因为这些疾病在荷兰的患病率有所上升，此外，慢性肝炎的治疗选择也有所改善。因此，及时识别慢性乙型或丙型肝炎患者并进行适当转诊变得更加重要。然而，许多慢性肝病患者没有症状。因此，全科医生应意识到，如果前来就诊的患者属于高危人群或有过高危接触，出现疲劳和不适症状时可能患有肝脏疾病。如果全科医生在对无症状患者进行常规检查时反复发现肝转氨酶值升高，应进行额外的诊断测试。进一步的检查应侧重于病毒性肝炎以及非酒精性脂肪性肝病和非酒精性脂肪性肝炎，或者根据病史，检查因过量饮酒、用药或吸毒导致的肝损伤。
