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diagnosis hepatology management differential algorithm gastroenterology transaminitis dili hepatitis indications treatment aclf aih albumin arthritis autoimmune calling chemistry consultation disease
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework Mild (<100-500): • NAFLD • Cirrhosis •
Tests (LFTs) - ... • NAFLD • Cirrhosis ... • Chronic Viral ... Hepatopathy • Acute ... injury) • Ischemic
Patterns of Liver Injury Transaminase Levels: > 50x normal - Ischemic Hepatitis > 20x normal
Patterns of Liver ... > 20x normal - Acute ... CMV), Alcoholic cirrhosis ... 5-10x normal - Chronic ... #LFTs #transaminitis
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... those with CLD (± cirrhosis ... Injury (DILI) ... #Chronic #Liver ... #Failure #Cirrhosis
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
Interpretation of LFTs ... > 2 • NASH, Chronic ... hepatitis: < 1 • Cirrhosis ... 3 • Chronic muscle ... transaminitis #LFTs
Acute Liver Injury - Differential Diagnosis Algorithm Vascular Causes of Acute Liver Injury: • Hepatic vein:
Acute Liver Injury ... Liver Injury: ... Liver Injury: ... hepatitis: < 1 • Cirrhosis ... 3 • Chronic muscle
The Liver Consult Primer - Guide to calling a consult HPI: - Start with reason for consult
Gl History - Cirrhosis ... - Vitals - LFTs ... current MELD - Chronic ... up - Liver US ... - Prior liver
Diagnosis and Management of Idiosyncratic Drug-induced Liver Injury (DILI) DILI Types: • Intrinsic - predictable, dose dependent
Injury (DILI) ... dose dependent injury ... presentation • Chronic ... - ongoing ↑ LFTs ... or symptoms of liver
Indications for Albumin for Management of Cirrhosis • Large volume paracentesis (>5 liter) - 8g per
Management of Cirrhosis ... ) - 8g per liter ... ascites removed • Acute ... kidney injury ( ... Indications #Management #Cirrhosis
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm DILI suspicion Features toxic aetiology: Skin involvement, Kidney injury,
Injury (DILI) - ... involvement, Kidney injury ... dechallenge • Acute ... or chronic atypical ... e.g. ascites), Chronic
Diuretics and Agents Regulating Renal Excretion Carbonic Anhydrase Inhibitors (Acetazolamide, Dichlorphenamide) • Glaucoma • Epilepsy • Altitude
Torsemide) • Acute ... cirrhosis, chronic ... cirrhosis, chronic ... cirrhosis, chronic ... hyperaldosteronism • Acute
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