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diagnosis hepatology differential algorithm gastroenterology management aclf chemistry cirrhosis drug druginduced elevation failure function functiontest hepatitis idiosyncratic induced interpretation patterns
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework Mild (<100-500): • NAFLD • Cirrhosis •
Cirrhosis • Chronic ... Hepatopathy • Acute ... (>1000): • DILI ... injury) • Ischemic ... Diagnosis #hepatology #transaminitis
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
Liver Function Test (LFTs) Elevation AST - Cardiac and skeletal muscle, kidney, brain ALT - More specific for
(LFTs) Elevation ... abnormality vs bone Bili ... Hepatocellular injury ... #FunctionTest #LFTs ... #Elevation #Transaminitis
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
Interpretation of LFTs ... > 2 • NASH, Chronic ... > 3 • Chronic ... differential #Hepatology #transaminitis ... #LFTs #RValue #
Patterns of Liver Injury Transaminase Levels: > 50x normal - Ischemic Hepatitis > 20x normal
Patterns of Liver ... Injury Transaminase ... > 20x normal - Acute ... 5-10x normal - Chronic ... #LFTs #transaminitis
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
Acute Liver Injury - Differential Diagnosis Algorithm Vascular Causes of Acute Liver Injury: • Hepatic vein:
Acute Liver Injury ... Liver Injury: ... Liver Injury: ... • Iatrogenic: DILI ... > 3 • Chronic
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... Liver Failure ( ... Injury (DILI) ... EmoryGastroHep #ACLF #Acute ... #Chronic #Liver
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