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diagnosis transaminitis management hepatitis abnormal aclf acute calling chemistry cirrhosis consultation drug druginduced elevated failure function giconsult hemodialysis hepatocellular idiosyncratic
Diagnosis and Management of Idiosyncratic Drug-induced Liver Injury (DILI) DILI Types: • Intrinsic - predictable, dose dependent
Injury (DILI) ... - ongoing ↑ LFTs ... #differential # ... #algorithm #gastroenterology ... #hepatology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework Mild (<100-500): • NAFLD • Cirrhosis •
Tests (LFTs) - ... Cirrhosis • Chronic ... (>1000): • DILI ... injury) • Ischemic ... Diagnosis #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... in those with CLD ... Injury (DILI) ... #Cirrhosis #Hepatology ... #gastroenterology
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm DILI suspicion Features toxic aetiology: Skin involvement, Kidney injury,
Injury (DILI) - ... Stepwise Diagnosis Algorithm ... dechallenge • Acute or chronic ... e.g. ascites), Chronic ... #Algorithm #hepatology
Acute Liver Injury - Differential Diagnosis Algorithm Vascular Causes of Acute Liver Injury: • Hepatic vein:
Acute Liver Injury ... - Differential ... Diagnosis Algorithm ... • Iatrogenic: DILI ... #hepatology
The Liver Consult Primer - Guide to calling a consult HPI: - Start with reason for consult
- Vitals - LFTs ... GTT, indirect bili ... current MELD - Chronic ... Calling #Referral #Hepatology ... #Gastroenterology
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
Interpretation of LFTs ... : > 3 • Chronic ... chemistry #diagnosis #differential ... #Hepatology #transaminitis ... #LFTs #RValue #
Hepatocellular Liver Injury - Differential Diagnosis Framework: Liver Injury → liver test abnormalities without evidence of liver
Injury - Differential ... Injury → liver ... Injury Differential ... #Injury #Differential ... #LFTs #hepatitis
Patterns of Liver Injury Transaminase Levels: > 50x normal - Ischemic Hepatitis > 20x normal
Patterns of Liver ... 5-10x normal - Chronic ... #Injury #hepatology ... #LFTs #transaminitis ... #differential #
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis Hepatocellular Pattern (ALT or AST > ALP):
Abnormal Liver Function ... Tests - Differential ... Ducts - CBD ... Burak @kwburak #LFTs ... #diagnosis #hepatology
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