13 results
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis
Hepatocellular Pattern (ALT or AST > ALP):
Abnormal Liver Function ... Severe - ALT >15X ULN ... Ducts - PBC ... 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 ... disease US — Normal ... Bile Ducts • PSC ... 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
Peritonitis - Spontaneous vs Secondary vs Peritoneal Dialysis Associated Peritonitis
Spontaneous Bacterial Peritonitis
 • Cirrhosis (high SAAG)
Peritonitis • Cirrhosis ... ) + ascites w/ PMN ... glucose < 50, LDH ULN ... cloudy effluent) 2) WBC ... > 100 WBC, >50%
Autoimmune Hepatitis

Clinical Presentation
 - Highly variable clinical presentation, from subclinical disease to acute liver failure.
 -
reported (eg AIH-PBC ... IgG typically elevated ... upper limit of normal ... 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
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Autoimmune hepatitis, PBC ... stone, Malignancy, PBC ... specificity to elevated ... function may be abnormal ... hepatitis: < 1 • Cirrhosis
Synovial Fluid Analysis:

Findings (COLOR	TRANSPARENCY	VISCOSITY	WBC COUNT (PER MM3)	PMN CELL COUNT (%)	GRAM STAIN	CULTURE	PCR TEST	CRYSTALS)

By Condition (Normal 
Noninflammatory 
Inflammatory:
TRANSPARENCY VISCOSITY WBC ... COUNT (PER MM3) PMN ... By Condition (Normal
►
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
Hepatitis B - Treatment Indications
Treatment not indicated:
 • Immune tolerant state - HBe-Ag detectable, high HBV
(>10^6 IU/mL), normal ... Presence of CP or PC ... Family history of cirrhosis ... IU/mL and ALT > ULN ... or fibrosis • Cirrhosis