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Shotgun Laboratory Testing for Severe Acute Livery Injury

https://www.journalofhospitalmedicine.com/jhospmed/article/143598/hospital-medicine/ammonia-levels-and-hepatic-encephalopathy-patients-known

#TWDFNR #Testing #Laboratory #LiverInjury #Diagnosis #Workup #Hepatology #EBM #ChoosingWisely
Shotgun Laboratory Testing ... for Severe Acute ... Livery Injury ... ammonia-levels-and-hepatic-encephalopathy-patients-known ... #TWDFNR #Testing
Causes of Acute Liver Injury - Differential Diagnosis
Hepatocellular - Liver Parenchyma
 • Infectious: Hepatitis C, A,
Causes of Acute ... Autoimmune hepatitis, Acute ... Vasculature • Hepatic ... Congestion/CHF • Hepatic ... #algorithm #hepatology
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Acute Liver Injury ... Differential Diagnosis Algorithm ... • Hepatic vein: ... Venoocclusive disease • Hepatic ... RBC (hemolysis, bleeding
Upper GI Bleed - Management Algorithm

Upper GI bleed Suspected: Melena, hematemesis, coffee-ground emesis, BRBPR
Initial Stabilization
Concern for
Bleed - Management Algorithm ... Stabilization Concern for Liver ... GI Bleed: • Peptic ... Disease • Variceal Bleeding ... GAVE (idiopathic, liver
Commonly Observed Laboratory Findings in Hepatic / Liver Failure
 - Elevated conjugated and unconjugated bilirubin -
Laboratory Findings in Hepatic ... / Liver Failure ... —100-fold with acute ... #LiverFailure #Hepatic ... Laboratory #Diagnosis #Testing
Upper Gastronintestinal Bleed - Differential Diagnosis Algorithm
Acute Hematemesis/Melena
 - Blood in vomitus?/black, tarry stools
 - If
Differential Diagnosis Algorithm ... Acute Hematemesis ... - Exclude bleeding ... Peptic Ulcer Disease ... - Stress (ICU Setting
Disseminated Intravascular Coagulation (DIC) Overview

Increased Clotting and Consumption of Clotting Factors

Findings:
 • Bleeding
 • Recent history
malignancy (Especially acute ... dysfunction (25%) • Hepatic ... DIC • Severe Liver ... deficiency) • HIT: Heparin-PF4 ... 100mg/dL) - Heparin
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Differential Diagnosis Algorithm ... Hypertension - Hepatic ... Infiltrative disease • Acute ... liver failure ... Hypertension - Post-Hepatic
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Stepwise Diagnosis Algorithm ... disease, Hepatic ... dechallenge • Acute ... presentation: Hepatic ... Injury #Diagnosis #Algorithm
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
Hepatocellular - Check Acute ... Mixed - Check Acute ... Imperative to Identify Acute ... replaced by non-hepatic ... RBC (hemolysis, bleeding