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hepatology diagnosis differential lfts management algorithm biliary pbc primary transaminitis treatment workup aih autoimmune calcium causes chemistry cholangitis endocrinology evaluation
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis Hepatocellular Pattern (ALT or AST > ALP):
Abnormal Liver Function ... Severe - ALT >15X ULN ... Mild - ALT < 5x ULN ... Congenital, Others, Cirrhosis ... kwburak #LFTs #Elevated
Elevated Liver Enzymes - Differential Diagnosis Algorithm Severe ALT > 15x ULN • Viral • Drugs/Toxins •
Elevated Liver Enzymes ... Severe ALT > 15x ULN ... Mild ALT < 5x ULN ... disease US — Normal ... Infiltrative • Cirrhosis
Primary Biliary Cirrhosis (PBC) - Summary PBC Epidemiology: • Female:Male 9:1 • Common European descent • Age:
Primary Biliary Cirrhosis ... cholestasis → Cirrhosis ... or slightly elevated ... early on but elevated ... • ALP > 1.5 x ULN
Hypercalcemia Evaluation 1) Clinical clues - Is the patient symptomatic? - Family history? - Have you done
likely - Mid range/ULN ... FeCa <1 %) - Low normal ... • If all normal ... endocrinology #calcium #elevated
Autoimmune Hepatitis Clinical Presentation - Highly variable clinical presentation, from subclinical disease to acute liver failure. -
IgG typically elevated ... upper limit of normal ... ALT + AST > 10x ULN ... ALT + AST > 5x ULN ... AND IgG > 2x ULN
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
R-value: Serum (ALT/ULN ... ALT) / (Alk phos/ULN ... specificity to elevated ... - If both are normal ... hepatitis: < 1 • Cirrhosis
Hepatitis B - Treatment Indications Treatment not indicated: • Immune tolerant state - HBe-Ag detectable, high HBV
(>10^6 IU/mL), normal ... (<2000 IU/mL), normal ... Family history of cirrhosis ... IU/mL and ALT > ULN ... or fibrosis • Cirrhosis
Primary Biliary Cirrhosis - Management A. Initiate therapy - Initiate 1st line therapy with UDCA (13-15
Primary Biliary Cirrhosis ... if ALP > 1.5x ULN ... and/or abnormal ... Primary #Biliary #Cirrhosis
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