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diagnosis liver differential injury lfts transaminitis management aclf albumin chemistry cirrhosis druginduced failure function gastroenterology gradient hepatorenal hrs interpretation nephrology
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm DILI suspicion Features toxic aetiology: Skin involvement, Kidney injury,
disease, Hepatic ischaemia ... dechallenge • Acute ... disorder (e.g. ascites ... ), Chronic hepatitis ... #hepatology
Patterns of Liver Injury Transaminase Levels: > 50x normal - Ischemic Hepatitis > 20x normal
20x normal - Acute ... Infection (EBV/CMV), Alcoholic ... 5-10x normal - Chronic ... AST:ALT > 2.5 - Alcoholic ... Liver #Injury #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... months without treatment ... Failure Infections Alcohol-Associated ... Liver Injury (DILI ... Failure #Cirrhosis #Hepatology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework Mild (<100-500): • NAFLD • Cirrhosis •
Cirrhosis • Chronic ... Hepatopathy • Acute ... (>1000): • DILI ... liver injury) • Ischemic ... Differential #Diagnosis #hepatology
Alcoholic Hepatitis - Management Algorithm Assess Eligibility for Treatment: - Maddrey Discriminant Function ≥ (or possibly MELD
Alcoholic Hepatitis ... - Management Algorithm ... blood, urine and ascites ... HCV, DILI, HCC, ... #Algorithm #hepatology
Acute Liver Injury - Differential Diagnosis Algorithm Vascular Causes of Acute Liver Injury: • Hepatic vein:
Differential Diagnosis Algorithm ... ALT Ratios: • Alcoholic ... > 2 • NASH, Chronic ... injury: > 3 • Chronic ... #hepatology
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis High albumin gradient (>1.1 g/dl): - Cirrhosis - Alcoholic
Cirrhosis - Alcoholic ... hepatitis - Cardiac ... Veno-occlusive disease - Acute ... associated with bowel ischemia ... Differential #Diagnosis #hepatology
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
viral hepatitis ... ALT Ratios: • Alcoholic ... > 2 • NASH, Chronic ... injury: > 3 • Chronic ... #differential #Hepatology
Hepatorenal Syndrome (HRS) Definition: • Functional, potentially reversible kidney impairment. • Occurs in advanced liver disease: cirrhosis, severe alcoholic
cirrhosis, severe alcoholic ... hepatitis, or acute ... diuretic-resistant ascites ... Treatment Overview ... Hepatorenal #Syndrome #Hepatology
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